Although nails may seem insignificant when it comes to diagnosing a patient, paramedics and emergency medical technicians (EMT) frequently analyze an individual’s fingernail bed using the capillary refill test (blanch test) to determine whether an individual is hypothermic, in shock, has peripheral vascular disease (PVD) or dehydrated.
Dr. Christine Poblete-Lopez is the Assistant Program Director in the Department of Dermatology at the Cleveland Clinic. Poblete-Lopez states that the characteristics of an individual’s nails are a good reflection of his or her health. Nail characteristics can indicate skin and/or systemic problems. A patient’s nails can indicate a serious disease, infection and vitamin deficiencies.
Characteristics of Healthy Nails
Fingernails and toenails consist of a protein called keratin. Healthy nails should have a pink nail plate and the tip should be white as it grows off of the nail bed.
What Health Issues Nail Color May Indicate
An infection of the nail frequently caused by trauma.
- Liver problems.
- Respiratory problems – chronic bronchitis.
- Swelling of the hands.
- Problems related to the lymphatic system.
Thick, Yellow Nails
Although yellow nails commonly occur with age, if a senior’s nails grow slowly, are thick and yellow they have a condition referred to as yellow nail syndrome, this may signify:
- Lung disease (e.g. chronic bronchitis or emphysema).
- Raynaud’s phenomenon – Poor circulation to the toes, fingers and nose. When the nails are blanched, they turn blue.
- Thyroid Issues.
- Rheumatoid arthritis.
This condition may cause nails to detach from the nail bed.
This characteristic is commonly referred to as salmon patch or oil drop and often indicates psoriasis, a skin and joint disorder.
Other signs in the nails that signify psoriasis include:
- Beau’s lines – lines running from one side to the other across the nail.
- Indentations on the nail plate in the form of pits or nicks.
- Nail loosening and/or skin thickening.
If the pale areas near the cuticle appear red, this could be another sign of psoriasis.
This blue discoloration can be seen in the crescent at the base of the nail, directly above the cuticle.
- Wilson’s Disease – a genetic condition in which a metabolic disorder leads to the accumulation of copper in the brain, kidneys, liver and cornea.
- Raynaud’s phenomenon.
- Lung and breathing problems – asthma, chronic obstructive pulmonary disease (COPD), emphysema and chronic bronchitis.
- Septicemia – a bacterial infection within the bloodstream.
- Cyanosis due to a lack of oxygen in the red blood cells.
- High level of an abnormal form of hemoglobin within the bloodstream.
How to Determine If a Patient’s Fingernails Are Blue Due to Constriction or Cold
Caregivers can massage or warm the patient’s hand to determine if the blue color is caused by constriction, cold or another reason. If after warming/massing the hands the nails remain blue, there could be a health issue.
A SIngle Dark Blue Line
A dark blue line may indicate skin cancer.
White or Pale Nails
- Liver or kidney disorders.
- An overactive thyroid.
- A vitamin deficiency.
- Heart failure.
White nails that have a rim of darker color at the tip of the nail may be indicative of cirrhosis
In the majority of cases, these white spots occur due to nail bed injuries or a zinc deficiency. However, they can also indicate internal problems like arthritis. These spots may also indicate poisoning.
White lines across the nail bed may be a sign of a protein deficiency. Although white lines across the nail can signify a serious disorder, the majority of the time these lines are due to a zinc or iron deficiency.
White Areas Beneath the Nails
White areas at the tip of the nail usually indicate a fungal infection.
Half White Nails with Dark Spots
Nails that are half white with dark spots on the tip of the nail may suggest the patient has a kidney disease.
- A B-12 deficiency.
- Chronic kidney disease.
- A bacterial infection.
- Liver disease.
- Problems with his or her adrenal gland.
- Heavy metal deposits.
- Trauma to the nail
Tiny Black Streaks/Thin Black Lines
Streaks may indicate a heart problem; whereas, lines frequently indicate heart disease.
Reddish Brown Spots
Could be indicative of a folic acid, vitamin C or protein deficiency.
- Edema – fluid collection throughout the tissues in the body (swelling).
- Post-operative issues.
- Lung problems.
- Cardio-pulmonary disease.
- Circulatory problems.
- An oxygen deficiency.
- Genetic issues.
- Heart disease.
- Brain hemorrhage.
- Lung disease.
- High blood pressure.
- Carbon monoxide poisoning.
Red and Brown Lines
These lines will be visible along the elongated section of the nail’s axis. These lines may signify inflammation of the heart membranes (endocarditis) or a parasitic infection derived from eating undercooked pork products (trichinosis).
- Localized fungal infection.
- Bacterial infection.
- Allergies related to cleaning products.
- Severe emphysema.
Other Nail Characteristics That Can Indicate Health Issues
While color bands are a natural occurrence for individuals who are not Caucasian, if a Caucasian individual has color bands beneath the nail, it may signify cancer.
Darkening on the Sides of Nails
This could be a sign of kidney disease.
The nails become curved and rounded due to swelling – this may indicate kidney or liver disease.
Similar to wrinkles, vertical ridges in the nail are usually just a sign of aging.
Side-to-side ridges in the nail are usually caused by direct trauma, or a serious illness. If this characteristic has to do with a serious illness, the ridges will be evident on more than one nail. These ridges occur because the body is working to combat the illness; therefore, it saves energy by pausing nail growth. Horizontal ridges may also occur due to a drug reaction (chemotherapy).
In the presence of kidney disease, nails may become rough and ridged. In addition, nails with this characteristic are frequently concave or spoon-shaped, which indicates an iron-deficiency.
Small Cysts On or Near the Cuticles
These cysts are benign and form due to arthritis.
Dry, Cracked and/or Brittle Nails
Seniors frequently have cracked, dry and/or brittle nails. Nails are absorbent; therefore, caregivers can help soothe brittle, dry and/or cracked nails by gently massaging moisturizer into the patient’s hands and nails.
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