From the Research
Koilonychia, a nail abnormality characterized by thin, spoon-shaped nails, is most commonly associated with iron deficiency anemia and should be treated by addressing the underlying cause, with oral iron supplements being a primary treatment option 1. The condition is frequently observed in chronic iron deficiency secondary to malnutrition, chronic blood loss, or malabsorption, and may also be idiopathic or related to occupation and rare systemic disorders 1. Some key points to consider in the diagnosis and treatment of koilonychia include:
- The presence of koilonychia should prompt investigations for iron deficiency 1
- Treatment primarily focuses on addressing the underlying cause, with oral iron supplements like ferrous sulfate, ferrous gluconate, or ferrous fumarate typically prescribed for 3-6 months to restore iron levels 2
- Patients should take iron supplements with vitamin C to enhance absorption and avoid taking them with calcium, coffee, tea, or antacids which can reduce absorption
- Patients should also consume iron-rich foods like red meat, spinach, and legumes
- If koilonychia is caused by trauma or chemical exposure, avoiding the triggering factors and protecting the nails is essential
- For fungal infections, antifungal medications may be necessary
- Improvement in nail appearance typically occurs gradually over several months as new, healthy nail grows out It is essential to note that nail conditions are not only aesthetic concerns, and nail changes may be a clue to an underlying systemic disease or infection 3. A thorough but reasonable search for a primary etiology should be made, and if a cause of koilonychia is found, it should be treated 4. However, when the physician becomes satisfied that no associated disorder exists, he should reassure the patient. The most recent and highest quality study 3 highlights the importance of a targeted treatment approach, including topical and/or systemic medications, discontinuation of offending drugs or surgical intervention, depending on the condition. Patient education on proper nail care and techniques to minimize further damage to the affected nails is also crucial. In terms of diagnosis, a detailed history and clinical examination of all 20 nail units, dermoscopy, diagnostic imaging, and histopathologic and mycological analyses may be necessary 3. Nail findings concerning for malignancy should be promptly referred to a dermatologist for evaluation and biopsy. Overall, the diagnosis and treatment of koilonychia require a comprehensive approach, taking into account the underlying cause and the patient's overall health.