Abstract
Background: No cutaneous examination is complete without a careful evaluation of nails. Nail changesare common in the elderly and include changes in color, contour, growth, surface and thickness.
Aim of the study was to identify nail changes due to various dermatologic or systemic disorders in the geriatric age group.
Material and Methods: A total of 100 elderly patients aged more than 60 years with nail changes were included in the study from at tertiary care hospital. In suspected case of fungal infection, KOH (potassium hydroxide) mount of the nail clippings and nail biopsy done, whenever indicated.
Results: The commonest nail change seen was onychorrhexis (97%). Other nail changes, in decreasing order, were altered contour (95%), alunula (93%), dark / dull opaque nails (91%), ragged cuticle (88%), slowing of nail growth rate (87%), thickened nail plate (69%), onycholysis (68%), subungual hyperkeratosis (62%), chromonychia (58%), ragged nail folds (45%), pitting (24%), Beau's lines (23%), onychoschizia (18%), brittle nails (18%), clubbing (17%), smooth shiny nails (13%), thinning of nail plate (9%), paronychia (6%), onychoptosis (5%), pterygium unguis (5%), onychomycosis (3%), brachyonychia (3%), longitudinal splitting (2%), subungual hematoma, plat forming of nail plate and powdery white patch on the nail (1% each).
Conclusion: Careful examination of nail is very important, especially so in elderly. The nail changes may be a marker for many dermatological as well as systemic disorders.
References
- Raja babu KK. Nail and its disorders. In: Valia RG, Valia AR, Bajaj AK, Ganapati R, Girdhar BK, Haldar B, et al, editors. IADVL Textbook and atlas of dermatology. 2nd Mumbai: Bhalani Publishing House; 2001.p.763-98.
- Drake LA, DinehartSM, Farmer ER, Goltz RW, Graham GF, Hordinsky MK, et al.Guidelines of care for nail disorders. J Am AcadDermatol. 1996;34:529-33.
- Cohen PR, Scher RK. Geriatric nail disorders: diagnosis and treatment. J Am Acad 1992;26:521-31.
- Baran R, Dawber RPR. The nail in childhood and old age. In: Baran R, Dawber RPR, Diseases of the nails and their management. 2nded. Oxford: Blackwell Scientific Publications; 1994.p.81-96.
- Theodosat A. Skin diseases of the lower extremities in the elderly. Dermatol Clin. 2004;22:13-21.
- Holzberg M. Nail signs of systemic disease. In: Hordinsky MK, Sawaya ME, Scher RK, editors. Atlas of hair and nails. Philadelphia: Churchill Livingstone; p.59-70.
- Cohen PR, Scher RK. Aging. In: Hordinsky MK, Sawaya ME, Scher RK, editors. Atlas of hair and nails. Philadelphia: Churchill Livingstone; 2000.p.213-25.
- Dawber R, Bristow I, Turner W. Nail Disorders. In: Text atlas of podiatric London: Martin Dunitz Ltd; 2001.p.105-31.
- Kushner D. Primary podiatric care of the vascularly compromised patient. ClinPodiatr Med Surg. 1992;9:109-23.
- Baran R, Dawber RPR. Physical signs. In: Baran R, Dawber RPR, editors. Diseases of the nails and their management. 2nd Oxford: Blackwell Science;1994.p.35-80.
- Rich P. Nail disorders: diagnosis and treatment of infectious, inflammatory and neoplastic nail conditions. Med Clin North Am. 1998;82:1171-83.
- Lewis BL, Mantgomery H. Thesenile nail.JInvest Derm 1955; 24:11-8.
- Cohen PR. The lunula.J Am Acad Dermatol. 1996; 34:943–53.
- Holzberg M, Walker HK. Terry's nails: revised definition and new correlations. Lancet. 1984;1:896-9.
- Nixon DW. Alterations in nail pigment with cancer chemotherapy. Arch Intern Med. 1976;136:1117-8.
Corresponding Author
Kishor Singh
Professor & HOD, Department of Dermatology, NIMS, Jaipur, Rajasthan
DOI: https://dx.doi.org/10.18535/jmscr/v5i8.80
