Nail Disorders Overview

Nail Examination

• Normally, nails are transparent, smooth, well-rounded, and convex with a nail bed angle of about 160 degrees.
• The surrounding cuticles are smooth, intact, and without inflammation.
• Abnormal findings:
  • Clubbing: increase angle and softening of the nail bed due to chronic oxygenation problems.
  • Cyanosis: bluish or purplish cast to the nail bed.
  • Anemia: white cast or pallor.
  • Paronychia: inflammation of proximal and lateral nail folds due to trauma and local infection.
  • Onycholysis: painless separation of the nail plate from the nail bed.

Nail Abnormalities

• Terry's nails: nail plate color mostly whitish with a distal band of reddish brown due to aging, liver cirrhosis, CHF, NIDDM.
• Leukonychia: white spots that grow slowly out of the nail plate after trauma.
• Transverse white lines (Mee's lines): curves similar to lunula.
• Beau's lines: transverse depression in nails associated with acute severe illness, nail injury.
• Psoriasis: small pits in the nails, marked nail thickening, onycholysis, circumscribed yellowish tan discoloration (oil spot lesion).
• Koilonychia (Spoon nail): concave curves due to iron-deficiency anemia, syphilis, or use of strong detergents.
• Splinter hemorrhages: red or brown linear streak in nail bed due to minor trauma, sub acute bacterial endocarditis, trichinosis.

Hair and Scalp

• Hair distribution patterns are examined for symmetry and distribution according to age and sexual development.
• Scalp: the skin covering the head, containing sebaceous glands that produce sebum, a mixture of keratin, fat, and cellulose debris.
• Types of hair covering the body:
  • Tan-brown: due to increased amount of melanin seen in sun tanning and pregnancy.

Skin Examination

• Moisture: refers to the wetness and oiliness of the skin, indicating body fluid imbalances, changes in the skin's environment, and regulation of body temperature.
• Normal findings: smooth and dry with minimal perspiration and oiliness.
• Abnormal findings: dullness, excessive dryness, crusting, flaking, scaling, overly moist and cool.

Skin Temperature

• Depends on the amount of blood circulating through the dermis.
• Normal findings: uniformly warm.
• Abnormal findings: generalized warmth in fever and hyperthyroidism, coolness in hypothyroidism, local warmth in inflammation, cellulitis, and pressure ulcer.

Skin Texture

• Refers to the character of the skin's surface and the feel of deeper portions.
• Normal findings: smooth, soft, even, and flexible in children and adults.
• Abnormal findings: scar or hardening (recent skin injury), tenderness or localized areas of induration or hardening due to repeated IM/SQ injections, roughness in hypothyroidism.

Skin Mobility and Turgor

• Turgor is the skin's elasticity, which can be diminished by edema or dehydration.
• Mobility is the ease in lifting up the skin when pinching and turgor is the speed with which the skin returns to its resting position.
• Normal findings: skin lifts easily and snaps back immediately to its resting position.
• Abnormal findings: skin stays or tented when turgor is poor (e.g., due to dehydration or edema).