Nails- a window to internal organs: a cross sectional study of nail changes in systemic diseases in a tertiary care hospital

Background: Many systemic disorders leave their mark on the nails and, therefore, provide physicians with valuable clues to diagnosis. In spite of this knowledge, there has been relatively little attention paid to the nails. This study will enlighten the importance of the nail changes associated with systemic diseases. Objectives of the study: ·         To evaluate the prevalence of the nail changes in systemic diseases. ·         To assess the specificity of the nail changes with the disease status. ·         To correlate nail changes with prognosis. Materials and Methods: One hundred and fifty patients attending the outpatient and inpatients from the hospital were included. With informed consent, detailed history and clinical examination done including general physical examination and cutaneous examination. Nails were examined for their appearance, colour, contour, lunula, nail folds. Investigations were done according to the system involvement. Results: Nail changes were common with inpatients (58.7%) compared to out-patients (41.3%) and in 5.4% patients it was incidental. Most commonly involved systems include respiratory system (23.4%) followed by haematopoietic (18%), GIT and liver (14%), renal (12%) and cardiovascular system (10%). Clubbing was the commonest nail change encountered (34.67%) followed by longitudinal ridging (29.33%), pallor of nail plate (28%), platyonychia (18.67%) and brittle nails (17.33%). Conclusions: Clubbing in cardio respiratory system, half and half nail (HHN) in renal system and terry’s nail in liver and GIT are the specific nail changes that can lead us to the diagnosis. Prognosis is not directly related to the nail changes, commonly to the severity of the underlying disorders. Keywords: Nail changes, Clubbing, Platyonychia