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Fingernails, Fingerprints, Nailfolds, and Cuticles

Author: Shelley Ensz. Scleroderma is highly variable. See Types of Scleroderma. Read Disclaimer
Overview
Cuticles: Periungual Erythema
Fingernail Abnormalities
Causes of Fingernail Symptoms and Abnormalities
Lack of Fingerprints
Manicure Safety
Nail Biting
Nailfold Capillaroscopy

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. (Also see: Skin Involvement, What is Scleroderma?, Types of Scleroderma and Systemic Symptoms)
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)

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.

Lack of Fingerprints

No Fingerprints? They have many ways of disappearing. the absence of fingerprints can be caused by trauma or burns or skin problems such as eczema , psoriasis, or something called scleroderma. Clay Thompson. The Arizona Republic. 02/10/10. (Also see: Fingernails, Fingerprints, Nailfold, and Cuticles)
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

Nailfold Capillaroscopy is the best way to tell if someone has primary or seconday Raynaud's. Capillaries are very tiny blood vessels. Capillaries are very close to the surface of the skin, particularly near the base of fingernails. ISN.
Overview
Handheld Dermatoscope Works, Too
Primary Raynaud's & Capillaroscopy
Secondary Raynaud's & Capillaroscopy
Photos of Nailfold Capillaroscopy
 
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