Blue nails: window to micronutrient deficiency (2024)

Blue nails: window to micronutrient deficiency (1)

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Blue nails: window to micronutrient deficiency

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  1. http://orcid.org/0000-0003-4253-3385Lesa Dawman1,
  2. Indar Kumar Sharawat1,
  3. Keshavamurthy Vinay2
  1. 1Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
  2. 2Department of Dermatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
  1. Correspondence to Dr Lesa Dawman, lesadawman{at}gmail.com

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    • childhood nutrition
    • dermatology
    • nutrition
    • skin
    • general practice / family medicine

    Description

    A 12-year-old boy presented with progressive darkening of nails of both hands and feet for the past 3 months. He noticed the blue-black pigmentation of all the fingernails and toenails (figure 1A,B). Pigmentation was more marked in fingernails, particularly over thumbnails (figure 1C,D). The pigmentation started proximally and progressed distally. It was associated with hyperpigmentation of distal phalanges and nail bed. There was no history of any exposure to dyes or work in factory, trauma or exposure to any other agents. There was no history of dermatitis or rash prior to this complaint. He was a non-vegetarian. Other systemic examination was unremarkable.

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    Figure 1

    Hyperpigmentation of nails. Blue-black pigmentation of all the fingernails and toenails (A,B) with associated hyperpigmentation of nail bed, distal phalanges and knuckles. It is more marked on thumbs and great toes (C,D).

    Lab investigations revealed macrocytic hypochromic anaemia (haemoglobin10.9 g/dL, mean corpuscular volume 110 fL), decreased serum vitamin B12 (80.61 pg/mL), normal serum folate levels (4.8 ng/mL), elevated serum hom*ocysteine level (55.47 µmol/L) and mildly elevated urinary methyl malonic acid. His serum adrenocorticotropin hormone level was within normal limits. The severe vitamin B12 deficiency was considered as the attributing factor for his nail hyperpigmentation. He was started on daily intramuscular vitamin B12 therapy (1 mg/day) for 7 days followed by weekly injections for 4 weeks along with oral B12 (1 mg/day) and other micronutrients. Serum hom*ocysteine became normal after 1 month of therapy (6.4 µmol/L).

    The clinical manifestations of vitamin B12 deficiency are megaloblastic anaemia, glossitis and neurological symptoms like sensory abnormalities, tremors and psychiatric symptom.1 Other less common features are cutaneous hyperpigmentation, aphthous stomatitis, cheilitis, vitiligo, sparse lusterless hypopigmented hairs and blue-black pigmentation of nails.2 Nail changes in vitamin B12 deficiency present as hyperpigmentation of nails like bluish discoloration of nails, blue-black pigmentation with dark longitudinal streaks, and longitudinal and reticulate darkened streaks. The nail pigmentation associated with B12 deficiency is more frequent in patients with dark skin. The mechanism of hyperpigmentation is proposed to be decreased glutathione levels resulting in disinhibition of tyrosinase, an enzyme of melanogenesis leading to increased melanin synthesis.3 The cutaneous manifestations can be reversed with B12 therapy. Possibility of vitamin B12 deficiency should be kept in a patient presenting with only cutaneous manifestation of hyperpigmentation. Complications of vitamin B12 deficiency may be prevented if the condition is recognised early and treatment isinitiated.

    Learning points

    • Possibility of B12 deficiency should be considered in case of unexplained pigmentation.

    • Vitamin B12 deficiency mimicking Addison pigmentation should be ruled out.

    • Early diagnosis and prompt treatment can cause the reversal of symptoms.

    References

      1. Demir N,
      2. Doğan M,
      3. Koç A, et al

      . Dermatological findings of vitamin B12 deficiency and resolving time of these symptoms. Cutan Ocul Toxicol 2014;33:703.doi:10.3109/15569527.2013.861477

      OpenUrl

      1. Niiyama S,
      2. Mukai H

      . Reversible cutaneous hyperpigmentation and nails with white hair due to vitamin B12 deficiency. Eur J Dermatol 2007;17:5512.doi:10.1684/ejd.2007.0285

      OpenUrlPubMed

      1. Mori K,
      2. Ando I,
      3. Kukita A

      . Generalized hyperpigmentation of the skin due to vitamin B12 deficiency. J Dermatol 2001;28:2825.doi:10.1111/j.1346-8138.2001.tb00134.x

      OpenUrlCrossRefPubMed

    View Abstract

    Footnotes

    • Contributors LD: clinician in charge, concept and design of the study, initial draft manuscript preparation, critical review of manuscript, final approval of the version to be published. IKS: patient management, literature review, initial draft manuscript preparation. KV: critical review of manuscript, literature review, final approval of the version to be published.

    • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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    Blue nails: window to micronutrient deficiency (2024)

    FAQs

    Blue nails: window to micronutrient deficiency? ›

    Nail changes in vitamin B12 deficiency present as hyperpigmentation of nails like bluish discoloration of nails, blue-black pigmentation with dark longitudinal streaks, and longitudinal and reticulate darkened streaks.

    Why do my nails turn blue when I'm anemic? ›

    Why Are My Fingernails Blue? A low level or lack of oxygen circulating in your red blood cells can cause blue fingernails. Other causes can include chronic conditions and cold temperatures. This condition is known as cyanosis.

    Which diseases are associated with blue nails? ›

    Conditions that cause blue nails
    • Lung diseases. Various lung conditions can result in the nails developing a blue tinge. ...
    • Heart diseases. Some cases of blue nails might be due to a heart condition, such as:
    • Blood cell and vessel abnormalities. Some issues relating to the blood cells and vessels can also cause blue nails.
    Apr 22, 2021

    What do nails look like with zinc deficiency? ›

    Zinc is an essential mineral for cell multiplication and protein absorption, functions that are important for thick, lustrous hair. White spots on the nails - sometimes called Beau's lines - are one of the important signs of a zinc deficiency. Nails can grow slowly, become brittle and break easily.

    How do fingernails look like with vitamin deficiency? ›

    Nail plate discoloration can result from several nutritional deficiencies. Research has shown vitamin B12 deficiency to cause brown-gray nail discoloration. White nails can be the result of anemia and pink or red nails may suggest malnutrition with several nutrient and vitamin deficiencies.

    Can B12 deficiency cause blue nails? ›

    Nail changes in vitamin B12 deficiency present as hyperpigmentation of nails like bluish discoloration of nails, blue-black pigmentation with dark longitudinal streaks, and longitudinal and reticulate darkened streaks. The nail pigmentation associated with B12 deficiency is more frequent in patients with dark skin.

    What do anemic fingernails look like? ›

    Koilonychia 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. Leukonychia is white streaks or spots on the nails often due to drugs or disease.

    When should I be worried about blue nails? ›

    The causes of cyanosis can include chronic health conditions, heart disease, and anemia. If you often have blue nails, consider speaking with a healthcare professional to rule out any underlying health conditions.

    What do liver failure nails look like? ›

    Terry's nails is a type of nail discoloration. The nailbeds look “washed out,” except for a thin reddish-brown strip near the tip. Often, Terry's nails is a symptom of a chronic condition, such as liver failure or diabetes. Sometimes, it is a sign of aging.

    Can heart problems cause blue fingernails? ›

    There are several reasons your nails could be blue, including heart conditions. Sometimes a heart murmur will cause blue nail beds. When a health-care provider listens to your heart and hears a certain swooshing sound, it's an indication that the blood is flowing through the heart abnormally.

    What does vitamin D deficiency show on nails? ›

    If your nails are peeling, brittle, or have vertical ridges, you may be vitamin D deficient. Dubbed “the sunshine vitamin,” one of the best sources is sunlight. It can also be found in fatty fish, beef, liver, egg yolk, and fortified dairy, orange juice, and cereals.

    What do protein deficiency nails look like? ›

    Brittle nails and hangnails could indicate a protein deficiency. A few studies have found that a lack of the following essential proteins and vitamins can result in hangnails: Folic acid.

    How do you know if you have magnesium deficiency in your nails? ›

    How does Magnesium affect my nails? This lesser-known mineral plays a crucial role in multiple bodily processes, including protein synthesis, which is essential for healthy nails. A magnesium deficiency can result in weak, flaky nails that are prone to breakage.

    What do kidney disease nails look like? ›

    Nail changes.

    People who have advanced kidney disease can develop: A white color on the upper part of one or more nails and a normal to reddish brown color below, as shown here (half-and-half nails) Pale nails. White bands running across one or more nails (Muehrcke's nails)

    What do calcium deficiency nails look like? ›

    When your body lacks calcium, your nails become thinner, weaker, and brittle. You may notice that they break easily and just don't look as healthy as they used to. Although nails and bones are made up of different substances, they're similar enough that poor nail health may be an early marker of bone density problems.

    What do diabetic fingernails look like? ›

    4 White/yellow/greenish discolouration and thickening at the end of the nail spreads gradually to involve the whole nail which may be thick and brittle. The distorted nail can become sharp or break off, and can dig into neighbouring toes.

    Do anemic people turn blue? ›

    Bluish discoloration of the skin may signal a lack of oxygen in the blood. It could also indicate an abnormal form of hemoglobin (a protein in red blood cells) like it does with sickle cell anemia. Cyanosis is the name for poor oxygen circulation in the blood that causes bluish discoloration of the skin.

    Can you get cyanosis from anemia? ›

    Cyanosis is caused due to an absolute increase in the deoxygenated hemoglobin. Therefore, in anemic patients, greater desaturation of arterial hemoglobin is required for cyanosis to manifest, as compared to individuals with normal hemoglobin levels.

    How do you fix anemic nails? ›

    If you have an iron deficiency, changing your diet or taking supplements may correct and prevent spoon nails. For example, you may eat more iron-rich foods, such as: Beans and lentils. Dark chocolate.

    What does it mean when your fingernails turn blue? ›

    If you have blue or purple nail beds or fingernails, it may be due to an underlying condition known as cyanosis . This condition is caused by a lack of oxygen in the blood. Cyanosis can result from exposure to cold temperatures, certain lung and heart conditions, circulation problems, issues with hemoglobin, and more.

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