Koilonychia, also known as spoon nails, is a condition that makes nails progressively thinner until their outer edges eventually start to lift. It is an inherited genetic problem that causes the edges of nails to become thinner due to an abnormal growth pattern. The root cause is a decreased level of iron in the blood. Eventually, the edges raise until the nail gets an unusual concave shape, resembling a spoon.

While the normal shape of the nail plate is concave, koilonychia reverses it completely and the nail turns concave, with a depressed center while the margins have a higher profile. The entire growth pattern of the nail is disturbed, the structure becomes weaker and the plate is thinner than usual.

A very easy method to diagnose this condition in mild cases is the so-called water test. If the nail plate is concave enough to keep a drop of water in the middle, it can be considered a case of koilonychias.

Koilonychia triggers significant changes of the nails on both fingers and toes, deforming their shape and changing their size, texture and thickness. This condition is usually an inherited autosomal dominant trait but it can also be caused by other diseases. One example is anemia caused by a lack of iron, which can have spoon nails as a side effect. The nails eventually recover after the disease is cured, but it can take a very long time.

The nails initially get thinner than normal. In time, their edges grow upwards, forming the distinctive spoon-like shape. There are a number of diseases that can have this effect, besides genetic factors. Any condition related to a lack of iron or poor iron absorption can be a cause of koilonychias. Other diseases related to it are Reynaud's syndrome, nail-patella syndrome, poor function of thyroid hormone, glossitis, hemochromatosis, muscle skinning and pica. Aggressive chemicals that can be found in some detergents and soaps can also attack the nails if used frequently.

People who undergo aggressive treatments like radiotherapy or chemotherapy against cancer can also be affected by koilonychias. It can also be caused by a low supply of iron and vitamins, either due to a poor diet that fails to supply enough nutrients or a digestive issue that prevents their absorption into the body. When the condition is inherited, it might not become active immediately and only develops later if the nutrition is poor during childhood. Nails become very fragile and any injury can make them simply detach from their nail beds.

What are the symptoms of koilonychia?

Koilonychia is very easy to diagnose because of the distinctive spoon-like shape of the nails. Koilonychia also makes them thinner than normal. As the edges of nails start to raise and turn outwards, they lose their connection to the nail bed. The condition is a clear sign of a lack of iron in the blood, also known as anemia, which usually can be corrected easily. Another common but completely unrelated cause is the bad habit of nail biting.

In many cases, the first sign of koilonychias is a change in the shape and color of nails. Koilonychia actually affects the nail structure, making them too thin and fragile. They will progressively lose their density until they turn concave with the trademark spoon shape. The edges become detached and the entire nail can easily fall off if injured. The complete detachment of the nail can be a painful process. If the lower part of the nail starts to change its color, it can be a sign of infection.

The lack of iron can also have other consequences, especially in kids. They can have all of the signs of anemia, which usually causes severe weakness and a lack of energy.

Treatment options

People with a family history of koilonychias should be very careful and take preventive measures. Even if you don't suffer from the condition yet, prevention is important because you might share the family's faulty genes. One of the easiest things to do is to abandon habits such as biting your nails, which is one of the most common causes for this condition. A proper diet is also very important, you must make sure that it includes foods with a high content of iron. Protect your hands as best as you can and try to wear gloves when you work with any kind of chemicals.

A good supply of vitamins can counter koilonychias, so try to have a healthy diet with as many nutrients as possible. Since your kids might have inherited the disease, take care of their nutrition as well. If you notice any signs of the condition or if your kids have them, inform your doctor immediately. He can advise you on how to stop its progress.

Koilonychia can be a sign of severe disorders, which makes it even more important to seek medical advice. Your doctor will examine your spoon nails and many other indicators and determine if they are caused by a dangerous disease or not. In such cases, koilonychia is not the main problem and it's the root condition that must be treated immediately. In most patients, curing it will also correct the shape and structure of nails. Doctors can help you treat your nails, especially if you report the condition in an early stage of development. The nail can be softened using various emollients and it is also possible to apply an overlay to protect the entire area from shocks.

Koilonychia can sometimes be treated easily, by simply softening the skin with cosmetic lotions and creams. The most effective counter is to change your diet and include more foods that are rich in iron. Iron dietary supplements or special medication are also required in some cases. However, the balance of iron in the body is very delicate and not easy to achieve. Too much iron can be equally harmful as an insufficient supply. Doctors or specialist dieticians can estimate your iron needs and advise you on a proper diet that will supply the required amount.

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