Spoon nails/brittle nails. Help.

Hello,

My father started having VERY dry, flaky skin about a year ago on his hands.  It's pretty severe... it's on his palms, and fingers mostly.  He has tried all sorts of moisturizers (because that's what his family doctor told him to do) but, these have not helped.

FYI. He is 54, white, 6'4", 350lbs...has a history of blood clots... he is positive for the MTHFR mutation that makes people prone to blood clots... and he is currently on coumadin.  Other than that and some chronic back pain from an injury that occured 24 years ago - he is pretty healthy.

Over the past few months, his nails have started to become very brittle.  They are becoming flat and almost spoon like.

This worries me... and his doctors are refusing to look into it further.  They just keep telling him to put lotion on his hands and that everything will fix itself.  Small town doctor's treating the common cold everyday don't seem to care about something like this.  It's VERY frustrating...  I'm a medical technology student and the only thing that comes to my mind is Iron Deficiency Anemia.  He has a decent diet... he is not mal-nourished at all... he doesn't have any other symptoms of IDA except for the deformed nails.  I know that IDA has a slow onset... but maybe there is another explanation for this.  

I'm wondering if you have ever seen any skin conditions that would cause a nail defect such as this...

Would a fungal infection explain this? Have you seen anything like this before?  ANY information you could give would be SO helpful.  Thank you.

[Bhupinder Kaur, MD]

Hello,
Your father seems to be having koilonychia. It is an abnormal shape of the fingernail. The nail has raised ridges and is thin and curved inward. This disorder is associated with iron deficiency anemia. The other possibility which can present with nail pitting as well thick, white, silvery, or red patches of skin is psoriasis. It is thought that psoriasis occurs when the immune system overreacts, causing inflammation and flaking of skin.
My sincere advice is to consult a dermatologist and get these two possibilities probed. Blood tests and biopsy skin can help in confirming the diagnosis.
I would suggest you to consult a dermatologist and get steroids prescribed. It is very difficult to precisely confirm a diagnosis without examination and investigations and the answer is based on the medical information provided. For exact diagnosis, you are requested to consult your dermatologist. I sincerely hope that helps. Take care and please do keep me posted on how you are doing.

[gresivs]

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