Seven Signs of Healthy Nails

Punctate depressions, onycholysis, linear black onychomycosis, yellow onychomycosis thickening, spoon-shaped onychomycosis, club-shaped onychomycosis, and recurrent redness, swelling and long barbs around the nail. As for the statements posted online that "the number of crescents represents qi and blood" and "vertical lines represent kidney deficiency", there is currently no clear clinical evidence to support them, so don't take them too seriously.

Let’s first talk about the punctate dents that people often ask about, which are pinpoint-sized pits on the surface of the nail. Last time, a 27-year-old girl came with her fingernails in hand and said that she checked on the Internet and said she was suffering from calcium deficiency. She took three monthly calcium tablets but nothing improved. I glanced at her with a magnifying glass and saw that her pits were densely packed and neatly arranged, like thimbles. Looking at the incomplete silver shavings covering her elbows, I could basically tell that psoriasis had affected her nails. However, there is also a different academic point of view here: some doctors who specialize in nail diseases believe that if there are only two or three sporadic pits and no symptoms of psoriasis or erythema on the skin, it is most likely physical damage caused by the removal of the cuticle on the nail surface during frequent manicures. It will recover on its own after stopping manicures for 1-2 months. There is no need to treat it as psoriasis. Oh, by the way, 90% of nail problems have nothing to do with calcium deficiency. Don’t buy calcium tablets randomly.

Speaking of problems caused by manicure, we have to mention onycholysis, which is the second most commonly asked question - that is, the front end of the nail is separated from the nail bed, leaving a vacant area that feels soft to the touch. Many people assume that they have onychomycosis when they see empty nails. There is really no need to scare yourself. I once met a girl who had done manicures for five years. Seven of her ten nails were empty. She bought a bunch of onychomycosis solution and applied it on for half a year, but the results were negative. The fungus microscopy was all negative. It was caused by long-term exposure to nail polish solvents and violent polishing during nail removal. Of course, if the empty nail area becomes yellow and brittle at the same time, and the residue is removed when you pick it, and it is also accompanied by athlete's foot, then it is most likely onychomycosis (also known as onychomycosis), and it can be treated as a fungal infection. There is another controversial point here: the nutritional community believes that long-term iron deficiency and zinc deficiency can also induce onycholysis. However, we have seen very few clinical cases of onycholysis caused simply by lack of nutrition, and most of them are accompanied by severe symptoms of malnutrition. Therefore, it is much more reliable to prioritize external stimulation than to supplement trace elements.

What is more alarming than the empty nails is probably the linear black nails that suddenly grow on the nails. Two weeks ago, I received an online consultation. A 24-year-old young man had a 2mm black line on his fingernail. I checked online and said it was melanoma and required amputation. I was so scared that I couldn't sleep all night. I asked him to take a high-definition picture. The black line has clear borders, uniform color, and no short-term widening. It is just an ordinary nail nevus. Just observe it regularly. There is also an interesting division between departments: oncologists are generally more cautious in judging black lines. Once the width exceeds 3mm, increases rapidly in the short term, and has blurred borders, most of them will recommend direct resection for pathology. ； Most dermatologists will perform non-invasive dermoscopy first, and then recommend nail removal when there is a high degree of suspicion of malignancy. After all, the newly grown nails after nail removal are likely to be deformed, which will have a great impact on daily life. Oh, by the way, if the black line appears after the nail was smashed and squeezed, it is subungual congestion. It will disappear by itself in two months, so there is no need to worry.

Let’s talk about thickening of yellow nails. Many people immediately label onychomycosis as soon as they see yellow and thick nails. In fact, this is not necessarily the case. I have a 72-year-old patient who has COPD for 20 years. All ten fingernails are yellow, thickened and deformed. Three fungal tests were negative. In fact, he has yellow nail syndrome, which is related to his chronic respiratory problems and lymphatic circulation disorder. Of course, most cases of yellowing and thickening of single nails, especially those with athlete's foot, are basically onychomycosis, which can be treated as a fungal infection. However, if the nails of both hands are yellowed at the same time, accompanied by long-term coughing and lower limb edema, it is best to check the respiratory department instead of just focusing on the nails.

There is another sign that is rarely seen but is very suggestive: spoon-shaped nails, which are nails that are concave in the middle and the edges are upward, like a small spoon. I met a 16-year-old girl before. After dieting for half a year, her aunt stopped. When she came here, her fingernails were all spoon-shaped. Her hemoglobin was only 70g/L. She was suffering from severe iron deficiency anemia. After three months of iron supplements, her nails slowly grew back. However, not all spoon-shaped nails are anemic. Chemical workers who have been exposed to strong acids and alkalis for a long time and patients with thyroid dysfunction may also develop spoon-shaped nails. Therefore, it is safer to check the blood routine and thyroid function first instead of just taking iron supplements.

The most easily overlooked thing is actually clubbed nails: the soft tissue at the end of the nail proliferates and becomes thicker, the nail bulges upward like a small drumstick, and the curvature of the nail is much larger than that of normal people. Last year I met a 56-year-old uncle who had clubbed nails for almost three years. He thought he was born with it. He recently coughed up blood and came for a check-up. He was already in the middle stage of lung cancer, which is really a pity. Of course, there are a small number of people with congenital nail clubbing without any organic problems. However, if it appears gradually the day after tomorrow, especially if it is accompanied by chest tightness, long-term cough, and palpitation, you must have your heart and lungs checked as soon as possible. This signal is really very suggestive, so don’t take it seriously.

Finally, let me talk about a situation that everyone has encountered: repeated growth of barbs, redness and swelling around the nails. Don’t believe that hangnails are caused by vitamin deficiency. I also get them when I wash my hands too much in winter and forget to apply hand cream. It’s because my skin is too dry and the cuticles around my nails are dehydrated and cracked. If the hangnail only grows occasionally, use nail scissors to cut it off at the root, and apply a thick layer of hand cream. Don't tear it, or it will bleed and it will most likely turn into paronychia. If you have repeated hangnails and pus and redness around your nails, you either have paronychia or are caused by long-term exposure to irritating items such as dish soap and disinfectant. Unless you have been unable to eat for a long time and are severely malnourished, you really don’t need to take vitamin tablets.

In fact, at the end of the day, nails are just one of the reference signals of health. You don’t have to go to Baidu to diagnose yourself at the slightest sign of trouble. If you are really unsure, call up a regular dermatology account for more than ten yuan, or get a dermoscope for less than 100 yuan. Everything will be clear. It is much more reliable than worrying at home and buying supplements indiscriminately.