Cambios en ls uñas que deben ser valorados por su Especialista en Dermatologia de la Asociación Costarricense en Dermatologia

12 nail changes a dermatologist should examine

Have you noticed a change to any of your nails lately? A change in color, texture, or shape can be harmless, but it can also be a sign of disease. If you notice any of the following changes to a fingernail or toenail, it's time to see a board-certified dermatologist.

1. 
   
2. Melanoma under nail
   
   Medical name: Acral lentiginous melanoma
   
   Dark streak
   If a fingernail or toenail has a new or changing dark streak, it's time to see a dermatologist for a skin cancer check. That dark streak could be melanoma, the most serious type of skin cancer.
   Not every dark streak is a melanoma, but it's always good to have a dermatologist examine one. Caught early and treated, that may be the only treatment you need.
   
   Allowed to grow, treatment becomes more difficult.
   
3. 
4. Fingernail lifting up
   
   Medical name: Onycholysis
   
   Nail lifting up
   If a nail starts to lift up so that it's no longer completely attached, you'll likely see white discoloration, as shown here. When a nail lifts up, the cause is often:
• A fungal infection
• Psoriasis
• Injury from an aggressive manicure
• Injury form cleaning under your nails with a sharp object

5. A dermatologist should examine any nail that's lifting up. You may need treatment to clear an infection. A dermatologist can also give you some tips that may help the new nail grow out normally.
6. 
   
7. Infection around fingernail
   
   Medical name: Paronychia
   
   Redness and swelling around a nail
   If you have redness and swelling around a nail, you may have an infection. When diagnosed early, you can often treat an infection with soaks and antibiotics. If an open sore forms, you'll need more extensive treatment.
8. 
   
9. Infection under nail
   
   Medical name: Paronychia
   
   Greenish black color
   When bacteria cause a nail infection, the nail can turn greenish black as shown here.
   
   Without treatment, a nail infection tends to worsen. Treatment can get rid of your pain and tenderness and help clear the infection.
10. 10.
    
11. Fingernail with pits
    
    Medical name: Pitting
    
    Pitted nails
    If you have dents in your nails that look like they were made by an icepick, this could be a sign that you have a disease that affects your entire body.
    
    People who have pits in their nails may have:

• Psoriasis
• Atopic dermatitis
• Alopecia areata

12. 12.Seeing a board-certified dermatologist for a diagnosis is important. Dermatologists are the specialists who diagnose and treat these diseases. Treatment can help you feel more comfortable and prevent the disease from worsening.
13. 13.
    
14. 14.Yellow nail syndrome
    
    Medical name: Yellow nail syndrome
    
    Yellow nails
    Wearing red nail polish without a base coat or smoking can turn your nails yellow. If your nails turn yellow, thicken, and seem to stop growing, it could be a sign of something going on inside your body.
    
    Lung disease and rheumatoid arthritis can cause yellow nails. You may also have a serious nail infection, which requires treatment.
15. 15.
    
16. 16.Deep groove in nail
    
    Medical name: Beau lines
    
    Deep grooves (or gaps)
    Lines that run the length of a nail are common and usually nothing to worry about. If you see deep grooves that run the width of your nail like the ones shown in this picture, it means that something slowed (or stopped) your nails from growing for a while.
    
    When something causes your nail(s) to completely stop growing for a while, you may see a gap. If this happens, you'll have a place on your nail(s) that's missing nail. The medical name for this condition is onychomadesis (on-ah-coe-ma-dee-sis).
    
    A fever, injury, chemotherapy, or major stress can cause your nails to grow slowly or stop growing.
    
    If you cannot think of what could may have caused your nails to grow slowly or stop growing, see your dermatologist or primary care doctor. Once you find and get rid of the cause, nails often start growing normally.
17. 
    
18. 18.Thick, overgrown nails
    
    Medical name: Onychogryphosis
    
    Ram's horn nails
    This happens when the nails thicken and overgrow. Some people get Ram's horns because the condition runs in the family.
    
    If you have a disease, such as psoriasis, ichthyosis, or circulation problems, you may also develop Ram's horn nails.
    
    Cutting and treating these nails requires help from a podiatrist or dermatologist.
19. 19.
    
20. 20.Spoon-shaped nails
    
    Medical name: Koilonychia
    
    Thin, spoon-shaped nails
    If you have thin fingernails that dip down in the middle and look like spoons, you may not be getting enough iron. People develop an iron deficiency for many reasons, including:

• Lack of proper nutrition
• A health problem with their stomach or intestines
• Sensitivity to gluten (celiac disease)
• High altitude

21. 21.Getting a proper diagnosis and treatment can help you feel better.
22. 22.
    
23. 23.Washboard nails
    
    Medical name: Onychotillomania
    
    Washboard nails
    If you have grooves and ridges in the center of your thumb that look like the ones shown in this picture, you may have developed a habit of picking at (or pushing back) the cuticles on your thumbnails. Many people are unaware that they do this.
    
    A dermatologist may be able to help you break the habit, allowing healthy nails to grow out.
24. 24.
    
25. 25.Clubbing causes nails to curve down
    
    Medical name: Clubbing
    
    Curved nails
    The curving can begin so gradually that many people are unaware it's happening. As the nails continue to curve downward, fingertips often swell and the nails start to feel spongy when pressed on.
    
    If you notice your fingernails start to curve, it's time to see a board-certified dermatologist. Curved nails can be a harmless trait, which runs in the family. Curved nails can also be a sign that you have a disease in the:

• Lungs
• Heart
• Liver
• Stomach or intestine

26. 26.
27. 27.Color change
    A disease inside your body can cause your nails to change color. Certain color changes can be a warning sign of a specific disease, as the following table shows.

1.Color	1.Disease or other health problem
Blue nails	Not enough oxygen in your bloodstream
White nails	Liver disease, diabetes
Pale nails	Anemia
Half pink, half white nails	Kidney disease
Yellow nails	Lung disease, nail infection
Dusky red half-moons	Could be lupus, heart disease, alopecia areata, arthritis, dermatomyositis
Blue half-moons	Could be sign of poisoning
44

Seeing a change to your nails or the half-moons doesn't always mean that you have a disease.

Still, it's important to see a board-certified dermatologist if you notice any changes. Board-certified dermatologists specialize in diagnosing and treating the skin, hair, and nails. They have the expertise to tell you whether the change is harmless or requires medical testing.

Related AAD resources

• Nail fungus
• What is nail psoriasis, and how can I treat it?
• Atopic dermatitis
• Alopecia areata

Images
Image used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides: 4,5,7,9,10, and 11

Getty Images: 3, 12

Images from the Journal of the American Academy of Dermatology

• 2: J Am Acad Dermatol. 2014;70(4):748-62.
• 6: J Am Acad Dermatol 2007;57:1-27.
• 8: J Am Acad Dermatol 2015;73:849-55.

References
Braswell MA, Daniel CR, et al. "Beau lines, onychomadesis, and retronychia: A unifying hypothesis." J Am Acad Dermatol 2015; 73:849-55.

Fawcett RS, Hart TM, et al. "Nail abnormalities: Clues to systemic disease." Am Fam Physician. 2004;69(6):1417-24.

Kiaravuthisan MM, Sasseville D, et al. Psoriasis of the nail: Anatomy, pathology, clinical presentation, and a review of the literature on therapy." J Am Acad Dermatol 2007;57:1-27.

Kumar V, Aggarwal S, et al. "Nailing the diagnosis: Koilonychia." Perm J. 2012;16(3): 65.

Ring DS. "Inexpensive solution for habit-tic deformity." Arch Dermatol. 2010;146(11):1222-3.

Schwartz RA, "Clubbing of the nails: Clinical presentation." Medscape. Last accessed 12/21/2017.

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Dieta en HS en la AAD



Is there a diet for hidradenitis suppurativa?

Take this poll by clicking on one of the options below. You'll immediately see how your experience compares with others.

A healthy diet can help people manage diseases ranging from diabetes to heart disease. To find out if diet could also benefit people with hidradenitis suppurativa (HS), dermatologists have been running small studies. While we need more research to know how diet affects HS, here's what these early studies show.

Weight loss diet: In a few small studies, weight loss was shown to lessen (and sometimes clear) HS in people who were overweight or obese. During one small study, most patients who lost 15% or more of their body weight benefitted. Nearly 50% saw their HS clear, and 20% had fewer HS lumps.¹

These studies also found that weight loss works best in the early stages of HS when you have painful lumps in your skin but no tunnels beneath.²

Mediterranean diet: This diet consists of mostly fresh vegetables and fruits, whole grains, fish, beans, seafood, and extra virgin olive oil. You rarely eat red meat. You also cut out processed foods, including sugary drinks, diet soda, bacon, cold cuts, chicken nuggets, hot dogs, and the like.

When a dermatologist in Arizona surveyed her patients with HS, she discovered that patients who followed a Mediterranean diet had fewer HS flare-ups than patients who ate foods not allowed on the Mediterranean diet.³

In a small study conducted in Italy, where many people eat a Mediterranean diet, researchers also discovered this connection. In this study, 41 patients had HS and 41 did not have HS. All of the patients were asked to record what they ate for seven days.

The researchers found that the patients with HS ate fewer foods found in the Mediterranean diet than did the patients without HS.⁴

Plant-based diet: The human gut contains trillions of microorganisms, which help keep us healthy. Scientists have discovered the following about these microorganisms:

• The more diverse these microorganisms, the healthier a person tends to be.

• The people who have the most diverse microorganisms in their guts eat only plant-based foods like vegetables, fruits, whole grains, and beans.

Dermatologists wanted to know if this knowledge could help their patients with HS, so they looked at the diversity of microorganisms in patients with HS and those without HS.

If you're wondering, doctors can figure out the diversity of microorganisms in your gut by looking at a stool (poop) sample.

In a small study, dermatologists found that patients with HS had less diverse microorganisms than did patients without HS. This suggests that the patients with HS were eating fewer vegetables, fruits, and other healthy plant-based foods than were the patients without HS.⁵ While more research is needed in this area, it's possible that eating a plant-based diet could lead to fewer HS flare-ups.

Sugar-free diet: Eating sugar causes insulin levels in your body to rise. As your insulin rises, it could increase HS flare-ups.

While research studies are needed to prove that cutting down on sugar can reduce HS flare-ups, it might be helpful to eat less sugar.⁶

Your body stores extra sugar as fat, which leads to weight gain. Being overweight or obese can worsen HS.

Dairy-free diet: A small study found that when 47 patients with HS went dairy-free, 83% of these patients had less HS and none of these patients had worsening HS. The patients in this study who did not stop eating dairy products did not have fewer HS flare-ups.^{7, 8}

If you decide to go dairy-free, be sure to include foods that give you calcium and vitamin D. These nutrients are essential for your good health.

Food sensitivities: If you have a food sensitivity, it might contribute to your HS flare-ups.

To test this idea, researchers have removed the following from the diets of patients with HS:

• Alcohol

• Brewer's yeast 

• Gluten

In one 12-month study, 12 patients followed a brewer's yeast-free diet. They no longer had bread or other baked goods, vinegar, soy sauce, beer, wine, or fermented cheese. At the beginning of this study, these patients also had an in-office procedure to treat their HS.

During the year in which they followed the restricted diet, they had no flare-ups of HS. The HS flare-ups began once the diet ended.⁹

While this is too small of a study to recommend that people with HS stop consuming foods and drinks that contain brewer's yeast, food sensitivities may be a topic that you want to discuss with your dermatologist.

Vitamin and mineral supplements:Researchers have taken a close look at two supplements in particular:

• Zinc 

• Vitamin D

While the studies are small, some findings suggest that zinc can reduce HS flares. In a small study of 22 patients who had mostly mild or moderate HS, taking a zinc supplement helped when medication failed. Eight patients saw their HS go away, and 14 had less HS.^{10, 11, 12}

Before you rush to buy a zinc supplement, it's important to know that taking zinc can cause side effects. When you get too much zinc, it can cause vomiting and diarrhea. In very high doses, it can damage your kidneys or stomach.¹³ If you're interested in taking zinc to treat HS, talk with your dermatologist first.

Vitamin D is another supplement that dermatologists have been studying. If you have HS and low vitamin D in your blood, taking a vitamin D supplement might help.

Vitamin D

Dermatologists recommend getting vitamin D from foods, supplements, or both rather than from the sun. Spending time in the sun without sun protection (or using a tanning bed) can increase your risk of developing skin cancer.

Twenty-two patients who had low levels of vitamin D were given a vitamin D supplement. Once their vitamin D level was within the normal range, 63% noticed a small decrease in HS.¹⁴

Like zinc, taking too much vitamin D can cause possible side effects. If you have too much vitamin D in your body, it can cause nausea, vomiting, and a feeling of weakness.¹⁵

Be sure to talk with your dermatologist or doctor before taking any vitamin or other supplement to treat HS.

Ask your dermatologist about diet

While these findings suggest that what you eat and drink can help control (or worsen) HS, there is no one diet for HS.

Because these studies were small and looked at different approaches, it's not clear what works. Like treatment for HS, the most effective diet for you may be unique to your needs.

If you're interested in following a certain diet or discovering what happens when you stop eating certain foods, talk with your dermatologist or primary care doctor. The type of HS you have, your overall health, and whether you have a food sensitivity all play a role in determining the best way to work diet into your treatment plan.

Related AAD resources

• Hidradenitis suppurativa: Treatment

• Hidradenitis suppurativa: How to cope when depression hits

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Images
Getty Images

References
Alikhan A, Sayed C, et al. "North American clinical management guidelines for hidradenitis suppurativa: A publication from the United States and Canadian Hidradenitis Suppurativa Foundations, Part I: Diagnosis, evaluation, and the use of complementary and procedural management." J Am Acad Dermatol. 2019;81:76-90.

Barrea L, Fabbrocini G, et al. "Role of nutrition and adherence to the Mediterranean diet in the multidisciplinary approach of hidradenitis suppurativa: Evaluation of nutritional status and its association with severity of disease." Nutrients. 2018 Dec 28;11(1):57.

Choi F, Lehmer L, et al. "Dietary and metabolic factors in the pathogenesis of hidradenitis suppurativa: a systematic review." Int J Dermatol. 2020 Feb;59(2):143-53.

Danby FW. "Diet in the prevention of hidradenitis suppurativa." J Am Acad Dermatol. 2015; 73(5 Suppl 1):S52-4.

Kurzen H, Kurzen M. "Secondary prevention of hidradenitis suppurativa." Dermatol Reports. 2019 Oct 25;11(2):8243.

Lyons AB, Shabeeb N, et al. "Emerging medical treatments for hidradenitis suppurativa." J Am Acad Dermatol2020;83(2):554-62.

Narla S, Price KN, et al. "Proceeding report of the fourth Symposium on Hidradenitis Suppurativa Advances (SHSA) 2019." J Am Acad Dermatol. (2020), doi:https://doi.org/10.1016/. [epub ahead of print].

Sivanand A, Gulliver WP, et al. "Weight loss and dietary interventions for hidradenitis suppurativa: A systematic review." J Cutan Med Surg. Jan/Feb 2020;24(1):64-72.

Thompson KG, Kim N. "Dietary supplements in dermatology: A review of the evidence for zinc, biotin, vitamin D, nicotinamide, and Polypodium." J Am Acad Dermatol. doi: 10.1016/j.jaad.2020.04.123. [Article in press].

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Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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Vitamin D and omega-3 supplements reduce autoimmune disease risk

For those of us who cannot sit in the sun and fish all day, the next best thing for preventing autoimmune diseases may be supplementation with vitamin D and fish oil-derived omega-3 fatty acids, results of a large prospective randomized trial suggest.

mong nearly 26,000 adults enrolled in a randomized trial designed primarily to study the effects of vitamin D and omega-3 supplementation on incident cancer and cardiovascular disease, 5 years of vitamin D supplementation was associated with a 22% reduction in risk for confirmed autoimmune diseases, and 5 years of omega-3 fatty acid supplementation was associated with an 18% reduction in confirmed and probable incident autoimmune diseases, reported Karen H. Costenbader, MD, MPH, of Brigham & Women's Hospital in Boston.

"The clinical importance of these results is very high, given that these are nontoxic, well-tolerated supplements, and that there are no other known effective therapies to reduce the incidence of autoimmune diseases," she said during the virtual annual meeting of the American College of Rheumatology.

"People do have to take the supplements a long time to start to see the reduction in risk, especially for vitamin D, but they make biological sense, and autoimmune diseases develop slowly over time, so taking it today isn't going to reduce risk of developing something tomorrow," Dr. Costenbader said in an interview.

"These supplements have other health benefits. Obviously, fish oil is anti-inflammatory, and vitamin D is good for osteoporosis prevention, especially in our patients who take glucocorticoids. People who are otherwise healthy and have a family history of autoimmune disease might also consider starting to take these supplements," she said.

After watching her presentation, session co-moderator Gregg Silverman, MD, from the NYU Langone School of Medicine in New York, who was not involved in the study, commented "I'm going to [nutrition store] GNC to get some vitamins."

When asked for comment, the other session moderator, Tracy Frech, MD, of Vanderbilt University, Nashville, said, "I think Dr. Costenbader's work is very important and her presentation excellent. My current practice is replacement of vitamin D in all autoimmune disease patients with low levels and per bone health guidelines. Additionally, I discuss omega-3 supplementation with Sjögren's [syndrome] patients as a consideration."

Evidence base

Dr. Costenbader noted that in a 2013 observational study from France, vitamin D derived through ultraviolet (UV) light exposure was associated with a lower risk for incident Crohn's disease but not ulcerative colitis, and in two analyses of data in 2014 from the Nurses' Health Study, both high plasma levels of 25-OH vitamin D and geographic residence in areas of high UV exposure were associated with a decreased incidence of rheumatoid arthritis (RA).

Other observational studies have supported omega-3 fatty acids for their anti-inflammatory properties, including a 2005 Danish prospective cohort studyshowing a lower risk for RA in participants who reported higher levels of fatty fish intake. In a separate study conducted in 2017, healthy volunteers with higher omega-3 fatty acid/total lipid proportions in red blood cell membranes had a lower prevalence of anti-cyclic citrullinated peptide (anti-CCP) antibodies and rheumatoid factor and a lower incidence of progression to inflammatory arthritis, she said.

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Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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