Nailing down health issues

Dr. Glenn Gold can tell if you had a high fever four months ago, just by looking at you.

"People say, 'How did you know that?' " he said.

The answer?

"Nails tell a story," said Gold, a podiatrist at Tanner Clinic in Layton. He can read the story because it's written on the toenails.

"The presence of any disease process which would cause high fever over a period of seven to 10 days will leave a permanent line across all the nails, until the nail grows out," Gold explained.

Fingernails also tell tales.

"There was a case I was involved with many years ago, where a patient had arsenic poisoning, and the diagnosis was made through hair and nails," said Dr. Julie Maughan. The nails were thicker than normal, and striped.

More often, Maughan, a dermatologist with a practice in South Ogden, looks at nails to confirm a diagnosis of psoriasis.

When doctors look at nails, they're usually looking at the color, texture and shape.

"The nail bed should be pink, and you should be able to see, at least on some nails, a small, white half-moon piece at the bottom called the matrix. ... You want the nail to be smooth. It can have some ridges, but it should not be marked or lined," said Dr. Scott Checketts, a dermatologist with Tanner Clinic.

It's OK to have little white marks occasionally, and there are normal variations in nails, but Maughan recommends seeing a doctor if you have concerns or pain.

Texture

As people age, nails are likely to get thinner and gain more ridges, said Checketts, but other changes may be signs of systemic health conditions.

SBlt Pitting. If a doctor suspects a case of psoriasis, she can look for nail problems.

"One you can see is a kind of pitting pattern that looks like someone took a little pin and poked depressions in the nail," said Maughan. The nail may begin to crumble, with the tip becoming jagged. Salmon or brown discolorations under the nail, called oil patches, may also indicate psoriasis.

SBlt Thickening. Thickening of nails is often a sign of fungus. Fungus can also cause nails to crumble, said Maughan.

Color

If you squeeze the nail and it's slow in returning to its normal pink color, Gold says, it demonstrates a decrease in circulation.

SBlt Yellow. Yellow coloring is often an indication of psoriasis or fungal infection, according to Maughan and Checketts.

SBlt Green. Green discoloration at the corner, under the nail, signals bacterial infection, said Checketts.

SBlt White. A white discoloration can be due to the nail lifting up off the nail bed, a condition called onycholysis. Onycholysis is often associated with psoriasis, but Checketts says it can be caused by some medications or infections.

SBlt Dark blue. If part of the nail is blue, it could indicate trauma, said Gold. If an entire toenail is blue, it can be caused by the nail hitting the end of the shoe during exercise.

SBlt Dark lines. Often, a dark line or spot is a bruise, which moves as the nail grows out. If it doesn't go away, it could be more serious.

"A brown or black streak can indicate melanoma," said Checketts, adding that cancer under the nails is often (but not exclusively) associated with those who have darker skin.

Maughan says getting it checked early could potentially save your life.

SBlt Splinter hemorrhage. If a person has a heart infection, with a bacterial clump on one of the heart valves, micro clumps can be sent into the body and result in splinter hemorrhages.

"You see little, tiny brown streaks in the nail, and they're usually along the length of the nail," said Maughan. Many internists check nails for this manifestation of heart health.

SBlt Mixed colors. Long-term liver and kidney patients may show Muehrcke's lines, in which paired white parallel lines cross nails horizontally; half-and-half nails (half white and half red); and Terry's nails.

"With Terry's nails, usually instead of just having a little tiny white moon at the bottom, most of the nail is white and only a little tiny rim of pink," said Checketts.

Maughan says if you see a pigment change that doesn't resolve, or it's getting larger, bring it to a dermatologist's attention.

Shape

SBlt Clubbing. A clubbed nail bows so that it looks bulbous.

"This is very commonly seen, usually with some kind of pulmonary disease where people don't get as much oxygen as they need, kind of on a regular basis," said Maughan.

Patients typically complain of shortness of breath long before clubbing occurs, adds Checketts.

SBlt Spooning. Spooning is associated with iron-deficiency anemia.

"A nail should be convex, but it can actually get concave," said Checketts, explaining that it's called a spoon nail, because you could put a drop of water on it and it stays there because of the spoon shape.

It's rare in this country, because doctors usually discover the problem before nails get this bad, said Maughan, but it's a dramatic example of how nails are affected by overall health.