Do you have dents in your fingernails? Maybe you first noticed them while you were painting your nails and the polish didn’t go on smoothly. Or perhaps you rub your nails when you’re nervous and noticed these dents in the nails during a particularly stressful week at work. Whatever the case may be, one thing’s for sure: Right now, you’re asking yourself, “Why do I have dents in my nails?” Your nails can reveal a lot about your health — including whether you’re at risk for other diseases. Keep reading to find out what causes dents in fingernails and how you can get rid of them.
- Dents in Nails: What Causes Them
- Beau’s Lines Pictures
- Do Beau’s lines go away?
- Why you shouldn’t ignore discolored nails, bad breath and more
- 1. Symptom: Brown vertical stripe on the nail
- 2. Symptom: Brittle nails
- Here’s how a tea bag will fix a broken nail
- 3. Symptom: Ridges on nails
- 4. Symptom: Small white spots on nails
- From dry lips to brittle nails, 6 health signals you shouldn’t ignore
- 5. Symptom: Yellow nails
- 6. Symptom: Series of horizontal depressions on the thumb
- 7. Symptom: Infected, inflamed skin around the nail
- Bottom line:
- Wavy nails
- What diseases may be associated with wavy nails?
- What are possible treatment options for wavy nails?
- When is it advised to consult with a doctor regarding wavy nails?
- All you need to know about ridges in fingernails
- Digital Myxoid Cysts: Causes and Treatment
- Enlarging nodule under the toenail • no history of trauma • unremarkable medical history • Dx?
- THE CASE
- Alternative Names
- Home Care
- When to Contact a Medical Professional
- What to Expect at Your Office Visit
Dents in Nails: What Causes Them
Dents in fingernails can be quite alarming the first time you discover them, especially if you have no idea why they’re there. Horizontal dents in fingernails or toenails specifically are likely Beau’s lines. Carol Thelen, CRNP, tells FirstforWomen.com that these dents on nails could signal a zinc deficiency. Additionally, Beau’s lines are associated with “uncontrolled diabetes and peripheral vascular disease, as well as illnesses associated with a high fever, such as scarlet fever, measles, mumps and pneumonia,” according to the Mayo Clinic.
Before you start freaking out, dents in thumbnails and toenails may also be caused by trauma rather than some underlying condition. “ develop when nail plate growth, which begins in the nail matrix (located under the cuticle), is temporarily disrupted,” Celeste Robb-Nicholson, MD, wrote for Harvard Women’s Health Watch. “This can occur with direct injury to the nail matrix; an inflammatory condition such as psoriasis; infection around the nail plate; repetitive picking at the nails or cuticles; or even a manicure. Systemic causes include nutritional deficiencies, illnesses accompanied by high fever, metabolic conditions, certain drugs (especially chemotherapy agents), and diminished blood flow to the fingers (from Raynaud’s phenomenon, for example).” (Raynaud’s phenomenon is a condition where areas of the body feel cold and numb and change color in response to stress or cold temperatures.)
Beau’s Lines Pictures
Beau’s Lines https://t.co/Yfa28sk1GY #BeausLines #Nailhealth #Dermatology pic.twitter.com/63EnbdmMRg
— News Medical (@NewsMedical) September 22, 2016
Do Beau’s lines go away?
The good news about Beau’s lines is that they’ll eventually go away. If they’re the result of one-time trauma, the nail will eventually grow out and the lines will disappear. Nails grow at roughly three millimeters per month, so it may take a few weeks or even months before you notice your Beau’s lines have vanished completely. Should the dents be the result of some kind of mineral deficiency, you can most likely take a supplement to get your body’s levels where they need to be. That said, consult a doctor before taking any new supplements.
Notice white spots that are powdery in consistency? An infection with a fungus (lovely!) could be to blame. Depending on what’s at play, your best bet will be an antifungal treatment like Kerasal Nail Fungal Nail Renewal Treatment ($22, amazon.com) or simply waiting it out—if the white spot is from trauma, it’ll grow out with the nail.
The Pan African Medical Journal
2. Brittle Nails (Onychoschizia)
Blame brittleness on a dry nail plate, says Debra Jaliman M.D., an assistant professor of dermatology at the Icahn School of Medicine at Mount Sinai and author of Skin Rules. Overdoing it with nail polish remover can cause this, but so can frequent dishwashing (sans gloves) or swimming, she says. “People who have professions with their hands constantly in chemicals, like photographic developers, can also get this.” If you suffer from hypothyroidism—when your thyroid is working too slow—it’s possible to see brittleness, too. The weather could also be to blame. Fall and wintry weather (and drying indoor heating systems) can bring about more dry air, says Adigun. The good news: The solution may be as simple as adding moisture back in. Adigun likes REJUVENAIL Fortifying Nail & Cuticle Treatment ($16, ulta.com).
Jere Mammino, doctor of osteopathy
3. Yellow Nails
Before you freak, know this: Yellow nails could just be staining from polish, says Adigun. (So think: How many manicures have you had recently?) But this change in color could also signal diseases like diabetes, says Jaliman, which need to be treated by prescription or insulin. Yellow Nail Syndrome—where the nail thickens, turns yellow, and growth slows—is often a sign of a respiratory disease like bronchitis, too, says Jaliman.
Clinical Medical Insights; Case Reports
4. “Lifting” Nails (Onycholysis)
Chefs, bartenders, or health-care workers may notice their fingernails separate from their nail bed. It seems scary, but often, it’s due to irritation from excessive water exposure, says Adigun. A too-aggressive manicure, nail hardeners, or glues could also cause the damage. Notice changes in color—to opaque white, green, or yellow? That could point to everything from a thyroid disease or psoriasis to injury and infection, says Jaliman. See your doc if you think something more serious could be the cause—and try to keep your hands dry whenever possible.
Watch a hot doctor teach you the best way to clean your ears:
5. Vertical Ridges
Those thin lines that run vertically up your nail are likely totally normal: “Vertical nail ridges are from aging,” says Jaliman. Think about them like the wrinkles of your nails, she says. Your best bet is keeping your nails (and cuticles) moisturized.
Mayo Foundation for Medical Education and Research
6. “Spoon” Nails (Koilonychia)
Nails curving up? Time to have some bloodwork done: “A very thin nail which becomes concave in shape is usually a sign of iron deficiency or anemia,” says Jaliman. If you’re deficient, a supplement will likely fix the problem. But ask your doctor about other issues that could be involved, too. Liver disease, heart disease, and hypothyroidism are also linked to spoon nails.
Indian Dermatology Online Journal
7. Pitting Nails
Little indents that look like they were made from a mini ice pick occur in up to 50 percent of people with the skin condition psoriasis, says Jaliman. It can also happen to people with alopecia areata—an autoimmune disease in which you lose patches of hair, she says. Creams with vitamin A and vitamin D can help—and in some cases, steroid creams can be used. If you have psoriasis, ask your dermatologist about the right treatment for you.
Journal of Cutaneous and Aesthetic Surgery
If your nails seem softer and the tips of your fingers appear larger or bulging, you might have something more serious on your hands. An increase in the tissue around the ends of your fingers (right where the nail curves) can indicate lung disease, says Jaliman. “It is caused by low oxygen in the blood,” she says. But clubbing nails are also associated with inflammatory bowel disease, cardiovascular disease, AIDS, and liver disease, she says. And Adigun notes that chronic respiratory disease or cardiothoracic disease could also be contributors. So if you notice these sorts of changes, make an appointment with your physician to be safe.
Mayo Foundation for Medical Education and Research Cassie Shortsleeve Freelance Writer Cassie Shortsleeve is a skilled freelance writer and editor with almost a decade of experience reporting on all things health, fitness, and travel.
You have access to important clues about your health right at the tips of your fingers.
Nails can signal everything from lung conditions to anemia, the American Academy of Dermatology notes.
Why you shouldn’t ignore discolored nails, bad breath and more
May 8, 201804:16
“A lot of times we’ll learn in training that the nails can be a window into your health because they can sometimes be an indicator of some underlying medical problems,” noted NBC News medical contributor Dr. Natalie Azar.
“Lots of things can be detected in the nail,” said Dr. Phoebe Rich, director of the Nail Disorder Clinic at Oregon Health and Sciences University and a dermatologist at the Oregon Dermatology and Research Center.
Here are seven nail symptoms and what to do next:
1. Symptom: Brown vertical stripe on the nail
This may be a sign of melanoma. While you may think the deadliest type of skin cancer always shows up as a mole or dark spot, it can actually start in the nail.
Only about 1 percent of all melanomas in Caucasians occur in the nail, but if you’re African-American, 20 percent of melanomas start there, Rich said.
“In more advanced cases, it can spread on to the cuticle area or the skin around the nail. That’s an ominous sign — it’s means it’s growing and spreading,” she noted.
Hormones and certain medications can also make pigmented bands in the nails, but be especially watchful for a brown or dark stripe that goes from the cuticle out to the free edge of the nail, especially one that’s getting wider.
Course of action: Get any brown pigmentation on your nail checked out by a dermatologist.
2. Symptom: Brittle nails
This common problem can happen because of an issue with your diet or the chemicals your hands are exposed to.
Nails are formed in the nail matrix, the root of the nail. If you are malnourished or lack certain nutrients, your body doesn’t have the material to make good nails, Rich said. That’s why people with eating disorders can notice problems with nails. Brittle nails can also indicate iron-deficiency anemia or thyroid diseases.
Remember: Nails are made of keratin, a protein. A common myth is that calcium plays a role.
“I see this all the time. People come in and say, ‘I’m taking a lot of calcium so my nails should be strong,’” Rich noted. “Calcium makes bones strong, but doesn’t have anything to do with making nails strong.”
Here’s how a tea bag will fix a broken nail
Nov. 16, 201601:01
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If your body has the material to create the perfect nails, harsh chemicals can still break them down as they grow. Think of nails as a brick wall: the chemicals can remove the mortar that holds the bricks together, Rich said. That can include detergent water and nail polish remover.
Course of action: Make sure you are eating a well-balanced diet that includes plenty of protein.
Avoid using harsh chemicals on your nails. Even acetone-free polish remover can make your nails brittle if you use it too often and too much, Rich said.
3. Symptom: Ridges on nails
Vertical ridges are common as you get older and most people eventually get them.
“They’re kind of like wrinkles in the nail,” Rich said. She discourages patients from buffing or filing the ridges smooth because that thins the nail.
Deep horizontal ridges or depressions, known as Beau’s lines, are more alarming. They indicate something caused the nail to stop growing temporarily. Triggers can include high fever, chemotherapy, a serious illness, major surgery, blood transfusion, a car accident or any major stress to your system, Rich noted. You can have a series of parallel Beau’s lines if you experienced multiple episodes of stress.
Course of action: If you can’t link your deep horizontal ridges to a specific episode in your life, ask your doctor what the cause could be.
Vertical ridges are usually just a part of aging. If you want to cover them up, don’t buff, but use a ridge filler.
4. Symptom: Small white spots on nails
Many people think the spots are related to a vitamin deficiency, but that’s a myth, Rich said. The condition, called punctate leukonychia, is actually due to some kind of minor trauma when the nail is being formed.
Course of action: Wait — the spots will vanish as the nails grow out. You’ll see them for a while because it takes about six months to grow a new fingernail from start to finish.
From dry lips to brittle nails, 6 health signals you shouldn’t ignore
July 26, 201603:57
5. Symptom: Yellow nails
Very yellow nails that are thick and slow growing may be associated with lung problems, Rich noted. If you have yellow nail syndrome, you may also experience excessively curved nails and see them separate from the nail bed.
Course of action: See your doctor.
6. Symptom: Series of horizontal depressions on the thumb
That’s a classic sign of a habit tic deformity, where people chronically rub or pick the cuticle of the thumb with their index finger as the nail is being formed. It creates a washboard-like series of horizontal depressions on the thumb nail.
“A lot of people do it when they don’t know they’re doing it,” Rich said. “We see it a lot.”
Course of action: People can fix the issue if they simply stop manipulating their thumb cuticles, Rich noted.
7. Symptom: Infected, inflamed skin around the nail
This is known as paronychia and can be caused by pushing back the cuticle.
“Cuticles are really important and probably shouldn’t be pushed back,” Rich noted. “They seal the skin to the nail and keep stuff out.”
The cuticle prevents bacteria, fungus, yeast and mold from getting underneath your nail and causing an infection.
Course of action: Soak your nail in hot water two or three times a day to help reduce the swelling and pain, experts note. Your doctor may prescribe oral antibiotics or other medicine.
To prevent an infection, don’t use any sharp implements to cut or push back your cuticles, and don’t allow your manicurist to cut them, Rich advised. The best way to manage cuticles is to gently rub a towel over your nails after a shower when your skin is soft to get rid of the dead skin on the surface of the nail, she noted.
Nail discoloration or thickening can signal systemic health problems. Check with your doctor if you spot any changes.
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Nail abnormalities are typically characterized by ridges that are irregularly shaped, crossing vertically, transversely or horizontally on the surface of the nail. Generally, the disorder affects all the nails on both hands. Wavy nails can be sign or symptom of transient conditions, environmental factors or of immune based diseases such as rheumatoid arthritis and lichen, metabolic disorders, malnutrition, or fungal diseases. They can also change with aging. As an individual grows older, the levels of natural oil and moisture in the nail plates decrease and so the ridges become prominent with age.
By keeping nails clean, hydrated, and by applying helpful ointments and lotions, an individual can see overall signs of improvement. Taking into account different diagnosis signs and symptoms of nail abnormalities (plus lifestyle, diet, family history, medical history, environmental factors), a treatment plan can be devised. Failure to seek treatment can result in complications and permanent damage.
What diseases may be associated with wavy nails?
While nail abnormalities are often a sign of fungal nail infection or injury, they can sometimes indicate a more severe underlying disease. The main diseases related to problems concerning wavy nails include the following:
- Syndrome Bashan
- Darier’s disease
- Osteo-onicodisplasia hereditary, also known as nail-patella syndrome (NPS)
- Eating disorders (bulimia, anorexia nervosa)
- Rheumatoid arthritis
- Hypodontia-nail dysplasia syndrome
- Lichen planus
Keep in mind that this list is not exhaustive and it is always advisable to consult with a doctor regarding any questions, concerns, or if symptoms persist.
What are possible treatment options for wavy nails?
Treatment options for wavy nails vary depending on the cause of the sign or symptom. Contacting a doctor is advisable for further examination and more effective therapies.
Generally, the use of ointments and lotions based on natural vegetable oils leave the nails soft and hydrated, helping to promote healing. Taking biotin supplements (vitamin H belonging to vitamin B complex and also called vitamin B8) prescribed by a physician and eating foods that are high in biotin, such as green leafy vegetables, brown rice, sunflower seeds, liver, cheese, soybeans, and sweet potatoes can help improve nail resistance. Other remedies made from organic silicon or sulfur are also considered useful to the healing process.
It may be helpful to wear gloves before immersing hands in the water or before coming into contact with harsh chemicals. Also, keeping hands in water for too long or applying glazes and solvents are best to be avoided.
When is it advised to consult with a doctor regarding wavy nails?
Having wavy nails is not a medical emergency; however an individual should contact a doctor immediately for diagnosis, regarding any medical conditions that may be associated with the disorder or in cases involving serious symptoms such as dehydration, confusion, convulsions or difficulty breathing. In determining the cause of the nail condition, it can be helpful to measure the distance of the ridge from the nail bed and recall what the patient was experiencing physically about the time it first developed.
All you need to know about ridges in fingernails
Share on PinterestRidges on the fingernails may be vertical or horizontal. Usually, the cause is aging.
Vertical ridges caused by aging
Just as the skin may show signs of aging, the fingernails and nail beds may also start to change with age. The nails themselves may also:
- become thicker or thinner
- lose their smooth shape
- begin to split
- break easily
The nails may also start forming any number of vertical ridges as they grow. These ridges run from the tip of the finger down to the bottom of the nail and are not usually a cause for concern.
A trip to a dermatologist may still help in cases where symptoms cause pain or unsightly nails.
Other causes of vertical ridges
Other conditions may also cause vertical nail ridges along with other symptoms. Some types of anemia may influence vertical ridges in the nails, often accompanied by color changes in the nails or changes in texture.
Anemia can cause vertical ridges to appear and may also make dents appear in the nail.
A splinter hemorrhage is a tiny blood clot that can create a vertical discoloration beneath the nail. If the person does not know what caused the bleeding from the hemorrhage, they should consider a trip to the dermatologist.
Other medical disorders that can cause vertical ridges to appear in the nail include:
- peripheral vascular disease
- rheumatoid arthritis
Ridges that appear alongside other symptoms such as rough or brittle nails that are not caused by aging may be a sign of other medical disorders and should be diagnosed by a doctor.
Horizontal nail ridges
Beau’s lines are nail ridges that run horizontally across the fingernail. These ridges are often deep, and multiple lines may appear across the nail.
Horizontal ridges are often a sign of an underlying condition that requires diagnosis and treatment. In some cases, the nails may stop growing until the condition is treated.
Beau’s lines might be a sign of:
- acute kidney disease
- thyroid disease.
Beau’s lines may also appear in people who have undergone chemotherapy. People who have had mumps or syphilis may also get horizontal ridges in their fingernails and toenails.
Anyone who develops horizontal nail ridges should see their doctor for a diagnosis as soon as possible.
“Your nails are a very good reflection of your health. Many things can occur in the nails that can signify systemic or skin problems,” says dermatologist Christine Poblete-Lopez, MD.
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Pay attention to anything on or around your fingernails or toenails that suddenly appears different, she says. “Anything that doesn’t look normal ought to be addressed. Your best course of action is to see a doctor as soon as possible.”
Here are six conditions that can also cause symptoms in the nails. However, for a diagnosis, it’s important to see your doctor, who will take many factors into account besides nail symptoms.
Fingernails and toenails are closely related to hair, Dr. Poblete-Lopez says. Just as your hair might fall out after an illness or a prolonged period of stress, your nails can also exhibit symptoms. Most frequently, stress will cause side-to-side lines to appear on your nails.
2. Moles or melanoma
A concern about nail color is one of the most common complaints dermatologists hear, Dr. Poblete-Lopez says. Discolorations usually appear in lines that run from cuticle to tip, and they can be benign moles or cancerous melanomas. African-Americans and Asians are more likely to experience normal pigmentation changes that are related to ethnicity.
You should consult a dermatologist if the skin under the nail plate — the hard part of the nail, covering the fingertips — develops any brown coloring, she says. These developments are always more of a concern if they affect a single finger instead of all. Brown lines that run into the cuticle could be a sign of melanoma. Ones that stop at or before the cuticle are likely caused by moles.
Small cysts that grow near or on the cuticles may arise with arthritis. These are benign (not cancerous) and best addressed by a hand surgeon.
This common skin condition is usually characterized by scaly, red patches, but it can also impact fingernails and toenails, Dr. Poblete-Lopez says.
If you have yellow-red discoloring on your nail, often called an “oil drop” or “salmon patch,” you should consult your dermatologist. Here are other symptoms that can also indicate psoriasis:
Indentations: Nicks or pits on the nail plate, which is the hard part of the nail that covers the fingertips.
Beau’s lines: Lines that run side-to-side across the nail.
Skin thickening/nail loosening: Thickening of skin under the nail, which can dislodge the nail (onycholysis) from the nail bed. This generally starts at the tip and works their way toward the cuticle.
White areas: Distinct white spots on the nails, also called leukonychia. (The cloudy white spots that sometimes appear on fingernails and toenails do not fall into the category, and aren’t cause for concern, according to Dr. Poblete-Lopez.)
Black lines: Black lines running from tip to cuticle could be tiny clots called splinter hemorrhages or dilated and burst capillaries — potential symptoms of psoriasis.
Redness: The usually pale areas near the cuticle turn red, which could be caused by congested capillaries, another possible sign of psoriasis.
RELATED: How to Deal If Your Psoriasis Leads to Psoriatic Arthritis
5. Kidney disease
Several nail changes can indicate the presence of acute or chronic kidney disease, Dr. Poblete-Lopez says:
- Beau’s lines: These side-to-side lines can be a symptom of acute kidney disease.
- Ridged nails: Also called koilonychia, rough nails with ridges can exist in the presence of kidney disease. These nails are also frequently spoon-shaped and concave, and they can point to iron-deficiency anemia.
- White streaks/spots: Similar to psoriasis cases, distinct white streaks and spots on nails can point to chronic kidney disease.
6. Darier disease
Darier disease is a rare genetic disorder that causes a skin rash and appears mostly in adolescence. It shows up in the fingernails and toenails as broad, white or reddish stripes that run from cuticle to tip. A V-shaped nick near the fingertip can also indicate this condition, Dr. Poblete-Lopez says.
Preventing underlying conditions that impact your nails isn’t always possible, Dr. Poblete-Lopez says, but you can care for your nails by staying hydrated and eating a well-balanced diet. Be sure you’re consuming enough Vitamin B and zinc because those nutrients greatly strengthen your nails.
In many cases, she says, changes to your nails can be normal and don’t point to any undiagnosed health changes. But, if you have a question, consulting your doctor is always best.
“Some nails may not appear smooth or they might have longitudinal strips or ridges. As long as whatever you see is consistent throughout the distribution of the nail, it’s likely OK,” she says. “If there’s something out of the ordinary, though, it’s reasonable to see a dermatologist.”
Digital Myxoid Cysts: Causes and Treatment
- Infrared coagulation.This procedure uses heat to burn off the cyst base. A 2014 review of the literature showed the recurrence rate with this method to be 14 percent to 22 percent.
- Cryotherapy.The cyst is drained and then liquid nitrogen is used to alternately freeze and thaw the cyst. The objective is to block any more fluid from reaching the cyst. The recurrence rate with this procedure is 14 percent to 44 percent. Cryotherapy may be painful in some cases.
- Carbon dioxide laser.The laser is used to burn off (ablate) the cyst base after it’s been drained. There’s a 33 percent recurrence rate with this procedure.
- Intralesional photodynamic therapy.This treatment drains the cyst and injects a substance into the cyst that makes it light-sensitive. Then laser light is used to burn off the cyst base. A small 2017 study (10 people) had a 100 percent success rate with this method. There was no cyst recurrence after 18 months.
- Repeated needling.This procedure uses a sterile needle or knife blade to puncture and drain the myxoid cyst. It may need to be done two to five times. The cyst recurrence rate is 28 percent to 50 percent.
- Injection with a steroid or a chemical that shrinks the fluid (sclerosing agent).A variety of chemicals may be used, such as iodine, alcohol, or polidocanol. This method has the highest recurrence rate: 30 percent to 70 percent.
Surgical treatments have a high success rate, ranging from 88 percent to 100 percent. For this reason, your doctor may recommend surgery as a first-line treatment.
Surgery cuts the cyst away and covers the area with a skin flap that closes as it heals. The size of the flap is determined by the size of the cyst. The joint involved is sometimes scraped and osteophytes (bony outgrowths from the joint cartilage) are removed.
Sometimes, the surgeon may inject dye into the joint to find (and seal) the point of fluid leakage. In some cases, the flap may be stitched, and you may be given a splint to wear after surgery.
In surgery and in nonsurgical methods, scarring that cuts the connection between the cyst area and the joint prevents more fluid from leaking to the cyst. Based on his treatment of 53 people with myxoid cysts, one researcher has argued that the scarring can be accomplished without the need for cyst removal and a skin flap.
You can try treating your cyst at home by using firm compression every day for a few weeks.
Don’t puncture or try to drain the cyst at home because of infection risk.
There’s anecdotal evidence that soaking, massaging, and applying topical steroids to myxoid cysts may help.
Enlarging nodule under the toenail • no history of trauma • unremarkable medical history • Dx?
A 28-year-old woman with an unremarkable medical history presented with an enlarging nodule that had been growing under her left great toenail for 6 months. The patient monitored the nodule, hoping that it would resolve on its own, but found that it steadily increased in size and began to displace the nail, causing pain. At the time of presentation, the nodule measured approximately 10 mm in diameter, and there was significant (~80°) superior displacement of the nail (FIGURE 1).
An initial radiograph identified a 5.5-mm bony density arising from the dorsal surface of the left first distal phalanx with no significant degenerative changes (FIGURE 2). A subsequent magnetic resonance image confirmed the bony excrescence and noted marrow continuity. A thin amount of T2 bright signal was also observed, suggesting either a cartilaginous cap or soft tissue edema secondary to pressure on the nail bed (FIGURE 3).
Histologic examination demonstrated a thin (3 mm) cartilaginous cap overlying an area of mature fibrocartilage with no definite periosteum. The osseous component appeared to mature from the cartilage, and the marrow was focally fatty and fibrosed (FIGURES 4A and 4B). Expert consultation with the Joint Pathology Center confirmed a benign osteochondromatous lesion.
The histologic differential diagnosis of this patient’s lesion included subungual exostosis and osteochondroma. Based on the patient’s age, location of the lesion, and histologic findings, the final diagnosis was subungual exostosis.
Subungual exostoses are benign osteocartilaginous tumors that most commonly affect children and young adults. They predominantly manifest on the dorsomedial aspect of the tip of the great toe (~80%), but can occur on other digits of the foot or hand.1 They are caused by a proliferation of fibrous tissue under the nail bed. The fibrocartilage cap then undergoes endochondral ossification to woven bone and lamellar bone trabeculae. As these lesions mature, they establish continuity with the underlying bone in the phalanx.2 Subungual exostoses were once thought to represent a proliferative response to trauma, but further research has identified a recurrent t(X;6) (q22;q13-14) translocation, suggesting a neoplastic origin.3
Osteochondromas are also common benign tumors formed by endochondral ossification, although secondary transformation into low-grade chondrosarcomas is well-documented.1 Osteochondromas commonly affect younger patients. They occur at epiphyseal areas of developing bone and have a hyaline matrix and chondrocyte pattern similar to that of a normal epiphyseal area, with confluence to the underlying trabecular and cortical bone. They are not caused by previous trauma and generally only become symptomatic after they have grown large enough to cause mechanical problems.1
Continue to: More diagnoses to consider
Nail abnormalities are problems with the color, shape, texture, or thickness of the fingernails or toenails.
Beau lines; Fingernail abnormalities; Spoon nails; Onycholysis; Leukonychia; Koilonychia; Brittle nails
Like the skin, the fingernails tell a lot about your health:
- Beau lines are depressions across the fingernail. These lines can occur after illness, injury to the nail, eczema around the nail, during chemotherapy for cancer, or when you do not get enough nutrition.
- Brittle nails are often a normal result of aging. They can also be due to certain diseases and conditions.
- Koilonychia is an abnormal shape of the fingernail. The nail has raised ridges and is thin and curved inward. This disorder is associated with iron deficiency anemia.
- Leukonychia is white streaks or spots on the nails often due to drugs or disease.
- Pitting is the presence of small depressions on the nail surface. Sometimes the nail is also crumbling. The nail can become loose and sometimes falls off. Pitting is associated with psoriasis and alopecia areata.
- Ridges are tiny, raised lines that develop across or up and down the nail.
To prevent nail problems:
- DO NOT bite, pick, or tear at your nails (in severe cases, some people may need counseling or encouragement to stop these behaviors).
- Keep hangnails clipped.
- Wear shoes that do not squeeze the toes together, and always cut toe nails straight across along the top.
- To prevent brittle nails, keep the nails short and do not use nail polish. Use an emollient (skin softening) cream after washing or bathing.
Bring your own manicure tools to nail salons and DO NOT allow the manicurist to work on your cuticles.
Using the vitamin biotin in high doses (5,000 micrograms daily) and clear nail polish that contains protein can help strengthen your nails. Ask your provider about medicines that help with abnormal-appearing nails. If you have a nail infection, you may be prescribed antifungal or antibacterial drugs.
When to Contact a Medical Professional
Call your health care provider if you have:
- Blue nails
- Clubbed nails
- Distorted nails
- Horizontal ridges
- Pale nails
- White lines
- White color under the nails
- Pits in your nails
- Peeling nails
- Painful nails
- Ingrown nails
If you have splinter hemorrhages or Hutchinson sign, see the provider immediately.
What to Expect at Your Office Visit
The provider will look at your nails and ask about your symptoms. Questions may include whether you injured your nail, if your nails are constantly exposed to moisture, or whether you are always picking at your nails.
Tests that may be ordered include x-rays, blood tests, or examination of parts of the nail or the nail matrix in the laboratory.