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.

How to identify disease by fingernails: main signs

Find out what signs of diseases can appear on fingernails, how to identify and what these diseases 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 the nails can indicate a disease

White spots on the 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 the 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:
  • Can 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 calcium and other nutrients0018

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 lines 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 discoloration 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 fingernails, 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 occur 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 deformity may result from:
  • Diseases of the lungs and respiratory tract;
  • Neurological diseases;
  • Fungal infections;
  • Injury, bruising or frostbite.

It is important to pay attention to the condition of the nails and, if there is the slightest suspicion of deformities, 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.

Related videos:

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 kidney and liver function are impaired, fingernails may lose their natural color and become pale, as well as wavy and brittle.

Can thyroid problems affect fingernails?

Yes, changes in the shape and color of the nails on the hands can be associated with hypothyroidism or hyperthyroidism, so you should consult an endocrinologist for such changes.

What is keratosis of the nail bed and how can it be treated?

Nail bed keratosis is a disease that occurs in most older people. You can get rid of it with the help of regular use of moisturizing hand creams, as well as by controlling the level of humidity in the room.

Subungual melanoma – diagnosis, treatment in the international clinic Medica24

There are cells in the skin that are responsible for its color – melanocytes. They produce the pigment melanin. The degeneration of these cells causes the formation of a malignant tumor – melanoma, which can occur in an open area or under the nail.

Our expert in this area:

Sergeev Petr Sergeevich

Deputy chief physician for medical work. Oncologist, surgeon, chemotherapist, Ph. D.

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Subungual melanoma is a relatively rare, but dangerous and insidious cancer. At an early stage, these neoplasms are quite successfully treated with the help of modern conservative methods and minimally invasive interventions used in the international clinic Medica24. But with the transition to the later stages, treatment becomes more complicated.

The danger of subungual melanoma is active metastasis to the liver, lungs, bones, despite the fact that it is not always possible to recognize it at an early stage. A person may not pay attention to a dark line or speck under the nail until it causes pain.

And only when the nail plate, soft tissues, bones are involved in the process, pressing on the nail becomes painful, the person goes to the doctor. As a rule, this means that the disease has reached the third or fourth stage, and a major operation is required.

Symptoms

The exact cause of nail melanoma has not been established. Contributing factors can be frostbite, burns, injuries, work with chemical toxins. Most often, the neoplasm affects the big toe or toe.

A characteristic external sign is a dark brown or dark blue stripe that divides the nail bed lengthwise into two equal or unequal parts. This is the so-called longitudinal melanoma or melanonychia.

Melanoma may start as a tiny spot less than 1 mm in diameter. Gradually it grows, increasing in size.

The first two stages of the disease differ in the size of the neoplasm – from 1 mm to 4 mm. In the third stage, subungual melanoma metastasizes to regional lymph nodes, and in the fourth – to distant organs.

In about a third of cases, the pigmentation of the neoplasm is absent, and melanoma is not visible externally, which makes it difficult to detect.

As the tumor develops, a dark line or spot may extend beyond the nail plate. The pain syndrome gradually arises and intensifies, at first only when pressed, then without it.

The nail separates from the bed, exfoliates, becomes thinner, becomes loose, brittle and darkens, acquiring a dark blue, brown or black color, tubercles form on its surface. In this case, we are talking, as a rule, about acral lentiginous melanoma. Pus oozes from under the nail plate, when it is destroyed, the skin is exposed, covered with manifestations, nodules.

Melanoma can arise and grow from 1) the nail matrix, 2) the area of ​​the nail bed, or 3) from the area that is adjacent to the nail plate. Periungual melanoma can metastasize to the nail matrix.

In the development of subungual melanoma, two stages are distinguished – horizontal and vertical. The first means growth in the surface layer under the nail, the second – the germination of the tumor deep into, the involvement of subcutaneous, muscle tissues, bones.

Cancer cells from the primary focus spread in the body, causing metastases, most often in the lungs, liver. Malignancy of secondary foci often exceeds the primary tumor.

Local symptoms are joined by general ones – loss of appetite, weight loss, weakness, fatigue, subfebrile temperature.

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Diagnosis

Not every dark spot under the nail is melanoma. It can easily be mistaken for a hematoma, nevus, hemangioma. You can understand the nature of the neoplasm using dermatoscopy – a visual examination with a strong increase.

Often this is not enough. If necessary, clarifying data is carried out by a cytological examination of the smear, a biopsy with a histological examination of the tissue.

Examination of tissue cells under a microscope provides a basis for a confident diagnosis. In this case, additional studies are prescribed – blood tests, urine tests, MRI, ultrasound, CT to study the condition of the internal organs, lymph nodes.

Treatment

The goal of treatment is to completely remove the tumor and minimize the risk of its recurrence. In the case of nail melanoma, this risk is unfortunately high, even after radical surgery.

The main treatment for subungual melanoma is surgery. In the international clinic Medica24, preference is given to organ-preserving surgeries by default. This means that we will do our best to achieve the goal of treatment, using the minimum possible amount of intervention.

Early melanoma can be destroyed with cryotherapy (liquid nitrogen) or laser.

Minimal surgery means removal of the tumor, a small amount of soft tissue and part of the nail (phalanx exarticulation).

Further, if necessary, 1) the phalanx, 2) part of the finger up to the middle of the middle phalanx, or 3) the entire finger can be amputated. In the most severe cases, amputation of the entire hand or foot is performed.

Before surgery, a course of neoadjuvant chemotherapy is performed, and after it – radiation therapy, adjuvant chemotherapy.

This is a classic, traditional treatment for subungual melanoma. In the international clinic Medica24, we actively apply progressive methods using immunotherapy, targeted therapy. In many cases they give very good results.

In particular, immunotherapy is used to strengthen the immune system, stimulate it and mobilize it to fight the neoplasm. On the other hand, immunostimulating drugs are used after chemotherapy, for which our clinic uses only the most effective, including the latest drugs.

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For a long time it was considered that in the case of melanoma of the nail, it is better to remove the entire finger. However, recent data show that the recurrence rate, metastasis and survival are very little or statistically independent of the volume of excision, if it is performed within the boundaries of healthy tissues.

This means that instead of amputating the entire finger, the same result can be achieved by removing only one phalanx or the distal part of the finger at the level of the middle of the second phalanx.

The material was prepared by the Deputy Chief Physician for Medical Work of the Medica24 International Clinic, Candidate of Medical Sciences Sergeev Petr Sergeevich.

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