At your fingertips

Dermatologist Ellen Cunningham recently diagnosed a hair-loss disorder in a patient by first examining the person’s fingernails.

“The patient presented with pits in their nails. That’s very common in someone with psoriasis (a skin disease), but it’s also (a sign of) a hair-loss disorder. Then,” she said, “I looked at the scalp and, sure enough, there was a huge patch of hair missing.” Further investigation determined the patient had a hair-loss condition known as alopecia, said Cunningham, who practices in Cedar Grove, N.J., and at Mountainside Hospital in Montclair, N.J.

Manhattan dermatologist Ellen Marmur always scrutinizes her patients’ nails as part of their routine skin exams. “I’ve diagnosed people with liver disease, just with their nails,” said Marmur, chief of the Division of Dermatologic and Cosmetic Surgery at Mount Sinai Medical Center.

While the eyes can be the windows to the soul, your nails can serve as the windows to the state of your health. Changes in the appearance of your nails are often due to skin problems such as a fungus, psoriasis or eczema. But they can also indicate the presence of serious medical conditions not really related to the skin, such as heart disease, diabetes and lupus.

“Patients may come to me and say, “I’m feeling crummy – and look at what’s going on with my nails.’ I just grab their hands and look at their nails,” Cunningham said.

The typical, healthy nail is fairly flat, pink and even in color, said dermatologist Joshua Fox, founder and director of Advanced Dermatology and the Center for Laser and Cosmetic Surgery, in Manhattan and Long Island.

“The take-home lesson is, if it doesn’t show the regular pinkness, maybe something is wrong,” Fox said.

For example, nails that appear half white and half pink may suggest kidney malfunction. Nails that are entirely white could mean liver diseases, such as hepatitis, according to the American Academy of Dermatology.

A very pale nail bed may be a sign of anemia while a red nail bed could indicate heart disease. According to the AAD, a slight blush at the base of the nail is sometimes a symptom of diabetes.

Your nails also can tip you off to the presence of melanoma, the most deadly form of skin cancer, through the appearance of a brown or black band that runs along the length of a nail. Such bands tend to be more common, as well as normal, when they appear in multiple nails of people with darker skin, Marmur said. “But if there’s rapid onset or it’s changing, you should get yourself to the skin doctor to make sure you’re not missing a melanoma,” Cunningham said.

Doctors advise you to regularly check your fingernails. Marmur tells her patients to do a self skin exam every month, “from head to toe, including their nails.”

“The beauty about the nail is, it’s located in a place that people can easily watch,” said Cunningham. Pay particular attention to any color changes and to changes in texture, such as pitting, or the appearance of ridges. The appearance of horizontal ridges, or grooves, which are known as “beau’s lines,” can correspond to periods of serious illness, according to physician David Leffell.

Some symptoms are subtle and would be difficult for a lay person to detect. “Also, they’re gradual. Some of these things, you almost need magnification,” Fox said.

You should get your nails examined by your primary care doctor or a dermatologist when you notice a change, advised Cunningham. “Change is key.”

Fox said you should consult a health professional if symptoms are still present a week after you first noticed them. Before you go the doctor, Fox added, make sure you remove your nail polish. “I can’t see what’s going on if you come to me with nail polish on.”