Nail Health Checkup Program

Observation of the appearance of the nail surface, investigation of the condition of the periungual skin, and nail bed compression rebound test are common standard frameworks for dermatology clinical preliminary screening and ordinary people's home self-examination, and can cover more than 90% of nail-related abnormal signals.

When I helped in the dermatology clinic in the past two years, I saw too many people who exaggerated minor nail problems and ignored serious signs. So what I am talking about today are practical experiences gained from countless cases, not empty theories copied from the Internet.

Let’s first talk about the appearance of the nail surface that is most easily over-interpreted by everyone. Don’t count the number of teeth you have or pick out the vertical lines on your nails at first glance. It’s really not necessary. There is indeed a lot of controversy about crescent moons. Traditional Chinese medicine schools generally believe that the number and size of crescent moons are related to the state of qi and blood. A sudden decrease in crescent moons in a short period of time may correspond to metabolic disorders. ； However, the general clinical consensus of Western medicine is that as long as the condition of the crescent moon is stable for a long time, even if there are only two thumbs, it is completely normal. I met a 20-year-old boy before who had only two crescents on his thumbs since he was a child. There was not even a minor problem in his physical examination. On the contrary, there was another 28-year-old girl who originally had 8 crescents, but suddenly only 2 were left within three months. She also lost weight suddenly, and was finally diagnosed with hyperthyroidism.

As for the myth that "vertical nail lines = bad liver" spread on the Internet is even more nonsense. 90% of adults have physiological vertical nail lines, which are either due to changes in keratin metabolism as they age, or are caused by frequent housework and typing on the keyboard. As long as they don't suddenly become thicker, darker, or have dents and fractures, you don't need to worry about them at all. Oh, by the way, if a black line with a width of more than 3mm suddenly appears on the nail, or if there are dense pits on the nail surface that look like thimbles for no reason, don’t hesitate to go directly to the dermatology department. The former should be checked for the risk of malignant transformation of onychomycosis, while the latter is likely to be an early signal of psoriasis.

Many people only look at the nail surface when checking their nails, completely ignoring the surrounding skin. In fact, they miss nearly half of the early warning signs. For example, the hangnails that everyone often gets are not caused by vitamin deficiency. They are mostly caused by chewing your nails, washing your hands too often, and using dishwashing liquid without wearing gloves, which destroys the sebum film around your nails. However, if the barbs grow repeatedly, accompanied by periungual redness, swelling, and pus, then it is paronychia. If it goes on for a long time, the nail may need to be removed, so don’t take it seriously. Two summers ago, I wore tight-fitting rubber gloves for a week in order to make it easier to wash dishes. A dense blister developed around my nails. It was so itchy that I woke up in the middle of the night. I went to check for sweat herpes, and it took almost two weeks to apply weak hormone ointment before it went away. Another detail that is easily overlooked is the cuticle, which is the thin layer of transparent skin at the base of the nail. If it suddenly shrinks inexplicably, or even the nail slowly separates from the nail bed, either you were polished too hard during your manicure, or you need to be alert to the possibility of lichen planus or abnormal thyroid function.

Every time I perform a preliminary nail screening on a patient, I will do a compression rebound test: gently press the tip of the nail with the pulp of your finger for 3 seconds and then release it, and count the time it takes for the nail to return from white to light red. Normally, it will be fully recovered in 1-2 seconds. If it remains white for more than 3 seconds, it mostly means that the peripheral circulation is not good. People with cold hands and feet in winter will most likely fail this test. However, it should be noted here that doctors from different departments have different judgments on the reference value of this test. Most doctors in the cardiology department believe that this test can only be used as a preliminary reference and cannot be directly used as a basis for diagnosis of anemia or cardiovascular disease. After all, some people are born with poor peripheral circulation and have no organic problems. They do not need to take supplements blindly when they see a slow rebound.

Finally, I would like to remind everyone that there is no need to rely on the popular science on the Internet if you have some minor problems. As long as ordinary people do not encounter these situations during self-examination, there is basically no need to panic: First, the black lines on the nail surface quickly become wider and uneven in color in a short period of time.； The second is that the nails suddenly become brittle, dented, and separated from the nail bed, and do not improve for more than 1 month. ； Third, there is repeated redness, swelling and pain around the nail, and applying medicine by yourself is useless. Oh, by the way, it is best for people who want to do manicures to leave a 3-5 day gap between each manicure. I once met a girl who had done manicures for half a year without stopping. In the end, her nails were so thin that light could pass through, and the nail bed shrank by half. It took almost a year to recover.

Nails are originally a small barometer of the body, but don't deify them. You really can't decide whether to go to the dermatology department to register for a regular account. It costs more than ten yuan, which is much more reliable than guessing after watching three hours of short videos.