What Causes Koilonychia?
Koilonychia or spoon nails is a deformity of an individual's nails that causes them to take on the appearance of a concave and spoon-like shape. Koilonychia begins as nails that are flat on the surface and not rounded. This deformity is typically first noticed in an individual's fingernails rather than in their toenails. The nails become increasingly soft, and the indentation that develops in the middle is typically big enough to hold a bead of liquid. Koilonychia is more common in infants where it resolves on its own, but it can be indicative of a serious medical condition when it occurs in adults. The treatment for this nail dystrophy is dependent upon its underlying cause. If the condition is caused by genetic factors, it may not be able to be prevented. However, cases where an individual's koilonychia is caused by environmental and nutritional factors, it can typically be prevented or treated.
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Iron Deficiency
The most prevalent cause of koilonychia is a deficiency of iron in an affected individual's body. Iron deficiency occurs most commonly in children and childbearing-aged women. Any of numerous medical issues can cause an individual to develop an iron deficiency. This condition can be the result of an insufficient amount of iron in an individual's diet. A patient may not be able to properly absorb a sufficient amount of iron from the food they consume. Individuals who live in a region plagued with malnutrition and famine also develop iron deficiency easily. Any individual who experiences a bleed in their intestine may develop a deficiency in iron. Patients affected by and being treated for numerous types of cancer also tend to develop iron deficiency anemia. The exact mechanism of which a lack of iron causes the development of koilonychia is not clear, but it is known to be associated with iron deprivation to iron-containing enzymes in the patient's epithelial cells.
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Lichen Planus
Patients affected by lichen planus may develop koilonychia as a result of their chronic inflammatory skin condition. Lichen planus causes an affected individual to develop a non-infectious, itchy rash on the skin of their legs and arms. This rash is characterized by purple or pink bumps or lesions that are flat on top, small, and have multiple sides to them. Lichen planus most commonly manifests in individuals who have reached at least their third decade of life. Lichen planus can be caused by certain inherited genetic factors, but in most cases, the cause is idiopathic or unknown. Changes in the nails of which include koilonychia have been observed in approximately ten percent of patients affected by this inflammatory skin condition. The immune-mediated inflammation that occurs in individuals affected by lichen planus can cause their nail matrix to become permanently damaged or destroyed. This mechanism can result in the development of many dystrophies of the nails, including twenty-nail dystrophy of childhood and koilonychia.
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