From the Guidelines
Iron deficiency anemia is most commonly associated with koilonychia, or spoon-shaped nails. This condition presents as thin nails with a concave depression in the center, giving them a spoon-like appearance. When iron levels in the body are depleted, nail formation is affected, leading to this characteristic change in nail structure, as noted in the British Society of Gastroenterology guidelines for the management of iron deficiency anaemia in adults 1. According to these guidelines, iron deficiency can lead to various symptoms, including angular stomatitis, glossitis, koilonychia, restless legs syndrome, pagophagia, and blue sclerae.
Key points to consider in the diagnosis and management of koilonychia include:
- Investigating iron deficiency anemia as the primary cause
- Looking for a personal or family background of GI disease that may provide a clue as to the cause of IDA, as suggested by the guidelines 1
- Considering treatment with oral iron supplements to address the underlying iron deficiency
- Being aware of potential gastrointestinal side effects of iron supplements, such as constipation or dark stools
It's essential to prioritize iron deficiency anemia as the most common cause of koilonychia, given the strong association supported by recent clinical guidelines 1. Other less common causes, such as hemochromatosis, Raynaud's disease, trauma, and certain occupational exposures, should also be considered but are less likely to be the primary cause.
From the Research
Koilonychia Association
- Koilonychia, also known as spoon-shaped nails, is most commonly associated with iron deficiency 2, 3, 4, 5.
- Iron deficiency can be caused by various factors such as malnutrition, chronic blood loss, or malabsorption 2.
- Koilonychia can also be idiopathic or related to occupation and rare systemic disorders 2.
- Other possible causes of koilonychia include psoriasis, fungus, or trauma 6.
- The presence of koilonychia should prompt investigations for iron deficiency 2.
Systemic Diseases
- Koilonychia may be a clue to underlying systemic diseases such as anemia, hemochromatosis, or connective tissue disorders 3, 5.
- It is essential to conduct a thorough but reasonable search for a primary etiology when koilonychia is present 6.
- In some cases, koilonychia may be completely idiopathic and of no consequence to the patient 6.