Stratification of nails: causes of appearance, in what diseases it occurs, diagnosis and methods of treatment. Description Nail delamination is a violation of the homogeneous structure of the nail plate, leading to its splitting into separate leaf-shaped scales. This condition refers to nail dystrophies, in which changes in the shape and structure of the nail plate are associated with a violation of the cellular nutrition of the nail.
Nails are horny (or keratinous) formations composed of -keratin, which determines their lamellar or layered structure. Keratin is one of the strongest proteins, second only to chitin – it is resistant to acids, alkalis, high and low temperatures. The composition of nails also includes water, cholesterol, sulfur, calcium, phosphorus, zinc, selenium. Healthy nail plate is transparent, smooth, shiny, 0.3-0.4 mm thick.
Layers of keratinized horny nail cells are formed from the outer germ layer of the embryo (ectoderm) from the end of the 3rd month of intrauterine development. First, the nail bed is formed, then the nail folds and nail skin, at the 7-8th month the nail plates are formed. Thus, nail pathologies can be associated with malformations of the ectoderm.
The nail plates on the hands and feet originate from the matrix area located at the base of the nail. The white crescent-shaped area of the nail root is the visible part of the nail matrix. Growth of the nail is carried out due to the division of germ cells in the matrix, which gradually “push” the old nail plate forward. The structure, shape, thickness and growth rate of the nail depends on the state of the matrix. The hardness and density of the nail plate is influenced by the amount of cysteine, a sulfur-containing amino acid. Between the layers of keratin are layers of water and fat, which give the nails shine and elasticity.
Varieties of nail delamination
Onychochisis is a transverse stratification of the nail.
Onychorexis is a longitudinal separation of the nails.
Onychomadesis is a stratification of the nail from the side opposite to the free edge.
Onycholysis – complete or partial detachment of the nail from the nail bed.
Possible causes of peeling nails
The appearance of nails on the hands and feet in many cases is an indicator of the state of health of the body as a whole, since changes in the nail plates can be the result of the influence of not only external factors, but also internal ones.
One or another type of nail exfoliation is not characteristic of a particular disease, therefore, with the same pathology, different exfoliating nails may occur. For example, with lichen planus, the delamination can occur in both the longitudinal and transverse directions.
Exogenous causes of nail delamination can be chemical and / or physical factors: contact with acids, alkalis, oil, improper manicure and pedicure techniques, tight shoes.
In women who are overly addicted to manicure, nail dystrophy can be the result of exposure to varnish and acetone; in musicians playing stringed instruments, with frequent injuries of the free edge of the nail, it is erased, worn out, and edge defects are formed.
The habit of biting your nails (onychophagia) leads to shortening, cracking, and flaking of the nails. In addition, infection and the development of an inflammatory process are often noted.
Unbalanced nutrition, stress, skin and chronic diseases, infections, fungal nail infections, hormonal imbalances, the effect of certain medications, lack of vitamins and minerals can be endogenous factors in the appearance of nail stratification.
With such skin diseases as psoriasis, eczema, lichen planus, in addition to the delamination of nails, pits often appear with a diameter of several tenths of a millimeter to 1-1.5 ml and a depth of 1 mm. At the same time, cracks form at the bottom of the longitudinal grooves, starting from the free edge of the nail, often reaching its proximal part. Individual nails as well as all fingernails may be affected. Toenails are less likely to be affected.
With eczema, peeling of nails is often observed in small thin plates. Deformation of the nail plate depends on the degree of damage to the nail fold and matrix. Often, due to pronounced inflammatory processes, the nail skin disappears. In severe cases, there may be a complete rejection of the nail plate from the nail bed. With acute eczema of the skin of the hands or feet, there is soreness, burning and itching in the area of the nail bed and skin of the nail phalanges.
In psoriasis, nail damage can manifest itself long before the formation of psoriatic plaques on the skin and, until a certain time, serve as the only manifestation of the disease.
With bullous dermatoses (true pemphigus, congenital epidermolysis bullosa, chronic acrodermatitis Allopo, etc.), the nails are deformed, may have transverse traces, striation, longitudinal grooves, depressions and splits starting from the free edge.
Changes in nails occur in the event of a fungal infection and is characterized by reddening of the nail fold – it becomes cushion-shaped and hangs over the nail. There may be scanty, crumbly discharge from under the nail fold, the nail plate becomes brownish-brown, its surface has transverse grooves, bulges and / or depressions. Spots of whitish-gray, yellow, or off-gray, round or irregular, may appear. Nails become thinner, become brittle, partially separate from the nail bed.
The defeat of the nail plate often occurs in patients with syphilis. Changes in the nail plate depend on the severity of the lesion of the periungual fold, which occurs both in the primary period of syphilis and in the later stages of the disease. The nail can have transverse grooves of various depths, be bumpy, loses transparency, becomes thinner, cracks from the free edge, and can separate from the nail bed.
Exfoliation of nails often indicates a lack of nutrients in the body, which can occur as a result of their insufficient intake with food, and as a result of diseases of the gastrointestinal tract.
Exfoliation of nails is affected by a deficiency of B vitamins. The absence of niacin (vitamin B3) leads to their slow growth, a lack of vitamin B6 causes fragility, dryness and flaking, biotin (vitamin B7) directly affects nail exfoliation. Vitamin C contributes to the formation of collagen – the basis of connective tissue, provides strength and elasticity of nails, therefore its lack is also fraught with their delamination.
Lack of vitamins E and D is also fraught with brittle and flaking nails.
In addition to vitamins, a number of microelements (silicon, selenium, iron, calcium, magnesium, zinc) are required for the strength of nails. With an iron deficiency, degeneration of the nail plate is observed.
Endocrine and metabolic disorders are diseases, the clinical picture of which may be accompanied by deformation of the nails. Diabetes mellitus, hyperthyroidism (increased thyroid function), hypothyroidism (decreased thyroid function), pregnancy, menopause (cessation of menstrual cycles in women) cause changes in nail conditions.
Which doctors should I go to for delamination of nails
To identify or exclude diseases that provoke delamination of nails, it may be necessary to consult a general practitioner , endocrinologist , gastroenterologist , surgeon , dermatologist, mycologist. Diagnostics and examinations in case of nail exfoliation Often, to find the exact cause of nail exfoliation, a whole range of laboratory and instrumental diagnostic methods is required, from which the doctor selects the necessary ones.
Diagnosis of diabetes mellitus:
complex ultrasound examination of the abdominal organs (liver, gallbladder, pancreas, spleen);