Clubbing of the fingers or toes Information | Mount Sinai

Clubbing

Clubbing is changes in the areas under and around the toenails and fingernails that occur with some disorders. The nails also show changes.

Clubbing may result from chronic low blood-oxygen levels. This can be seen with cystic fibrosis, congenital cyanotic heart disease, and several other diseases. The tips of the fingers enlarge and the nails become extremely curved from front to back.

Clubbed fingers is a symptom of disease, often of the heart or lungs which cause chronically low blood levels of oxygen. Diseases which cause malabsorption, such as cystic fibrosis or celiac disease can also cause clubbing.

Considerations

Common symptoms of clubbing:

• The nail beds soften. The nails may seem to “float” instead of being firmly attached.
• The nails form a sharper angle with the cuticle.
• The last part of the finger may appear large or bulging. It may also be warm and red.
• The nail curves downward so it looks like the round part of an upside-down spoon.

Clubbing can develop quickly, often within weeks. It also can go away quickly when its cause is treated.

Causes

Lung cancer is the most common cause of clubbing. Clubbing often occurs in heart and lung diseases that reduce the amount of oxygen in the blood. These may include:

• Heart defects that are present at birth (congenital)
• Chronic lung infections that occur in people with bronchiectasis, cystic fibrosis, or lung abscess
• Infection of the lining of the heart chambers and heart valves (infectious endocarditis). This can be caused by bacteria, fungi, or other infectious substances
• Lung disorders in which the deep lung tissues become swollen and then scarred (interstitial lung disease)

Other causes of clubbing:

• Celiac disease
• Cirrhosis of the liver and other liver diseases
• Dysentery
• Graves disease
• Overactive thyroid gland
• Other types of cancer, including liver, gastrointestinal, Hodgkin lymphoma

When to Contact a Medical Professional

If you notice clubbing, call your health care provider.

What to Expect at Your Office Visit

A person with clubbing often has symptoms of another condition. Diagnosing that condition is based on:

• Family history
• Medical history
• Physical exam that looks at the lungs and chest

The provider may ask questions such as:

• Do you have any trouble breathing?
• Do you have clubbing of the fingers, toes, or both?
• When did you first notice this? Do you think it is getting worse?
• Does the skin ever have a blue color?
• What other symptoms do you have?

The following tests may be done:

• Arterial blood gas
• Chest CT scan
• Chest x-ray
• Echocardiogram
• Electrocardiogram (ECG)
• Pulmonary function tests

There is no treatment for the clubbing itself. The cause of clubbing can be treated, however.

Drake WM, Chowdhury TA. General patient examination and differential diagnosis. In: Glynn M, Drake WM, eds. Hutchison’s Clinical Methods. 24th ed. Philadelphia, PA: Elsevier; 2018:chap 2.

Fajardo E, Davis JL. History and physical examination. In: Broaddus VC, Ernst JD, King TE, Lazarus SC, Sarmiento KF, Schnapp LM, Stapleton RD, eds. Murray and Nadel’s Textbook of Respiratory Medicine. 7th ed. Philadelphia, PA: Elsevier; 2022:chap 18.

Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM. Cyanotic congenital heart lesions: lesions associated with decreased pulmonary blood flow. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 457.

Last reviewed on: 5/24/2021

Reviewed by: Neil K. Kaneshiro, MD, MHA, Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Lichen planus Information | Mount Sinai

Lichen planus is a condition that forms a very itchy rash on the skin or in the mouth.

Lichen planus is an intensely itchy (pruritic) inflammatory lesion of the skin. The lesions are generally violaceous (red-purple), slightly raised bumps (papules) with fine scales. The papules may run together (coalesce) to form a larger raised surface (plaque). This is a condition usually seen in adults, although it can occur in children.

Lichen nitidus consists of tiny flesh colored to pink raised lesions (papules). The papules are asymptomatic but persist for long periods of time. They generally occur only on the abdomen, flexor surfaces of the elbows and palms, and on the male genitalia.

The cause of lichen planus is unknown. It appears as raised, many-sided purple bumps (violaceous polygonal papules) with overlying white lines (Wickham’s striae). It commonly involves the wrists (flexor surface), lower back (lumbar region), shins, and ankles. The lesions often itch. Females are more frequently affected than males and the age range is approximately 30 to 60 years of age.

The cause of lichen planus is unknown. It appears as raised, many-sided purple bumps (violaceous polygonal papules) with overlying white lines (Wickham’s striae). It commonly involves the wrists (flexor surface), lower back (lumbar region), shins, and ankles. The lesions often itch. Females are more frequently affected than males and the age range is approximately 30 to 60 years of age. This is a less common variant, shown here with scales.

Oral lichen planus occurs in about half of the people who have lichen planus on their skin. It consists of painless, whitish streaks on the mucous membranes. This may also produce ulcers, which are usually painful.

Lichen striatus begins similarly to lichen planus, with small bumps (papules), but over a period of days expands to form a long streak or band of affected skin. The condition clears spontaneously (without medication) over a period of months. This condition is seen frequently in children less than 16 years old, but may also occur in adults.

Lichen striatus begins similarly to lichen planus, with small bumps (papules), but over a period of days expands to form a long streak or band of affected skin. It clears over a period of months without needing treatment. This condition is seen frequently in children less than 16 years old but, also occurs in adults.

Lichen striatus begins similarly to lichen planus, with small bumps (papules), but over a period of days expands to form a long streak or band of affected skin. The condition clears spontaneously over a period of months. This condition is seen frequently in children less than 16 years old, but also occurs in adults.

Causes

The exact cause of lichen planus is unknown. It may be related to an allergic or immune reaction.

Risks for the condition include:

• Exposure to certain medicines, dyes, and other chemicals (including gold, antibiotics, arsenic, iodides, chloroquine, quinacrine, quinine, phenothiazines, and diuretics)
• Diseases such as hepatitis C

Lichen planus mostly affects middle-aged adults. It is less common in children.

Symptoms

Mouth sores are one symptom of lichen planus. They:

• May be tender or painful (mild cases may not cause pain)
• Are located on the sides of the tongue, inside of the cheek, or on the gums
• Look like bluish-white spots or pimples
• Form lines in a lacy network
• Gradually increase in size
• Sometimes form painful ulcers

Skin sores are another symptom of lichen planus. They:

• Usually appear on the inner wrist, legs, torso, or genitals
• Are extremely itchy
• Have even sides (symmetrical) and sharp borders
• Occur alone or in clusters, often at the site of a skin injury
• May be covered with thin white streaks or scratch marks
• Are shiny or scaly looking
• Have a dark, violet color
• May develop blisters or ulcers

Other symptoms of lichen planus are:

• Dry mouth
• Hair loss
• Metallic taste in the mouth
• Ridges in the nails

Exams and Tests

Your health care provider may make the diagnosis based on the appearance of your skin or mouth lesions.

A skin lesion biopsy or biopsy of a mouth lesion can confirm the diagnosis.

Treatment

The goal of treatment is to reduce symptoms and speed healing. If your symptoms are mild, you may not need treatment.

Treatments may include:

• Antihistamines
• Medicines that calm down the immune system (in severe cases)
• Lidocaine mouthwashes to numb the area and make eating more comfortable (for mouth sores)
• Topical corticosteroids or oral corticosteroids to reduce swelling and lower immune responses
• Corticosteroid shots into a sore
• Vitamin A as a cream or taken by mouth
• Other medicines that are applied to the skin
• Dressings placed over your skin with medicines to keep you from scratching
• Ultraviolet light therapy

Outlook (Prognosis)

Lichen planus is usually not harmful. Most often, it gets better with treatment. The condition often clears up within 18 months, but may come and go for years.

If lichen planus is caused by a medicine you are taking, the rash should go away once you stop the medicine.

Possible Complications

Mouth ulcers that are present for a long time may develop into oral cancer.

When to Contact a Medical Professional

Contact your provider if:

• Your skin or mouth lesions change in appearance
• The condition continues or gets worse, even with treatment
• Your dentist recommends changing your medicines or treating conditions that trigger the disorder

James WD, Elston DM, Treat JR, Rosenbach MA, Neuhaus IM. Lichen planus and related conditions. In: James WD, Elston DM, Treat JR, Rosenbach MA, Neuhaus IM, eds. Andrews’ Diseases of the Skin: Clinical Dermatology. 13th ed. Philadelphia, PA: Elsevier; 2020:chap 12.

Patterson JW. An approach to the interpretation of skin biopsies. In: Patterson JW, ed. Weedon’s Skin Pathology. 5th ed. Philadelphia, PA: Elsevier; 2021:chap 2.

Last reviewed on: 11/18/2022

Reviewed by: Elika Hoss, MD, Assistant Professor of Dermatology, Mayo Clinic, Scottsdale, AZ. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Nail cancer – symptoms, treatments, prevention and diagnosis

Nail melanoma is a malignant tumor characterized by rapid growth and multiplication. The appearance of nail cancer is similar to a post-traumatic bruise. In this case, the thumb is considered the most common place of occurrence.

Development of nail melanoma

Primary nail melanoma is almost invisible. Outwardly, it is difficult to identify a malignant tumor, while the nail plate acquires a dark brown and dark blue color. Melanoma under the nail is also colorless due to a small amount of melanin. Nail cancer destroys the nail slowly. Melanoma of the nail does not leave the opportunity to recover. Timely detected melanoma under the nail makes it possible to prescribe treatment with greater efficiency. Melanoma of the big toe nail appears more often due to the presence of a weak point. Melanoma of the nail of the hand is accompanied by a change in the appearance of the fingers.

Causes

Melanoma under the nail is more common in the elderly. The true causes of nail cancer have not yet been identified. Factors affecting the appearance of nail melanoma:

• the presence of moles and warts;
• skin defects of fingers from birth;
• development of tumors in other organs and tissues;
• treated fungus or viral infection;
• regular injury to the site of nail melanoma;
• late treatment of injuries with antiseptics;
• UV burns;
• lack of melanin;
• heredity.

Among the likely causes of nail cancer is a violation of the principle of a healthy lifestyle – lack of sleep, lack of physical activity, malnutrition. All this contributes to a decrease in immunity, which allows the development of melanoma of the nail.

Types of nail melanoma

In the selection of adequate therapy for cancer under the nail is the definition of its type. According to the forms of nail cancer, the following types are distinguished:

• superficial – develops in a horizontal position;
• nodal – characterized by deep penetration and rapid spread;
• lentigo – differs from horizontal uneven staining;
• achromatic – characterized by a dark shade of nail melanoma;
• acrolentiginous – initially appears on the surface and gradually penetrates deep into, affecting, including lips, palms and fingers. There are three types depending on the location: nail matrix, plate, epidermis.

How the disease develops

Development stage nail melanoma has the following:

• initial stage nail melanoma is almost impossible to diagnose due to the absence of any manifestations and discomfort;
• Stage 2 is characterized by the appearance of nodules and penetration into the depths, as well as a change in color;
• Stage 3 occurs with damage to the lymph nodes and destruction of the nail;
• Stage 4 occurs with damage to other vital internal organs and severe pain.

Each stage of nail melanoma has its own signs and characteristics.

Symptoms

Symptoms of melanoma:

• separation of the nail plate and the appearance of a thickening in the form of a tubercle;
• discoloration of the nail plate for no apparent reason;
• the appearance of a longitudinal strip in the center of the nail;
• purulent discharge in advanced disease;
• throbbing pain in the affected area, first on pressure, then constant;
• detachment of the nail.

If there are several symptoms, the specialist correctly diagnoses melanoma of the toenail or handnail.

Diagnostics

Melanoma of the toenail or handnail does not allow to determine the disease by external signs. In the process of diagnosis, an anamnesis is collected and dermatoscopy is performed. Examination of melanoma of the nail on the leg or hand occurs with a magnifying glass or other magnifying device. Examining melanoma under the thumbnail is a difficult task. For an accurate diagnosis of toenail or handnail cancer, a biopsy is necessary, as well as blood sampling for tumor markers. With melanoma of the big toe on the leg or arm, the diagnosis is carried out by the following methods – urine and venous blood analysis, MRI, ultrasound of internal organs. The examination is carried out under the supervision of a dermatologist and an oncologist.

Contacting a specialist

In the oncological center “Sofia”, located in the center of Moscow, patients will be provided with the necessary medical care by dermatologists and oncologists trained in leading foreign clinics, as well as psychologists aimed at the correct perception of the diagnosis and the patient’s aspirations to a cure.

Here we are ready to offer you the most modern diagnostic methods that allow you to make an accurate diagnosis and start an adequate treatment. To diagnose melanoma of the toenail or hand, the following procedures are used – MRI, CT, SPECT, PET, radiography, fluoroscopy, ultrasound, laboratory tests.

Treatment

Thumbnail melanoma is the most common form of this disease. The only effective way to treat melanoma of the nail on the thumb and all other places is surgery to remove it.

There are several types of operations:

• a simple operation – the neoplasm itself is removed;
• cryotherapy is exposure to liquid nitrogen, effective in the initial stages;
• laser removal – carried out only in the initial stages of the disease.

Before surgery, it is necessary to undergo a course of chemotherapy, to stop the reproduction of malignant cells. And after surgery, a course of radiation therapy is needed to suppress the remaining atypical cells.

How to make an appointment with a doctor? Melanoma of the toenail or hand has more promising prospects due to the fact that the high qualifications and extensive experience of specialists make it possible to accurately diagnose and choose the best method of therapy.

How to identify a disease by fingernails: main signs

Find out what signs of diseases can appear on fingernails, how to identify and what kind of diseases they are, in order to take timely measures for their treatment. Tips and tricks in the article on the site.

Nails are not only an element of appearance, but also a good indicator of human health. Many diseases can manifest themselves on the nails. Therefore, it is worth paying attention to their condition in order to timely notice possible problems with the body.

Nails can give rise to various diseases, ranging from simple deformity to serious diseases of the internal organs. For example, a change in the color or texture of the nails may indicate a lack of oxygen in the blood, a lack of calcium and vitamins, and may also be an introductory sign of various diseases.

If you have recently noticed something suspicious on your nails, you should contact your doctor. He or she will be able to perform additional tests and diagnostic procedures to identify possible health problems and provide the best possible treatment and support.

Yellow nails

Yellow nails can be a sign of various medical conditions such as fungal infections, psoriasis, eczema and other health problems.

Fungal nail infections are a common disease that can cause yellow nails. With this disease, the nails become thick and brittle. If you notice such changes, you need to see a doctor and start treatment.

• How to deal with yellow nails:
• Keep your nails clean and dry.
• Avoid contact with fungal infections.
• Treat health problems that can cause nail discoloration.
• Consult your doctor if you notice changes in the color of your fingernails.

How White Spots on Nails May Indicate Disease

White spots on nails may be normal, but in some cases may indicate a disease. They can be caused by trauma to the nail, lack of calcium, or even allergies. However, if the spots appear regularly and do not disappear, this may be a sign of an illness.

Vitamin deficiencies: White spots on nails may indicate zinc, iron or protein deficiency. If you find such spots on your nails, consult a doctor for advice and recommendations on proper nutrition.

Fungal infection: If white spots on the nails are accompanied by thickening, bulges, or discoloration of the nail, it may be a fungal infection. In this case, visit a doctor and start treatment as soon as possible to prevent complete destruction of the nail.

1. Allergies: White spots on the nails can also be caused by an allergic reaction to cosmetics or foods. If you are allergic to anything, try avoiding contact with the allergen to avoid recurring stains.
2. Kidney disease: White spots on the nails may be associated with chronic kidney disease. In addition, they may be accompanied by other symptoms, such as swelling and problems with urination. If you suspect kidney problems, see your doctor for additional tests.

Crooked nails

Crooked fingernails can be a sign of several conditions, including psoriasis, lichen, and Raynaud’s disease. Curvature of the nail plate can occur due to deformation of the plate itself, problems with lifting the skin, or due to conditions associated with holes in the nail plate or formations near the edge of the nail.

One of the most common types of nail curvature is the crooked nail. Nails that become very wide or split across can also indicate a problem. Sometimes the nails curve in the form of a wave (wavy nails) – this can be a sign of a serious illness for a long time on the body.

• Crooked nail:
  • Glomerular thickening of wadded skin at the end of the nail plate.
  • May be caused by stress, diabetes, heart disease.
• Split nail:
  • May be associated with thyroid disease, psoriasis, skin lichen.
• Wavy nail:
  • May be a sign of a wide range of diseases, including obesity, amiodarone therapy, long-term use of AV blockers.

As a rule, curvature of the nails is the result of a disease, and not something that is worth worrying about personally. If you’re concerned about crooked fingernails, talk to your doctor.

Split nails: causes and treatment

Split nails is a painful condition in which fingernails become weak, thin and often break easily. This problem often occurs due to improper nail care, low-quality cosmetics, or poor diet.

Treatment of split nails includes a healthy diet, nail care and the use of vitamin complexes. It is necessary to remove excess cuticles, do not use aggressive cosmetics and trim nails frequently.

• Daily nail hygiene
• Regular intake of food containing calcium and other nutrients
• Use of quality nail cosmetics
• Taking vitamins and mineral complexes

If self-treatment does not help, you should consult a doctor who will prescribe a comprehensive treatment and help restore healthy nails.

Red stripes on the nails: what can they mean?

Red streaks on the nails can be signs of various diseases. They can indicate problems with the cardiovascular system, as well as the presence of infections or allergies.

One of the most common causes of red streaks on nails is injury or bruising. If you notice that red streaks have appeared after the impact, this is most likely not a serious problem and will go away on its own after a while.

Some conditions that can show up as red streaks on the nails include rheumatoid arthritis and cardiovascular damage such as endocarditis, pericarditis, or aortitis. In such cases, red staining of the nails may be one of many symptoms.

• If you notice red streaks on your nails that do not go away after a few days or weeks, you should contact your doctor.
• Also, some drugs and chemicals can cause red streaks on the nails, so it is important to pay attention to side effects when taking medications.

Blue fingernails

Blue coloration of fingernails may be a sign of circulatory problems. This symptom can be caused by both a congenital pathology and an acquired disease.

In most people, blue nails are caused by insufficient oxygen in the blood or damage to the lungs, heart, or blood vessels. But this symptom can also be caused by poisoning, injury, a reaction to certain medications, or a thyroid disorder. In some cases, blue nails may be associated with certain types of cancer.

If you notice blue discoloration of your fingernails, you should immediately consult a doctor to determine the cause of this symptom and take appropriate measures.

Black streaks on the nails

If black streaks are observed on the nails on the hands, you should consult a dermatologist. This can be a sign of various diseases.

Black streaks can be caused by melanoma, tumor, thrombosis or trauma. People suffering from fungal infections may also develop a black streak on their nails.

To determine the exact cause of the appearance of black stripes on the nails, the doctor will conduct a comprehensive examination of the patient. This may include a visual examination of the nails, blood and tissue tests.

Black streaks on the nails can be dangerous, so it is important to see a specialist in time. The doctor will prescribe the appropriate treatment depending on the cause of these stripes on the nails.

Nail thickening

Nail thickening is a change in which the nails become thicker and harder. Often this becomes a noticeable problem when performing normal activities in daily life.

This condition can be caused by a variety of factors, including fungal infections, aging, damage to the nail plate by poor circulation, use of harsh cosmetic products, and even ingrown fatty tissue in the nail plate.

It is important to know that thickening of the nails can be a symptom of a medical condition such as a heart defect or a temporary granuloma of the ear. It is best to conduct an examination with a doctor to determine the cause of this change and begin treatment.

Symptoms of thin nails

Thin nails can be a sign of several conditions, including iron deficiency, anemia and hormonal disorders. They can also be a side effect of certain medications.

The main features of thin nails are their flatness and flexibility. Nails can also become brittle and break easily. Thin nails may also appear paler as blood may not reach their roots due to poor circulation.

• Iron deficiency: One of the most common causes of thin nails is iron deficiency. It can occur as a result of malnutrition or blood loss (for example, from menstruation).
• Anemia: Thin and brittle nails can also be a symptom of anemia. This is a condition in which the level of red blood cells in the blood is too low.
• Hormonal disorders: Thin nails can also be due to hormonal disorders such as hypothyroidism or hyperparathyroidism.
• Drugs: Some drugs, such as chemotherapy, can cause thin nails as a side effect.

Deformed nails

Deformed nails can be a sign of various diseases and conditions of the body. Deformities can be caused by malnutrition, metabolic disorders, chronic diseases, and mechanical damage.

One of the most common types of deformities are bent nails that have developed an elongated depression in the center. This type of deformation can indicate a disease of the cardiovascular system, as well as iron deficiency in the body.

Another type of deformity is bumpy nails, which are formed due to disorders in the thyroid gland. This type of deformation can take various forms, but most often the fingers swell and many tubercles form on their surface.

• Other types of deformities may result from:
  • Diseases of the lungs and respiratory tract;
  • Neurological diseases;
  • Fungal infections;
  • Injuries, bruises or frostbite.

It is important to pay attention to the condition of the nails and at the slightest suspicion of deformity, consult a doctor to diagnose and determine the cause. Treatment of deformities is carried out on the basis of the diagnosis and can be medical or surgical, depending on the patient’s condition and the degree of the disease.

When to see a doctor about changes in nails

Daily monitoring of nail health is an important preventive measure. However, if you find unnatural changes, you should consult a doctor.

If you notice the appearance of directional or transverse white streaks, deep furrows or bumps on the nail plate, carefully look at your health and consult a dermatologist.

Changes in the color of the nail may indicate the presence of a disease such as anemia or lung disease. The shape of the nail and texture may indicate diseases associated with impaired functioning of the liver, kidneys, thyroid gland and the cardiovascular system. If you find these signs, see your doctor.

Inflammatory processes around the nails also require the attention of a dermatologist. Various types of fungal infections can cause changes in the color and texture of the nail plate, which can lead to its loss.

• If you experience red, painful bumps around the nail plate, be sure to see a doctor for a diagnosis.

Thus, if you suspect the presence of a disease due to changes in the nails, it is important to consult a doctor in a timely manner. Do not postpone the visit until later, as such changes may indicate the presence of a serious illness that needs to be treated urgently.

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Q&A:

Why do fingernails peel off?

Peeling fingernails can be associated with vitamin deficiencies (especially vitamin A), infectious diseases, allergic reactions, and psoriasis and eczema.

What diseases can indicate yellow fingernails?

Yellow fingernails can indicate the presence of a fungal infection, psoriasis, onymycosis, and other health problems.

What diseases can cause changes in the shape of fingernails?

The shape of the fingernails may change in the presence of anemia, psoriasis, osteoporosis, hyperthyroidism, and lung or heart disease.

How can fingernails indicate kidney and liver dysfunction?

If the kidneys and liver function are impaired, the nails on the hands may lose their natural color and become pale, as well as wavy and brittle.