Dr. Jacoby describes the nail condition koilonychia and explains why nail changes can indicate a more serious health problem.
Koilonychia is a change in the character of the nail plate, usually a concavity in the nail and is indicative of something again, systemic, but more specifically oxygen content of the blood going to the toenail. So we think in terms of lung infections as emphysema, some type of problem with the lungs that doesn’t oxygenate the blood enough to cause the most distal part of our body to grow properly. Koilonychia – cupping in the nail. And the same thing with club nails where the nail changes the opposite position because the nail is starved for oxygen.
I think if you see a change on the nail plate to that degree, whether it’s clubbing or koilonychia, I think it probably does related to a more systemic disease. I would start with your family doctor first, then maybe a dermatologist, then get a general physical exam to look to the part of the body that might be causing it.
The reason that the nail shows lots of different pathologies is because the nail is very sensitive to oxygen content and oxygen content comes from the blood and blood is oxygenated at the level of the lungs. So most of these changes we see in the nail plate most likely are associated with lung-type diseases.
I don’t know that I would run directly to a pulmonologist. I would see your family doctor, follow up with a dermatologist and then be referred to a pulmonologist. But I think it is a serious disease.
About Dr. Richard Jacoby, D.P.M.:
Dr. Richard Jacoby, D.P.M., graduated from the Pennsylvania College of Podiatric Medicine. He completed his residency at Parkview Hospital, Philadelphia, specializing in foot and ankle surgery. Board certified by the American Board of Podiatric Foot and Ankle Surgeons, he is currently president of Valley Foot Surgeons in Scottsdale, Arizona. In addition, Dr. Jacoby is chairman of the board of Healthcare Networks of America.
Dr. Jacoby has been named the 2010 President of The Association of Extremity Nerve Surgeons.