01) and suggested collagen abnormality as the cause of these changes in nail bed, bone, and skin.
GRAYISH PURPLE NAILS SKIN
1 One study found that osteoporosis and thin skin were significantly associated with this peculiar nail alteration ( P <. A peculiar discoloration observed in around one-fifth of people older than 70 years of age is “Neapolitan nail,” which is characterized by an absent lunula in addition to 3 horizontal bands of white (proximal), pink (middle), and opaque (distal) discolorations. 1, 2 Among nail plate colour changes in elderly people, the most commonly observed alteration is a yellow to gray discoloration with dull, pale, or opaque appearance. 1, 2 As for texture, there is usually a tendency of the normally smooth nail plate texture to become progressively more friable with increasing age, resulting in fissuring, splitting, and longitudinal superficial or deep striations. 1, 2 A decrease in the longitudinal curvature and an increase in the transverse convexity characterize senile changes in the contour of the nail plate. With advancing age, various changes in nail plate thickness might occur, becoming thicker, thinner, or remaining the same. 1, 2 Men generally have thicker nail plates than women do the normal average thickness of fingernails and toenails is 0.5 and 1.38 mm in women and 0.6 and 1.65 mm in men, respectively. 1, 2Īge-related changes in the morphology of the nail plate include alterations in its thickness, contour, surface, and colour. With advancing age, starting at the age of 25 years, this rate tends to decrease by approximately 0.5% per year. Nail plate growth rates of fingernails and toenails normally average 3.0 and 1.0 mm/mo, respectively.
1, 2 The underlying mechanisms for these changes are still not completely understood but might be related to dysfunctional blood circulation at the distal extremities or to the effects of ultraviolet radiation.
With advancing age, normal characteristic changes in the growth rate and morphology of the nail plate occur. A primary care physician who is knowledgable about and familiar with these age-related nail alterations and disorders will be able to recognize and manage common pathologic changes, as well as refer patients for more specialized care, if needed. These nail changes can either cause serious symptoms, impairing the daily activities of this older population whose activities might already be restricted, or be asymptomatic but associated with substantial cosmetic problems, leading to negative psychological effects. 1, 2 These factors can affect primarily the nail plate or involve other components of the nail unit such as the matrix, nail bed, hyponychium, or nail folds ( Figure 1), with secondary abnormalities in the nail plate. Secondary factors are important contributors to pathologic nail changes, including impaired circulation at the distal extremities, faulty biomechanics, infections, neoplasms, and skin or systemic diseases with nail manifestations. Older people are at an increased risk of nail alterations, including normal age-related changes and disorders that more commonly affect this specific population.
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