- The Washington Times - Monday, February 27, 2006

Licensed nail technician Nancy Nguyen says she turns away customers who want acrylic nails if their natural nails are unhealthy. And if she sees nails that are brittle or weak, she recommends forgoing nail polish and using a nail hardener instead.

“When I start to see nails grow, I know I’m doing a good job and they’re taking my advice,” says Ms. Nguyen, a Silver Spring resident who works at a nail salon in Capitol Heights.

Ms. Nguyen is not alone in keeping an eye out for unhealthy-looking nails. A few Washington-area dietitians, nutritionists and dermatologists use the fingernails and toenails as a way to identify nutritional deficiencies and various health conditions and diseases.

“Nails can be tremendously valuable as an indicator of health,” says Sara Ducey, certified nutrition specialist and associate professor of nutrition at Montgomery College in Rockville.

Using the nails, however, can be a difficult proposition if patients buff their nails, get manicures or pedicures, or wear nail polish or artificial nails, Ms. Ducey says.

Nutritional deficiencies, including the two most common, iron and zinc, can be evident in the natural, unpolished nail.

A translucent nail plate and a pale nail bed, which is the tissue underneath the nail plate, can indicate iron deficiency anemia, Ms. Ducey says. A deficiency in zinc can appear as white spots and dings on the nail plate, caused by slow healing from the mineral deficiency, she says.

“Most people injure their nails to some degree every day. That’s why your nails are there to protect you,” Ms. Ducey says.

Nails regenerate to recover the damage, growing at an average rate of 3 millimeters per month and take about six months to grow from base to tip of the fingers, area dermatologists say. Toenails grow an average of 1 millimeter per month and take a year to fully regenerate, they say.

Hangnails can be an indication of lack of protein, vitamin A or folic acid, says Lois Durant, a dietitian for dining services at George Mason University in Fairfax. Brittle, cracking nails can result from deficiencies in iron, zinc, calcium, vitamin A or vitamin B-12, she says.

“Nails can give you an indication of your nutrition status,” Ms. Durant says.

Nails that are brittle and split can indicate a deficiency of silica, a trace mineral found in plant foods, such as leafy greens, oats, brown rice, wheat bran and soy beans, Ms. Ducey says. Vertical ridges across the surface of the nail can result from either an iron deficiency or decrease in hormone production from the thyroid, she says.

However, vertical ridging of the nails is normal over the age of 30 or 40 and can be part of the aging process, says Dr. Jane Chew, a dermatologist at Howard County General Hospital in Columbia, Md.

The most common nail problems Dr. Chew sees at her office are brittleness and fungal infections, which can cause the nail to yellow and thicken at the tip. When her patients complain about ridges or brittle, chipped nails, the first question she asks is whether they wear nail polish, which can remove natural oil and moisture and dry out the nails. She recommends her patients avoid having their cuticles clipped during a manicure, because infections and dryness can result from exposing the matrix, the area underneath the cuticle.

“The cuticle is a barrier to the world. It acts like a protective layer,” Dr. Chew says.

The nail technicians at Peter’s Nail and Skin Care Salon in Kensington do not cut away cuticles, but will remove any dry, protruding areas, says Julie Nguyen, owner of the salon. The technicians also avoid over-filing nails, she says.

“The more you file, they thinner they will get,” Ms. Nguyen says.

If nails aren’t cared for, the result can be a fungal infection. The infections can come from a variety of sources, including contaminated manicure instruments, says Dr. Paula Bourelly, a dermatologist with a private practice in Olney. She is an assistant clinical professor of dermatology at Georgetown University Medical Center in Northwest.

“We want it to be treated so the nail is clear,” she says.

A Silver Spring woman who did not want to be identified had to have three-quarters of her left thumbnail removed due to a fungal infection.

“It’s looking great now for three to four months. It’s completely healed up,” the woman says. “We just knew there was something underneath the bed of the nail that had to work itself up and out. … It was ugly, but it didn’t take long.”

Skin infections also can cause symptoms in the nails.

For example, psoriasis and eczema can pit the nails, while melanoma can cause dark vertical lines across the nail, Dr. Bourelly says.

Nicole Brown, a registered dietitian, recommends first looking for any environmental assaults on the nails, such as frequent use of hot water and soap or chemicals.

“When nails are wet for a long time, they get brittle when they dry out,” says Ms. Brown, a member of the Virginia Dietetic Association in Centreville. She is a nutrition consultant for a nutrition and health promotion practice, For the Health of It!, in Springfield. “People need to realize their nails are actively growing tissue. Like with anything, putting chemicals on them can damage the tissue, especially on a repeated basis,” she says.

Second, Ms. Brown recommends looking at nail health as an indication of a deeper health problem.

Splitting nails is another version of dry skin, but also can be a symptom of anorexia nervosa, Ms. Brown says. A nail plate bluish in color can indicate a circulatory problem or heart disease, the color the result of a decrease of oxygenation of the tissues, she says. Thick yellow nails might be indicative of a thyroid, lymph system or respiratory problem, while clubbing or curled nails could be caused by a liver or heart condition, she says.

White nails could point to liver disease and yellowish nails, diabetes, while nails that are half pink and half white could mean kidney disease, Ms. Durant says.

Ms. Durant recommends seeking medical help for any changes of color in the nail.

A healthy nail should be pinkish in color with a lunula, a whitish half-moon shape at the base of the nail, she says.

“In practice, when you’re trying to figure something out, the nails can be a good source of information for a doctor,” Dr. Bourelly says.


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