Are vertical lines and white spots on the nails a “signal of death”?

Are vertical lines and white spots on the nails a “signal of death”?

In life, many people's nails are not only not smooth and rosy, but also always have some problems. For example, some people's nails have obvious uneven vertical stripes, some people have spots, and some people's nails are very thick or suddenly become smaller... Some people say that this means poor gastrointestinal health, some people say that there are parasites in the body, and some people say that this is a "death signal"... So, what is the truth? What conditions of nails may indicate that there is really something wrong with the body?

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01

Rumor: Vertical lines on nails mean poor digestion and malnutrition.

The truth: It is a normal physiological phenomenon. Most people have small vertical lines.

Most people have tiny vertical lines on their nails, the only difference is that some are obvious and some are not. As they age, the vertical lines may become more obvious. This is a normal physiological phenomenon and has no obvious relationship with poor digestion or malnutrition.

More obvious and deeper longitudinal lines are medically called " longitudinal nail grooves ", which may even develop into longitudinal fissures. They are seen in lichen linearis, lichen planus, subungual warts, and nail dystrophy, and may also occur in X-ray, chemical, or mechanical damage to the nail plate.

02

Rumor: White spots on nails are caused by internal parasites.

The truth: Parasites say they cannot take the blame.

Small white spots appear on the nails, medically known as "punctate leukonychia", which is very common in the normal population and is mostly seen on the nails. It is caused by minor trauma and slight bumps. As the nails grow, they will move outward until they are trimmed off.

03

Rumor: Black lines on nails are a warning sign of cancer.

The truth: It’s a good thing to be vigilant, but you can’t generalize.

① Melanocyte activation. Generally, the nail pigment stripes caused by melanocyte activation are benign black nails. Melanocyte activation refers to the increase in the synthesis of melanin by melanocytes under the stimulation of various factors, without an increase in the number of melanocytes. Melanocyte activation is the main cause of single-fingered black nails, which occurs in more than 70% of adult patients. Various physiological factors, local traumatic stimulation, bad behavioral habits, systemic diseases, drug factors and certain skin diseases can lead to melanocyte activation.

② Nail matrix nevus. The black color of the nail matrix nevus is longitudinal black nail, which often occurs in childhood. The strip-like pigmentation is obvious, and pigmentation may also appear in the proximal nail folds and periungual tissues (pseudo-Hutchinson's sign). If it is difficult to understand, you can just regard it as a "pigmented nevus" growing at the root of the nail.

③Nail lentigo, which is very similar to nail matrix nevus in clinical manifestation, is also a linear black nail and is a benign lesion.

④ Subungual melanoma, this disease is a malignant tumor, but it is relatively rare, so you don’t need to be overly nervous. This type of black line on the nail does not look as "well-behaved and clean" as the previous benign lesions - the pigment bands vary in depth (dark brown, black or multi-color), the edges are unclear, the widths vary, and there may even be nail damage such as nail plate ulceration, nail peeling, and nail loss, as if the nail plate has been "eaten". "Unwell black lines" are not the only manifestation of subungual melanoma. 25% of patients also show achromatic nodules, which often rupture and bleed. If there is Hutchinson's sign (pigmentation of the proximal nail fold or subungual skin accompanied by longitudinal black nails), nail melanoma should be highly suspected.

The appearance of linear black nails on multiple fingernails and toenails is often caused by the activation of nail melanocytes and does not require active treatment; single linear black nails in children or young people are often nail matrix nevi or onychomycosis, which are benign lesions and can be locally removed if necessary; single linear black nails in adults need to be given proper attention. Although most of them are benign lesions, they still need close follow-up observation. Face-to-face consultation with a specialist physician may use non-invasive dermatoscopy for identification and regular monitoring. If changes are found or there is a possibility of malignancy, they must be removed as soon as possible and a pathological examination should be performed to confirm the diagnosis.

04

Rumor: The more half-moons on your nails, the healthier you are.

The truth: The number and size of lunulae vary from person to person and do not reflect health status.

The "lunula" on the nails is actually a newly produced keratin cell, scientifically known as the "lunula". Below the "lunula" is the nail matrix responsible for producing keratin, and our nail plate is produced by the nail matrix. There is a "lunula" on each finger or toe, but some are covered by the proximal skin and cannot be seen.

The number and size of "lunula" are related to the rate of keratin production and cannot reflect physical health. Age, disease, nutritional status, environment and changes in lifestyle habits can affect the growth rate of the nail plate.

Children have a fast metabolism and their nail plates grow fast, so they have more "lunulae", while the "lunulae" of the elderly gradually become smaller with age, which is a normal physiological phenomenon. For people who use their hands frequently, the "lunulae" on the fingers with fast nail wear will be more obvious.

If the "lunula" suddenly becomes larger or disappears, it indicates that the growth rate of the nail has suddenly accelerated or slowed down or even stopped, and we should be alert to the possibility of thyroid disease. Hyperthyroidism can cause metabolism to speed up, and the "lunula" will become more obvious; hypothyroidism will cause metabolism to slow down, and the "lunula" will also become smaller or disappear.

05

Myth: Hangnails around the nails are caused by vitamin deficiency.

The truth: The medical name for hangnails is excoriation, which is mostly caused by external stimuli and dry skin on the hands and has nothing to do with vitamin deficiency.

Reverse peeling refers to the long triangular epidermis that is dry and cracked around the nails. The skin around the nails is relatively thin and lacks hair follicles and sebaceous glands. The stratum corneum that lacks oil and moisture is easily separated due to dryness and lack of water, thus cracking and curling.

In daily life, factors such as daily cleaning products, physical friction, or changes in temperature can reduce the amount of oil in the stratum corneum. The stratum corneum, which lacks oil protection, loses water, resulting in dryness and cracking. Reverse peeling can also be caused by sports, occupational injuries, and neurotic habits (for example, nail biting).

If a barb has appeared, remember not to bite or tear it. Improper treatment will cause the injury area to increase and bleed. If it is not disinfected, it will cause local infection and paronychia. The correct way to deal with it is to use clean scissors or nail clippers to cut off the raised cuticle.

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06

Rumor: Nail biting is caused by iron and zinc deficiency.

The truth: Nail biting has nothing to do with iron and zinc deficiency, but is related to mental stress.

Nail biting is medically known as onychophagia. It is common in children and adolescents, and is characterized by repeated biting of the free edge of the nail, which shortens the nail plate. The free edge of the nail plate often becomes serrated, and sometimes the entire nail surface is bitten, causing the nail plate to lose its luster and develop transverse grooves or ridges.

The main causes of this disease are mental stress, imitating family members or transferring thumb sucking habits. The cause of mental stress may be related to the family and school environment. We should check whether there are any factors that make him nervous and uneasy, and if so, eliminate them as much as possible.

For the two reasons of imitating family members and diverting the thumb sucking habit, you can distract him by participating in interesting activities or games to help him slowly get rid of this bad habit. Blindly criticizing or ordering the patient to stop biting can sometimes cause the patient to rebel and may even strengthen the biting behavior, which is very unfavorable to correcting the behavior.

If the above methods are ineffective, we need to consider consulting a psychologist to improve symptoms through psychological suggestion or medication.

07

Rumor: Clubbing of fingers indicates the risk of cardiovascular disease, respiratory disease, digestive disease, nutritional disorders and chronic altitude sickness.

The truth: This is true, but it is not complete. Hereditary clubbing does not mean that there is a disease.

Clubbing is characterized by hypertrophy of the distal phalanx into a drumstick shape, thickening of the nail plate, increased lateral curvature, and disappearance of the Lovibond angle (Lovibond angle, i.e. the angle between the nail plate and the proximal nail fold seen from the side, is 160° in normal nails, while clubbing is greater than 180°). Clubbing is mostly secondary, most often associated with chronic cardiopulmonary diseases, but can also be seen in digestive system diseases, infectious diseases, endocrine system diseases, infectious diseases, parasites, autoimmune diseases, etc.

For example, chronic obstructive pulmonary disease, interstitial pulmonary fibrosis, lung cancer, congestive heart failure, infective endocarditis, cyanotic congenital heart disease, primary biliary and portal cirrhosis, ulcerative colitis, gastrointestinal tumors, inflammatory bowel disease, etc.

Clubbing of fingers (toes) indicates the possibility of disease, and we need to seek medical attention in time. Please ask professional doctors to help us judge and treat the primary disease in time.

In addition, a small portion may be congenital, often with a family history and related to genetics. It does not mean the presence of a disease and does not require special intervention.

Although most of the above online content is not very accurate, nails can indeed reflect our health status to a certain extent and are a "barometer" of health. If the following conditions occur, it means that there may be something wrong with your body:

1

Nails turn yellow

Yellowing of nails is most common in the elderly, which is a manifestation of natural aging. In addition, nail fungus (commonly known as onychomycosis) and psoriasis can also cause nails to turn yellow.

If the nails turn yellow and are accompanied by thickening, brittleness, and subungual debris, it is very likely that you have "onychomycosis". At this time, go to the hospital for a fungal test, which is often positive. Although the nails of psoriasis patients will also turn yellow, they usually have pinpoint-sized pits, and the fungal test is negative.

2

Nail color turns red

The nail bed is dark red, which is common in polycythemia.

Cherry-red nail beds are seen in carbon monoxide poisoning.

Localized bluish-red spots with tenderness may be subungual glomus tumors.

3

Nails turning blue

Clinically, it is called blue nails. Blue nails are common in heart and lung failure, and all nail beds and half-moons are cyanotic. Taking certain medications can also cause blue nails.

4

Nails turning green

Clinically, green striped nails can be seen in patients with iron deficiency anemia. Green striped textures appear on the nail plate, which may be accompanied by ingrown nails and gray nails.

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How to scientifically protect armor?

1. Proper nail trimming: Trim the nails 1-2 times a week according to the growth rate of the nail plate. It is usually recommended to keep the free edge of the nail plate 1-2mm. Avoid excessive trimming of the two ends of the nail plate, especially the big toe. Excessive trimming of the outer ends is prone to ingrown nails or worsening ingrown nails. If the nail plate is very fragile and easy to split, you can wash your hands or trim it after bathing. Avoid soaking it for too long. Excessive soaking will make the nail plate brittle.

2. Try not to trim the cuticle: The cuticle is a small layer of thin skin covering the nail near the root of the "lunar" that protects the nail matrix at the root of the nail and prevents the invasion of bacteria and foreign objects.

3. Try to reduce direct contact between your nails and objects, or use your nails as tools. Use your fingernails instead of your nails to reduce the chance of injuring your nails.

4. Keep your hands dry: Try to minimize soaking your hands in water, washing hands frequently, or keeping your hands in a wet state for a long time. In a dry state, germs are not easy to grow and the chance of infection will be reduced.

5. Reduce contact with various irritants, such as soap, organic solvents, etc. If you must contact irritants, wear protective gloves as much as possible.

6. Avoid washing your hands with overheated water. Apply hand cream immediately after washing your hands to protect the moist cuticle, especially in winter when the skin is prone to dryness. Don't forget to take care of the surface and root of the nails to prevent moisture loss.

Summarize

Vertical lines and white spots on the nails have nothing to do with digestion, nutrition, or parasites; the appearance of black lines on the nails does not necessarily mean a warning of cancer; the number and size of half-moons cannot reflect health status; the appearance of hangnails around the nails is not caused by a lack of vitamins; and nail biting is not caused by a lack of iron or zinc.

Author: Yu Sisi Department of Dermatology and Medical Cosmetology, Shijingshan Branch, Beijing Chaoyang Hospital

Review | Tao Ning Associate Researcher, Institute of Biophysics, Chinese Academy of Sciences

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