What is Spoon Nails (Koilonychia)?
The term “koilonychia” is based off the Greek words meaning “hollow” and “nail”. It refers to a nail condition where the nails appear spoon-shaped or curved inward. This condition can make the nails thin, brittle, and warped either horizontally or vertically. It often looks like the nail dips inward at the center and flares out at the sides. Koilonychia can occur in newborns, children, and adults. If the person has this condition, it’s important to check for other potential health issues that could be more serious.
What Causes Spoon Nails (Koilonychia)?
Koilonychia, often called “spoon nails,” can occur for many reasons, which for simplicity, we can split into three categories: hereditary (something a person is born with), acquired (something a person develops), and idiopathic (unknown cause). It’s mainly seen as a sign of persistent iron deficiency anemia, a condition where the body lacks enough healthy red blood cells due to poor nutrition, worms, celiac disease, losing blood through the digestive tract, or cancer.
Sometimes, koilonychia might be a sign of skin diseases like lichen planus or psoriasis. It can also be due to changes in the body from conditions like thyroid problems, diabetes, Plummer-Vinson syndrome, alopecia areata, nail fungus, injury, working with petroleum products, high altitude, blood vessel problems, issues with the muscles or skeleton, genetic problems, or autoimmune diseases where the body attacks itself. However, spoon nails are most commonly seen in people with iron deficiency anemia, skin inflammation, and nail fungus.
Nail issues in kids differ from those in adults in terms of diagnosis and treatment. Though, some nail problems occur only in children. Kids with underlying health issues are more likely to develop nail problems. In newborns, koilonychia often occurs for no known reason and is seen as normal in a third of cases. It usually affects the big toe and often clears up by itself after the age of 9 when the nail becomes thicker and harder.
Risk Factors and Frequency for Spoon Nails (Koilonychia)
Koilonychia, also known as spoon nails, can have many different causes. It’s hard to know exactly how common it is, because we don’t have exact numbers. Also, not everyone with a condition that can cause koilonychia will actually have spoon nails. Not enough information exists about how common koilonychia is across different ages and genders. The same is true for related conditions like Plummer-Vinson syndrome.
One of the major causes of koilonychia is iron deficiency, also known as anemia. This is especially common in developing countries. In fact, out of the 3.8 billion people in developing countries, about 1.4 billion or 36% have anemia. In contrast, in developed countries, about 100 million people or 8% of the 1.2 billion population have anemia. Anemia can affect a person’s mental and physical growth, their behavior, and how they perform at work. Because of this, tackling anemia is a significant public health goal.
Signs and Symptoms of Spoon Nails (Koilonychia)
Koilonychia is a nail condition that can be present at birth or appear gradually over time. It typically involves nails having a scooped out appearance and can occur at any age. This unusual nail shape is often easier to spot when observing the nail from its side. Patients or their family members might notice and report this nail abnormality. More medical findings can help pinpoint the exact cause for the nail’s shape.
Diagnosing minor cases of koilonychia might be difficult just by looking at the nails as it’s not realistic to measure the curvature of the nail in a typical clinical setting. A simple test, known as the “Water-drop test”, is often used to help confirm diagnosis. In this test, a few droplets of water are placed on the nail using a syringe. In koilonychia, the nail’s scooped shape allows the water to pool up, which wouldn’t happen on a healthy nail that is typically more arched.
Occasionally, this test might give a false-positive result in people with smooth arched nails. A study on koilonychia patients used spherical plastic beads on the nail plates to avoid this issue. This test not only helped identify false-positive results but also gave a clearer visual impression to clinicians and patients. Despite these promising results, this method needs to be further confirmed by larger studies.
Testing for Spoon Nails (Koilonychia)
It’s crucial to correctly investigate any potential skin or internal health conditions. This investigation, also known as a workup, depends on the individual’s health history, current health condition, and physical examination, which provides a clearer picture of the underlying issue.
So, if koilonychia (a condition where your nails become thin and spoon-shaped) is suspected, it’s important to conduct a thorough investigation. This would involve gathering detailed information about any other health issues you might have, whether you’re taking any medication, if you’ve had any surgeries, your family’s health history, and your diet and lifestyle habits. Once this information is gathered, a detailed physical examination can start.
Based on the results of the physical examination, further tests might be needed. For instance, a Complete Blood Count (CBC) can be done to see if you’re low on red blood cells (anemic). The CBC also gives other useful information about red blood cells such as their size and color intensity. If you are indeed anemic, a test to check the levels of iron in your body can be ordered for more detailed evaluation. If the CBC test doesn’t show any problems, your doctor can decide to order other necessary tests depending on what he or she thinks might be the root health problem.
For patients of PVS (a medical condition affecting blood vessels) who have trouble swallowing (dysphagia) and a long history of iron deficiency anemia, it might be necessary to do an esophagogram. This test examined the esophagus for issues and is done because some conditions can go unnoticed during other types of tests like an esophagogastroduodenoscopy, a type of endoscopy examination of the upper digestive tract.
In some cases, even after all the blood tests have been done and the cause of koilonychia remains unknown, the condition might be inherited or run in the family. Therefore, it’s important to consider a hereditary cause for koilonychia.
Treatment Options for Spoon Nails (Koilonychia)
Koilonychia, a condition where the nails become abnormally thin and curve inward, is typically treated by addressing the underlying condition causing it. There can be many causes for koilonychia, but an accurate diagnosis can often be made based on factors such as the person’s age, personal and family history, and their work environment. A thorough physical examination is also crucial. Noticing that someone has koilonychia can help doctors identify other skin conditions or systemic diseases, showing how interconnected our bodies are.
Following up with the right medical tests is important. Not only can these help rule out any underlying skin or body wide diseases, but they can also help pinpoint the exact cause of koilonychia. This information can then guide the right course of treatment. Many times, when koilonychia is due to a specific cause, the condition can be reversed.
Koilonychia is quite common in newborns. Their nails are usually thin and soft, and can often show signs of koilonychia. However, this is generally a normal part of their growth and doesn’t require any treatment. Rather, what’s recommended is a policy of monitoring and waiting, along with reassurance to the parents. However, it is still important to keep an eye on these cases to make sure this normal condition doesn’t develop into a problem later on.
What else can Spoon Nails (Koilonychia) be?
Dermatologic conditions such as nail psoriasis, lichen planus, and 20-nail dystrophy can cause abnormalities in the nail bed like Koilonychia. This makes them appear like a spoon. But in onychomycoses, pressure beneath the nail bed causes this malformation.
Koilonychia can also occur due to some systemic conditions, and here are some examples:
- Nutritional Deficiencies: Issues like iron deficiency can cause Koilonychia in about 5.4% of patients. This condition can be more evident in children where iron deficiency is a common cause. The nail iron levels may increase with oral supplementation, but it doesn’t necessarily mean it will fix Koilonychia. Besides, deficiencies in vitamin C, zinc, copper, selenium, and other amino acids can lead to Koilonychia, especially in people living in poor nutritional conditions such as those in rural communities, alcoholics, child laborers, and patients with chronic kidney diseases.
- Plummer-Vinson Syndrome: This rare syndrome has a triad of symptoms including iron deficiency anemia, difficulty in swallowing, and esophageal webs. Koilonychia may be a first sign in about 37-50% of the cases.
- Hemochromatosis: This condition, characterized by excessive accumulation of iron in the body, can lead to Koilonychia in about 49% of the patients. Even if phlebotomy (blood removal therapy) is tried, it doesn’t seem to fix the nail deformation.
- Endocrine Disorders: Conditions like hypothyroidism can lead to Koilonychia, making the nails grow slowly and become brittle. This condition may also be seen in diabetes as a result of nutrient deficiencies or microvascular dysfunction.
- Autoimmune Conditions: Koilonychia can rarely appear in patients with systemic lupus erythematosus and Raynaud’s disease.
- Early Childhood Koilonychia: Infants or young children may develop temporary Koilonychia, mainly affecting the big toe.
Other conditions and scenarios that may cause Koilonychia include:
- Familial Koilonychia: A rare condition generally inherited and seen in certain families, affecting fingers, toes or certain parts of the hands.
- Trauma: Common in children, it may be due to habits like thumb sucking or the use of tight shoes.
- Occupational Koilonychia: Workers exposed to petroleum, organic solvents, and chemicals causing skin irritations can develop Koilonychia. These changes could become permanent.
- Regional Koilonychia: This condition can be seen among certain population groups in India living at high altitudes. The reasons are thought to include a vegetarian diet with low iron content, physical labor, and the geographical conditions in those areas.
What to expect with Spoon Nails (Koilonychia)
Once koilonychia (also known as spoon nails, a condition where the nails become thin and concave) is diagnosed, the affected nail may turn paler and become even more spoon-shaped if the root cause of the condition isn’t treated. How quickly the nails revert to their normal shape generally depends on what’s causing the problem in the first place. If anemia (a deficiency in the number or quality of red blood cells) is the cause, the nails will typically return to normal within 4 to 6 months of increased iron intake.
Patients with PVS (a nail disorder that causes nails to become overly curved) tend to have positive outcomes, but they are at a higher risk of developing squamous cell carcinoma, a type of skin cancer, in the lower part of the throat or upper part of the esophagus (the tube that connects the throat to the stomach). This is why people with PVS should be regularly screened for this type of cancer.
Toenails grow more slowly than fingernails and could take up to a year and a half to fully regrow, compared to just six months for the fingernails.
Possible Complications When Diagnosed with Spoon Nails (Koilonychia)
Koilonychia, on its own, doesn’t lead to any complications. It’s actually a sign of an underlying health condition, which, if left untreated, can have potentially serious consequences.
For instance, if someone has chronic iron deficiency and it’s not treated, the lining of the mouth could be permanently altered. This alteration may increase the risk of the cells becoming malignant, or cancerous. Also, if a condition called PVS isn’t treated, it could cause the esophagus to turn into a specific type of cancer known as squamous cell carcinoma. The esophagus, which is the tube that food travels down from your mouth to your stomach, could also become significantly blocked. This would make it hard to swallow if the thin, flat pieces of flesh, or “webs”, that grow inside of it aren’t treated.
Potential Problems in Not Treating These Conditions:
- Chronic iron deficiency can lead to permanent changes in the mouth lining
- Persistent difficulty swallowing
- Obstruction in the esophagus
- Risk of squamous cell carcinoma
Preventing Spoon Nails (Koilonychia)
Koilonychia, more commonly referred to as “spoon nails,” is a condition where the nails sink in the middle and rise on the sides. This peculiar shape can indicate other underlying health issues or be due to a birth defect. It’s a good idea for patients to keep their nails short and clean to avoid worsening the spoon-like shape and to prevent possible infections in the affected areas. Regularly applying a moisturizer or oil to the nails after taking a shower or bath can also help keep your nails in good shape.
We should focus efforts on educating health and agricultural organizations over the long term, especially focusing on iron deficiency anemia — the most common cause of spoon nails. Initiating nationwide educational programs that consider changes in economic and cultural dynamics could be key in reducing iron deficiency anemia and malnutrition, particularly among lower socio-economic groups. For these initiatives to be effective, they need to emphasize the importance of food nutrients, individual nutritional requirements, environmental hygiene, personal cleanliness, and comparing the health benefits and costs of different foods. Offering additional programs, like those that provide iron supplements and control parasites, could also motivate people to learn more about nutrition and health.
In order to tackle problems like iron deficiency anemia and other nutritional deficiencies, we should encourage the intake of affordable, nutritionally dense foods. This means we need to ensure that nutritious food is easily available and that people have enough money to buy it in sufficient quantities.
Further strategies could involve promoting longer intervals between births and educating parents about the special dietary needs of young mothers, which could help decrease anemia problems. Additionally, we should encourage medical institutions to use advanced laboratory methods to aid in research, especially in developing countries.
Preventing PVS, an extremely rare condition, is challenging. If you have any other questions or concerns about this or any other condition, please don’t hesitate to ask your doctor.
