| SKIN INVOLVEMENT: MAIN MENU |
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| Fingernails, Fingerprints, Nailfolds, and Cuticles |
| This page was written by Shelley Ensz, and has not yet been medically edited. Scleroderma (SD) affects everyone differently. Just because something is listed here does not mean an individual patient will ever experience it. See Disclaimer. |
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| Overview |
| Hundreds of conditions can affect the fingernails. Dry or rough cuticles can be caused by many things, including frequent hand washing or lack of moisturizers. |
| The systemic forms of scleroderma can cause the fingernails to become smaller, and cuticles to become hard or rough. But because there are so many possible causes of poor fingernail or cuticle condition, they are not part of the diagnostic criteria for any form of scleroderma. |
| However, viewing the nailfolds under a microscope can disclose certain abnormalities of the small blood vessels, and specific findings can be very useful in diagnosing, classifying and staging forms of systemic scleroderma. |
| Unfortunately, in the U.S. such testing is frequently not covered by insurance companies, so there is widespread reluctance to do nailfold testing -- even though it is a very quick, easy, noninvasive, and economical way to diagnose and classify systemic forms of scleroderma. (Also see: What is Scleroderma? and Symptoms of Scleroderma) |
| Cuticles: Periungual Erythema |
| The relation between periungual erythema and nailfold capillary abnormalities in patients with connective tissue diseases. Periungual erythema can be used for the detection of scleroderma spectrum disorders and dermatomyositis/polymyositis in clinical practice, although nailfold capillary microscopy is more accurate. European Journal of Dermatology. |
| Photo of periungual erythema in a patient with dermatomyositis. UpToDate. |
| Fingernail Abnormalities |
| Nail Abnormalities. Just like the skin, the fingernails tell a lot about your health. Photos and descriptions of nail pitting, ridges, Beau's lines, leukonychia (white streaks or spots), koilonychia, and brittle nails. Medline Plus. |
| Nail changes in connective tissue diseases: do nail changes provide clues for the diagnosis? Proximal nailfold is the most important site of affection in CTDs. These nail changes can be used in combination with highly sensitive diagnostic modalities to establish an accurate diagnosis. PubMed. J Eur Acad Dermatol Venereol. 2007 Apr;21(4):497-503. (Also see: Common Medical Tests) |
| Pulmonary Disorders. Clubbing is enlargement of the fingertips (or toes) due to proliferation of connective tissue between the fingernail and the bone. Clubbing is most commonly observed in lung cancer but is an important sign of chronic pulmonary disease, such as cystic fibrosis and idiopathic pulmonary fibrosis. The Merck Manuals. November 2005. (Also see: Pulmonary Involvement) |
| Nail Abnormalities: Clues to Systemic Disease. The visual appearance of the fingernails and toenails may suggest an underlying systemic disease. Clubbing of the nails often suggests pulmonary disease or inflammatory bowel disease. R. S. Fawcett, M.D., M.S. American Family Physician. March 15. 2004. (Also see: Pulmonary Involvement) |
| Causes of Fingernail Symptoms and Abnormalities |
| Causes of Types of Fingernail Symptoms. There are over 200 possible causes of nail symptoms. WrongDiagnosis.com. |
| Manicure Safety |
| It is particularly important for people with scleroderma and other illnesses to take good care of their fingernails and toenails, to ward off unnecessary complications. Use ample moisturizers, manicure nails weekly, and consult the doctor if you have troublesome nail symptoms. |
| How to keep your fingernails healthy and strong. Your nails may be small but they play an important role, serving to help protect your fingers and improve dexterity. They may also reveal clues to your general health. Mayo Clinic. |
| 10 Tips for Healthy Manicures. Lower your risk of developing an infection or fungus, or HIV/AIDS, caused by a manicure. Buy your own manicure or pedicure kit and take it with you when you visit your manicurist. Clean and disinfect your manicure kit after each use. Bring your own nail polish, base coat, and top coats. About.com. |
| Fungal Infections of Fingernails and Toenails. A fingernail or toenail infection that is caused by a fungus is called onychomycosis (say: "on-ee-koh-my-ko-sis"). Toenails are more likely to become infected than fingernails. This infection can make your nails thick and discolored. Your nails may also be brittle or change their shape. FamilyDoctor.org. |
| Nail biting: Does it cause long-term damage? Nail biting can worsen some existing conditions of the nail bed, such as infection of the skin around the nail bed (paronychia) or warts around the nail bed. In addition, you can pass bacteria or viruses from your nails and fingers to your mouth by biting your nails, making it more likely you'll catch a cold or other infection. Most nail biting is merely a bad habit that most people eventually break. But constant, severe nail biting can be a sign of anxiety or compulsive behavior. Mayo Clinic. |
| Lack of Fingerprints |
| Fingerprints (Dactylography). Fingerprints can be permanently destroyed in some chronic skin diseases (as leprosy and scleroderma), lost in surgical removal, chemical destruction and by LASER (leaving no scar for identification). |
| Marthie D: CREST Scleroderma. I have just applied for a new driver's license, for which fingerprints are taken. Eventually I had to get a doctor's letter to confirm that I have a skin problem and that the lines and cracks on my fingers are because of this. Now I have a driver's license card which states 'no prints'. (Does this mean I can perhaps have a new job? Shall we say, that of thief or any such one, seeing that I have no prints? Ha-ha!)... |
| Nail Biting |
| How can I kick the nail biting habit? One proposed method is a transparent nail paint that tastes very bitter. The idea is that the bitterness at least helps to make you aware of when your fingers are in your mouth. If you find the taste unpleasant (as you're supposed to!) it might also act like a form of aversion therapy, putting you off the whole idea. NetDoctorUK. |
| Nail biting: Does it cause long-term damage? Nail biting can worsen some existing conditions of the nail bed, such as infection of the skin around the nail bed (paronychia) or warts around the nail bed. In addition, you can pass bacteria or viruses from your nails and fingers to your mouth by biting your nails, making it more likely you'll catch a cold or other infection. Most nail biting is merely a bad habit that most people eventually break. But constant, severe nail biting can be a sign of anxiety or compulsive behavior. Mayo Clinic. |
| Nailfold Capillaroscopy and Nailfold Videocapillaroscopy for Diagnosis of Scleroderma |
However, very few doctors know how to do a nailfold exam! |
Viewing the nailfolds with special instruments can disclose certain abnormalities of the small blood vessels, and specific findings can be very useful in diagnosing, classifying and staging forms of systemic scleroderma. |
| Unfortunately, in the U.S. such testing is frequently not covered by insurance companies, so there is widespread reluctance to do nailfold testing -- even though it is a very quick, easy, noninvasive, and economical way to diagnose and classify systemic forms of scleroderma. |
There are occasional patients with changes visible to naked eye. Unfortunately, many doctors mistake prominent venular system (not signficant) with these changes. About 95% of patients need a nailfold exam with magnifying glass or ophthalmoscope on high diopter with oil or KY jelly on the nailbed to assess properly. However, very few doctors do this or even know how. (Also see: What is Scleroderma? and Symptoms of Scleroderma) |
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| To do a nailfold capillaroscopy, a drop of oil is placed on the patient’s nailfold, which is the skin at the base of the fingernail. The nailfold is then examined under a microscope. If the capillaries are enlarged or abnormal, this may indicate that the patient has a connective tissue disease. |
| Includes excellent photos of nailfold abnormalities --> |
The Handheld Dermatoscope as a Nail-Fold Capillaroscopic Instrument. The presence of nail-fold capillary abnormalities may be useful in diagnosing several connective tissue disorders, including scleroderma, dermatomyositis, and mixed connective tissue disease, and in differentiating primary Raynaud phenomenon from Raynaud phenomenon due to scleroderma and mixed connective tissue disease. Archives of Dermatology. Vol. 139 No. 8, August 2003. (Also see: Common Medical Tests) |
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| Capillaroscopy. Capillaroscopy is the most reliable way to distinguish between primary and secondary Raynaud's phenomenon through identification of an early pattern of systemic sclerosis. (PubMed) M. Cutolo. Best Pract Res Clin Rheumatol. Dec 2008. (Also see: Raynaud's Diagnosis) |
| Diagnostic utility of nailfold capillaroscopy. Qualitative nailfold capillarscopy performed by an experienced operator is considered to have high diagnostic utility in the early assessment of patients with Raynaud's phenomena, and when abnormal, is highly suggestive of scleroderma, dermatomyositis or antisynthetase myositis. APLAR Journal of Rheumatology. 10(4):275-279, 2007. |
| Scleroderma patients nailfold videocapillaroscopic patterns are associated with disease subset and disease severity. Our study showed that scleroderma microangiopathy correlates with disease subset and severity of peripheral vascular, skin, heart and lung involvement; patients with late pattern showed an increased risk to have an active disease and to show a moderate/severe skin or visceral involvement compared to patients with early and active patterns. Therefore nailfold videocapillaroscopy, a simple, non-invasive and non-expensive investigation, is useful in staging scleroderma patients and also provides prognostic information. Rheumatology 2007 46(10):1566-1569. |
| Nailfold videocapillaroscopic (NVC) patterns and serum autoantibodies in systemic sclerosis. NVC is an appropriate tool for differential diagnosis between primary and secondary RP through the clear recognition of the early NVC scleroderma pattern. Rheumatology 2004; 43: 719-726. |
| Scleroderma-like nailfold capillaroscopic abnormalities are associated with anti-U1-RNP antibodies and Raynaud's phenomenon in SLE patients. The association of RP, anti-U1-RNP antibodies, and ‘scleroderma-like’ findings on nailfold capillaroscopy (SD-pattern) in patients with SLE may suggest a new SLE subset with subclinical features of systemic sclerosis. Lupus, Vol. 11, No. 1, 35-41 (2002). |
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| Nailfold Capillaroscopy and Diagnosis of Raynaud's |
| Raynaud's is an extreme spasm of blood vessels in response to cold or stress. The fingers and/or toes become white and/or blue, and may become red on re-warming. ISN. |
| Raynaud's Diagnosis may include nailfold capillaroscopy, particularly to determine whether the Raynaud's is primary, or secondary to a connective tissue disease, such as scleroderma, lupus or dermatomyositis. ISN. |
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| Nailfold Capillaroscopy and Nailfold Videocapillaroscopy for Diagnosis of Pulmonary Hypertension |
| Pulmonary Hypertension (PH) is high blood pressure in the arteries which take blood between the heart and lungs. Primary pulmonary hypertension occurs by itself and not secondary to another illness, such as scleroderma. Nailfold capillary examination can easily tell whether pulmonary hypertension is primary or secondary. ISN. |
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| Primary Pulmonary Hypertension Is Not Associated With Scleroderma-Like Changes in Nailfold Capillaries. The prevalence of scleroderma-associated nailfold changes in patients with primary pulmonary hypertension (PPH) was dramatically lower than that in patients with scleroderma. The distribution of nailfold grades for the PPH patients was indistinguishable from that of the healthy control subjects. Chest. 2001;120:796-800. (Primary Pulmonary Hypertension is pulmonary hypertension that occurs by itself, and not secondary to scleroderma. (Also see: Pulmonary Hypertension) |
