Koilonychia

Defination:

Spoon nails (koilonychia) are soft nails that look scooped out. The depression usually is large enough to hold a drop of liquid. Often, spoon nails are a sign of iron deficiency anemia or a liver condition known as hemochromatosis, in which your body absorbs too much iron from the food you eat.

Instructions by the examiner:

• Perform the general examination.
•  Look at the nail. What is your diagnosis?

causes of koilonychia:

1. Iron deficiency anaemia (commonest cause).

2. Others (rare, better do not mention until asked):

• Trauma (rarely in garage mechanics, who regularly fit tyres).
• Thyrotoxicosis.
•  Fungal infection.
• Raynaud’s disease.

Mechanism of koilonychia:

• It is characterized by concave or spoon shaped nail. Mechanism is unknown, probably due to slow growth of nail plate.

stages of koilonychia:

•  Stage 1—Dryness, brittleness and ridging.
• Stage 2—Flattening and thinning.
• Stage 3—Spooning or concavity.

Plummer–Vinson syndrome: 

It is the combination of:

• Iron deficiency anaemia.
• Dysphagia (due to post-cricoid web secondary to epithelial degeneration).
• Glossitis.

It is also called Paterson–Brown–Kelly syndrome. Common in women, cause is unknown.

There is constriction in upper oesophageal sphincter in the post-cricoid region and appears radiologically

as a web, which may be asymptomatic or may cause dysphagia. Difficult to see endoscopically.

Rarely, there is increased risk of squamous cell carcinoma.

Treatment

•  If severe anaemia, blood transfusion should be given.
•  Iron therapy.
• Rarely, dilatation may be required.