5 Importance Of Nails In Health And Disease Diagnosis

The nails are present at the end of each finger tip on the dorsal surface.

The main function of nail is protection and it also helps for a firm grip for holding articles.It consists of a strong relatively flexible keratinous nail plate originating from the nail matrix.

Under the nail plate there is a soft tissue called nail bed.Between the skin and nail plate there is a nail fold or cuticle.

Normal healthy nail is slight pink in colour and the surface is convex from side to side.Finger nails grow 1 cm in three months and toe nails take 24 months for the same.

Importance of nails in disease diagnosis:

The colour ,appearance,shape and nature of the nails give some information about the general health and hygiene of a person .

Nails are examined as a routine by all doctors to get some clues about underlying diseases.Just looking at nails we can make out the hygiene of a person.

The abnormal nail may be congenital or due to some diseases.The cause for changes in the nail extend from simple reasons to life threatening diseases.Hence the examination by a doctor is essential for diagnosis .Some abnormal findings with probable causes are discussed here for general awareness.

1) Hygiene:- We can make out an unhygienic nail very easily .Deposition of dirt under the distal end of nail plate can make a chance for ingestion of pathogens while eating.If nail cutting is not done properly it can result in worm troubles in children.

When the worms crawl in the anal orifice children will scratch which lodges the ova of worms under the nails and will be taken in while eating.Prominent nail can also complicate a skin disease by habitual scratching.Sharp nails in small kids cause small wounds when they do feet kicking or hand waving.

2) Colour of the nails:-

a) Nails become pale in anaemia.

b) Opaque white discolouration(leuconychia) is seen in chronic renal failure and nephrotic syndrome.

c) Whitening is also seen in hypoalbuminaemia as in cirrhosis and kidney disorders.
                              
d) Drugs like sulpha group,anti malarial and antibiotics ect can produce discolouration in the nails.
                       
e) Fungal infection causes black discolouration.

f) In pseudomonas infection nails become black or green.

g) Nail bed infarction occures in vasculitis especially in SLE and polyarteritis.

h) Red dots are seen in nails due to splinter haemorrhages in subacute bacterial endo carditis, rheumatoid arthritis, trauma, collagen vascular diseases.

i) Blunt injury produces haemorrhage and causes blue/black discolouration.

j) Nails become brown in kidney diseases and in decreased adrenal activity.

k) In wilsons disease blue colour in semicircle appears in the nail.

l) When the blood supply decreases nail become yellow .In jaundice and psoriasis also nail become yellowish.

m) In yellow nail syndrome all nails become yellowish with pleural effusion.

3) Shape of nails:-

a) Clubbing: Here tissues at the base of nails are thickened and the angle between the nail base and the skin is obliterated.

The nail becomes more convex and the finger tip becomes bulbous and looks like an end of a drumstick. When the condition becomes worse the nail looks like a parrot beak.

Causes of clubbing:-

Congenital Injuries

Severe chronic cyanosis

Lung diseases like empyema,bronchiactesis,carcinoma of bronchus and pulmonary tuberculosis.
Abdominal diseases like crohn's disease,polyposis of colon,ulcerative colitis,liver cirrhosis ect...

Heart diseases like fallot's tetralogy,subacute bacterial endocarditis and ect..
             
b) Koilonychia:-

Here the nails become concave like a spoon.This condition is seen in iron deficiency anaemia.In this condition the nails become thin,soft and brittle.The normal convexity will be replaced by concavity.

c) Longitudinal ridging is seen in raynaud's disease.

d) Cuticle becomes ragged in dermatomyositis.

e) Nail fold telangiectasia is a sign in dermatomyositis ,systemic sclerosis and SLE.

4) Structure and consistancy:-

a) Fungal infection of nail causes discolouration,deformity,hypertrophy and abnormal brittleness.

b) Thimble pitting of nail is characteristic of psoriasis ,acute eczema and alopecia aereata.
  
c) The inflammation of cuticle or nail fold is called paronychia.

d) Onycholysis is the seperation of nail bed seen in psoriasis,infection and after taking tetracyclines.

e) Destruction of nail is seen in lichen planus,epidermolysis bullosa.

f) Missing nail is seen in nail patella syndrome.It is a hereditary disease.

g) Nails become brittle in raynauds disease and gangrene.

h) Falling of nail is seen in fungal infection,psoriasis and thyroid diseases.

5) Growth:- Reduction in blood supply affects the growth of nails. Nail growth is also affected in severe illness. when the disease disappears the growth starts again resulting in formation of transverse ridges.

These lines are called Beau's lines and are helpful to date the onset of illness.

Some Causes Of Low Back Pain

Low back pain is a usual symptom among the modern civilized people.It affects mainly the middle aged and young adults of both sexes.People who work on the chair with out exercise and those who carry heavy loads regularly are prone to get this complaint.

We can hardly find a person who has not suffered from back pain at least once in life.The causes of  low backpain ranges from simple reasons like muscular strain to cancer of spine and hence backache should not be ignored.The pain is felt in lumbar and sacral region and may radiate to nearby sites.

The following are some causes for backache.

1) Backache due to diseases in the back.

2) Backache due to gynaecological problems.

3) Backache due to problems in other parts of the body.

1) Backache due to diseases in the back:--
                            
a) Injuries :-

     1) Compression fracture of the vertebral column.
     2) Rupture of intervertebral discs.
     3) Injuries to ligaments and muscles of back.
     4) Lumbosacral strain.
     5) Intervertebral joint injuries. 
     6) Fracture of processes of vertebra.

b) Functional backache due to imbalance:-

     1) During pregnancy.
     2) Pot belly.
     3) Diseases of the hip joint.
     4) Curvature in the spine due to congenital defect.
     5) Short leg in one side.
 
c) Backache due to inflammatory conditions:-

     1) Infection of the bone due to bacteria.
     2) Tuberculosis of the spine.
     3) Arthritis.
     4) Brucellosis.
     5) Lumbago or fibrositis.
     6) Inflamation of the muscles.
     7) Anchylosing spondylitis.

d) Backache due to degenerative diseases in the back.

     1) Osteoarthritis.
     2) Osteoporosis in old people.
     3) Degenaration of the intervertebral disc.

e) Tumour in the spine:--

     1) Primory tumour of the bones in the spine.
     2) Metastatic tumours from other sites like prostate,lungs,kidneys,intestine ect.

2) Backache due to gynaecological problems:-

     a) After childbirth.
     b) After gynaecological operations.
     c) Prolapse of the uterus.
     d) Pelvic inflammatory diseases.
     e) Cancerous lesions of the pelvic organs.
     f) Endometriosis.

3) Backache due to problems in other parts of the body.

     a) Renal stones.
     b) Ureteric stone.
     c) Cancer of prostate.
     d) Pancreatitis.
     e) Biliary stones.
     f) Peptic ulcer.
     g) Inflammations of pelvic organs.
     h) Occlusion of aorta and illiac arteries.

Investigation of a case of backache:-

1) Complete blood count.

2) Routine urine examination.

3) Ultrasonography of the abdomen and pelvis.

4) X-ray of the lumbar and sacral region.

5) MRI of the spine.

5) CT scan of abdomen and pelvic region.

6) Examination of rectum,prostate,genito urinary organs.


Treatment of back ache:-

1) Removing the cause for backache.

2) Symptomatic treatment.

2) Back exercises.

3) Traction.

3) Yoga.

5) Surgery.

7) Homoeopathy.

What Is Rash, The Different Kinds And Cures

"Rash" is a kind of red bump that forms on your body and could be caused due to a variety of reasons. This word is freely used in normal language to denote a number of skin conditions. Most commonly occurring skin conditions or skin rash types are:

    * Non infected scaly patches on the skin.

    * Scaly patches on skin caused by fungal or bacterial infection.

    * Red, itchy patches or bumps all over the skin.

Skin rashes are rarely classified as dangerous, but still warrant medical attention. Rashes should not be self-diagnosed. Proper evaluation of the skin rash type requires a doctor visit. The following list of skin rash types may help you to categorize the condition.

Non infected scaly patches on the skin:

Scaly and itchy skin rash type usually represents a condition known as eczema.

Atopic dermatitis: The most common form of eczema is known as Atopic dermatitis. This skin rash type is normally hereditary which often starts in childhood with symptoms like scaly patches on the arms, legs, scalp and torso. 

During teenage the condition of atopic dermatitis may spread to inner elbows and knees. Adults are affected by atopic dermatitis on the genitals, around the eyelids, on the hand and all over the body as well.

"Dermatitis" means skin inflammation. "Atopic" refers to hereditary diseases. These diseases may include hay fever, asthma and atopic dermatitis. In a condition of atopic dermatitis, the skin turns extremely itchy and inflamed which may cause redness, swelling and cracking. 

Atopic dermatitis affects off and on for no apparent reason. It is at its worst in winter months, when the air becomes cold and dry.

Contact dermatitis: Contact dermatitis is a skin rash type caused due to contact with a specific material which may cause allergy to the skin. For example poison ivy and jewelry containing nickel causes reactions. Contact dermatitis affects only the touched parts.

The other kinds of skin rash types are scaly rashes. The ones worth mentioning are psoriasis, also a hereditary condition affecting knees, elbows and pityriasis rosea, which forms scaly rashes on the chest and back and generally disappears in a month. Xerosis or very dry skin, may appear as rash during the cold, dry months of the year.

Scaly patches on skin caused by fungal or bacterial infection:

Fungal infections: Fungal infections are common but don't appear as often as rashes in the eczema category. Fungal infections are not due to hygiene, clean people are also prone to them. The fungal infection skin rash type is not caught from animals, nor is it transmitted in gyms, showers or pools. They are not contagious.

Bacterial infections: The most common skin rash type caused by bacterial infection is impetigo. Impetigo is caused by strep germs and is more common in children. This again is not due to poor hygiene.

Red, itchy patches or bumps all over the skin:

This form of skin rash type is caused by virus or allergy.

Viral rash: Viral infections of the skin like herpes mostly occurs on one part of the body, viral rashes also occur all over the body and are symmetrical. These viral rashes usually last about a week and vanish on their own.

Allergic drug rash: Rashes caused due to drug allergy start in about two weeks of a new medication. It is very unlikely that a medicine which has been prescribed for a few months or years to cause a reaction. There is no specific test to prove whether a rash is allergic as a result of which doctors recommend stopping a suspected drug to see the results.

Other rashes

Hives or Urticaria are red welts that are itchy. They appear and disappear on different parts of the body. Because of the vagueness of the term, most people use "rash" to describe the conditions of pimples or rosacea on the facial skin. They certainly do not fall into any skin rash types.