It’s not a coincidence that at medical school, when student doctors are first taught how to examine patients, they are always told to start by looking at the hands. They can reveal a lot about your health. Read on to discover the warning signs for disease, just a fingertip away.
Each hand consists of bone, nerves, blood vessels, connective tissue, and skin. Under each fingernail, the nail bed contains a capillary network. Healthy nails look pink as they are near the skin surface and you can see the red oxygenated blood within these capillaries. If your oxygen stores are depleted, for example, in chronic lung or heart disease, your fingers become blue—and this is called cyanosis.
Examples of medical conditions which cause peripheral cyanosis include: Chronic Obstructive Pulmonary Disease (COPD), asthma, congenital heart disease, pulmonary embolism and heart failure. Abnormal haemoglobin, such as carbon monoxide poisoning, is also a cause of cyanosis.
You’ll notice if you’re ever a patient at the hospital, you have to take your nail polish off. This is why.
A tremor in both hands can be a sign of anxiety, alcohol withdrawal or too much caffeine. Other examples include Parkinson’s Disease—typically a “pill-rolling tremor”—or an overactive thyroid gland. Sometimes a tremor can be caused by antipsychotic medication used to treat schizophrenia or bipolar disorder. A “liver flap” is a sign of serious liver failure.
A tremor in one hand could be due to a neuromuscular weakness such as a stroke, or rarely, a brain tumor.
You may notice looking at the color of the skin on the hands, that it is yellowed. In fact, the skin all over the body may be yellow, even the whites of the eyes. This is jaundice and is a sign of liver, gall bladder or pancreatic disease.
Cold, pale, puffy hands may be a sign of an underactive thyroid gland.
Anemia may also cause the palmar skin creases to look pale, instead of pink.
Liver disease causes bright red palms—”liver palms.”
If the skin is reddened, and has characteristic features such as thickening and fissures, this may be eczema or contact dermatitis—sometimes due to occupational exposure to allergens.
- A common problem is nickel allergy—nickel being a common ingredient of jewellery, watches, coins, cosmetics and so on. Nickel is also frequently present in food and drink such as black tea, soya milk, chocolate, nuts and seeds. This is a common cause for contact dermatitis.
- Psoriasis – often pustular, is an alternative inflammatory skin condition affecting the hands. There may be blisters on the palms, and the skin may swell and crack.
- Scabies is a mite which lives under the skin and causes intense itching. The mite tends to live in the webs between the fingers and burrows under the skin to lay eggs. It has the appearance of tiny red spots, which get scratched and can be secondarily infected. can be a tricky diagnosis to make and needs careful treatment.
Arthritis affects the joints of each finger, the thumbs and the wrists. These may appear red, swollen and may be tender to touch. Rheumatoid and osteoarthritis have different characteristic features.
Rheumatoid arthritis causes the fingers of each hand to splay out in an ulnar distribution. The tendons become inflamed, and there are painful synovial cysts which can rupture. The fingers become overextended at the joints and become misaligned. Typically the distal finger joints are spared. Rheumatoid arthritis is also associated with Sjogren’s syndrome, a condition in which sufferers have dry eyes and a dry mouth.
Osteoarthritis causes hard bony lumps at the distal and middle finger joints. Those of the distal joints are called Heberden’s nodes. In fact, osteoarthritis can affect any joints of the body.
Gout can result in acute, painful swelling of one or more joints of the fingers. Gout is a condition in which your body either produces too much or can’t break down uric acid. As a result, uric acid crystals are deposited in the joints. Sometimes these look like hard, white lumps called tophi.
Cholesterol deposits may occur around the knuckles—called tendon xanthoma. These are a sign of familial hypercholesterolemia, a condition affecting 1 in 500 of the population.
Dupuytren’s contracture is a condition in which connective tissue in the palm of the hand becomes thickened. The tendons become shortened, pulling the 4th and 5th fingers of the hand inwards so they are fixed in a resting position, partially flexed. It means you are unable to fully straighten your fingers and can become very disabling.
Trigger finger occurs when a tendon in the finger or thumb, becomes inflamed (tenosynovitis) and cannot function properly. You can bend the finger, but you cannot straighten it again without manually putting the finger back in place. Sometimes it may “pop” when you try to bend or straighten it.
Carpal tunnel syndrome is a common condition in which the median nerve becomes compressed as it passes from the forearm through the carpal tunnel and into the hand. You may get numbness and tingling in the thumb and index fingers, and over time muscle wasting and weakness. Carpal tunnel syndrome is associated with diabetes, rheumatoid arthritis and thyroid disease. It may be a problem in pregnancy.
Anaemia may cause nails to be brittle or even spoon-shaped—koilonychia. This can be a sign of celiac disease, diabetes, vitamin B12 deficiency or haemochromatosis (a condition in which your body iron stores are too high).
Diabetics may have a condition known as cheiroarthropathy. In this condition hands and fingers are stiff. If you put your two palms together and straighten your fingers as much as possible, you will not be able to touch the full length of each finger together.
“Half and half” nails are a rare but pathognomonic sign of kidney failure. When they occur the proximal part of the nail near the nail bed is pale or white, and the distal part of the nail is brown.
Raynaud’s Disease occurs when the blood vessels in your fingers or toes suddenly become constricted. As a result, there is a reduced blood supply to the fingers or toes. They may turn white, then blue, and it can be painful. The fingers or toes feel very cold. If the area is warmed, the fingers and toes will then flush red as the blood supply returns.
An overactive thyroid may cause hot sweaty palms.
Acromegaly is a condition in which your body produces too much growth hormone. People with acromegaly may have extra-large hands and feet.
Bitten nails—the medical term is onychophagia—may be a sign of anxiety. They may have deep-seated roots including separation anxiety, stress, or Attention Deficit Disorder (ADHD).
Deliberate self-harm—this may be apparent if you look at the wrists and see scars from attempts to cut the wrists. This may represent depression and/or true suicidal intentions.
Around 80% of people with psoriasis, find the disease affects their fingernails. (Sometimes, it is only the nails which are affected.) The nails appear crumbly, thickened, discolored and have small dents or “pits” within them. Sometimes they lift off the nail bed—onycholysis.
Fungal nail infections can occur on the hands, although they are more common on the feet. They are commonly caused by a dermatophyte infection with the organism tinea unguium, but also sometimes by other yeasts or fungi. The nails look discolored and there is thickening and lifting of the distal portion of the nail. This can also occur if someone is immune-suppressed—for example, if they are on chemotherapy, or have diabetes.
Small hemorrhages may occur in the nails called splinter hemorrhages. These may be a sign of psoriasis, lichen planus or are sometimes drug-induced. They can also reflect subacute bacterial endocarditis – a bacterial infection of the heart muscle.
The skin cancer melanoma can develop under a fingernail. It is a black or brownish streak developing in the nail bed. It is usually just one nail affected. The overlying mail may appear brittle, with lifting of the nail off the nail bed. This is an emergency and must be referred immediately to a dermatologist.
Clubbing is a condition in which the nails grow right around the fingertip to give it a bulbous appearance. This is seen most commonly in people with chronic lung disease, and congenital heart disease, TB or lung cancer.
One of the first things to notice when examining hands is that they give us an indication of your age. As you age, the skin on the back of your hands gets thinner and the veins become more prominent. Sometimes people get brownish patches of discoloration called age spots. As for yourself: To get through this pandemic at your healthiest, don’t miss these 35 Places You’re Most Likely to Catch COVID.
Dr. Lee is a physician at Dr Fox Online.