Anaesthesiologist and interventional pain medicine physician Dr Kunal Sood recently highlighted how subtle shifts in the hands and nails can reflect deeper issues within the body, including chronic diseases that benefit from early diagnosis. In a video shared on Instagram, he explained five distinct changes worth paying attention to.
For instance, clubbing causes the fingertips to become rounded with curved nails. As he put it, “It occurs when megakaryocytes bypass the lungs and release growth factors like VEGF (Vascular Endothelial Growth Factor) and PDGF (Platelet-Derived Growth Factor) at the fingertips. It is linked to chronic lung disease (lung cancer, bronchiectasis, pulmonary fibrosis, cystic fibrosis) and heart conditions with long-term low oxygen, such as cyanotic congenital heart disease or endocarditis.”
Another sign is koilonychia, or spoon-shaped nails. “Koilonychia creates thin, concave nails due to impaired keratin formation when iron-dependent enzymes weaken. It often reflects iron deficiency due to blood loss, heavy periods, low intake, malabsorption, or increased need during pregnancy. These nail changes can precede other symptoms for months,” he noted.
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Red streaks on the nails, known as splinter haemorrhages, can also serve as a warning. According to him, “Splinter haemorrhages look like red-brown lines under the nails from ruptured capillaries. While trauma is common, multiple streaks or those near the nail base raise concern for systemic conditions such as vasculitis, lupus, connective-tissue disease, or infective endocarditis.”
Dr Sood added that swollen finger joints can point to both degenerative and inflammatory forms of arthritis. “Swelling may reflect osteoarthritis from cartilage loss or inflammatory arthritis like rheumatoid or psoriatic arthritis involving synovial inflammation. Because trauma, gout or metabolic issues can mimic this finding, clinical exam and imaging help distinguish causes.”
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Finally, nail pitting may be an essential early clue for psoriasis. “About one-third of psoriasis patients show pits, and prevalence increases with disease duration. It may accompany discolouration, thickening or onycholysis and is common in psoriatic arthritis, making it a useful early clue.”
But how can people differentiate between harmless variations and signs that warrant medical evaluation?
Dr Palleti Siva Karthik Reddy, MBBS, MD, general medicine, consultant physician, tells indianexpress.com, “Nails go through minor texture and colour variations throughout life, many of which are completely benign. The concern arises when changes are persistent, progressive, or appear without any clear trigger, such as injury or frequent salon treatments. A harmless variation usually resolves on its own within a few weeks and does not affect the shape of the nail bed or surrounding skin.”
Warning signs that require a medical evaluation include nails becoming unusually thick or thin, significant changes in curvature, persistent discolouration, new ridges running across the nail, or swelling and tenderness around the fingertips. When these changes are accompanied by fatigue, breathlessness, joint pain, or skin rashes, the likelihood of an underlying systemic condition increases, the doctor notes.
What should individuals do when they notice these changes?
Any structural change in the nails that develops gradually or affects multiple fingers should prompt a clinical assessment. Dr Reddy states, “These changes provide important early clues because many of the underlying diseases may remain silent until they are advanced.”
Early detection significantly improves outcomes by enabling targeted investigations before major complications develop. Nails often act as an early warning system, Dr Reddy stresses, so taking these signs seriously can accelerate diagnosis and treatment.
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