Recognizing Nail Signs of Anorexia Nervosa: A Visual Guide to Early Detection and Treatment

Anorexia nervosa, often just called anorexia, is an eating disorder and serious mental health condition. People who have anorexia try to keep their weight as low as possible, and they might do this in different ways such as not eating enough food, exercising too much, taking laxatives, or making themselves sick. This can make them very ill because they start to starve. Men and women of any age can get anorexia, but it's most common in young women and typically starts in mid-teens.

Nail conditions are common in individuals with anorexia nervosa, primarily due to malnutrition and the body's response to starvation. While these conditions are not always present, there has been an association with six specific nail signs that we're going to cover here, including photos to help you recognize them.

The first nail sign is Beau's lines. These are horizontal depressions or grooves in the nail plate, visible as lines running across the nails. They are typically caused by a temporary interruption of nail growth due to severe illness, malnutrition, or stress. In anorexia, it could be due to a lack of dietary zinc. Treating these means addressing the underlying nutritional deficiencies and managing the anorexia. As the individual recovers and nail growth resumes, Beau's lines typically grow out and disappear.

The second nail sign is brittle nails, also known as onychorrhexis. This condition is characterized by increased fragility and a tendency for nails to split or break. Typically, nails appear dry, easily breakable, and may have vertical ridges. This is often a result of malnutrition, particularly deficiencies in vitamins and minerals like iron, biotin, and zinc. Nutritional rehabilitation is key here, along with possible supplementation of specific nutrients. Keeping nails trimmed and avoiding harsh chemicals can also help.

The third nail sign is koilonychia, also known as spoon nails. These are thin, concave nails that resemble the shape of a spoon. Koilonychia is commonly associated with iron deficiency anemia, which can be a complication of anorexia. Treatment involves iron supplementation, both in the form of medications and encouraging the consumption of iron-rich foods. Addressing overall nutritional deficiencies typically allows the nails to return to normal as iron levels are corrected. Examples of iron-rich foods include beans and lentils, dark chocolate, iron-rich fruits such as dates, figs, prunes, and raisins, leafy greens like spinach and kale, nuts, seeds, tofu, and meat like steak.

The fourth nail sign is leukonychia, which is a white discoloration with spots or streaks on the nails. In anorexia, this can happen due to zinc or selenium deficiency. The spots are usually harmless and grow out over time, and zinc supplementation might be helpful.

The fifth nail sign that can be seen is something called Terry's nails. This is where nails appear white with a narrow pink band at the tip. While it can be associated with aging, in the context of anorexia, it is often due to malnutrition and reduced blood flow. Resolving this involves treating the underlying anorexia and improving overall health and nutrition.

Finally, case reports in the scientific literature have highlighted nail clubbing in some individuals with anorexia. Finger clubbing is where there is enlargement of the fingertips and nails that curve around the fingertips. This process typically happens in five stages:

1. The nail bed becomes soft.
2. Changes occur in the angle of the nail fold, the skin beneath the cuticle that holds the nail in place.
3. The nail takes on a more obvious curve.
4. The end of the finger becomes thicker or club-like, thus giving it the name finger clubbing.
5. The nail takes on a shiny appearance.

There are many causes of fingernail clubbing, including heart and respiratory issues that are much more common than anorexia. However, when present in the case of anorexia, it might be linked to underlying heart or lung issues. Either way, if an individual with anorexia has finger clubbing, it requires a thorough medical evaluation to determine the exact underlying cause and appropriate treatment.

For all of these conditions, the primary approach is essentially to treat the underlying cause, which in this case is anorexia nervosa. This usually involves a multi-disciplinary team management plan that addresses both nutritional deficiencies as well as the psychological aspects of the eating disorder. Dermatological treatments for nails are often supportive and secondary to the overall management of the individual's health.

For more information on anorexia, including where you can get help, please see the description box of this video. If you found this content helpful and would like to support our mission or scale your medical brand on YouTube, consider booking a consultation or sponsoring our videos with your products. Thanks for watching, and until next time, take care.