The structure of human nails is altered by malnutrition. This impacts the nail’s physical characteristics. Patients who suffer from anorexia nervosa and bulimia nervosa are at increased risk for development of abnormal nails from both the dietary deficiency and compulsive actions associated with the eating disorder. Physical exam findings include linear patterns on the nail plate, such as those seen in Beau’s lines, Terry’s nails, and Muehrcke’s lines, as well as color changes seen in B12 deficiency and splinter hemorrhages. Nutrition is essential for the development of healthy nails, and nutrient deficiencies may lead to brittleness or koilonychia of the nail plate. Abuse of medications, such as anorectics, diuretics, and laxatives, produces nail changes that include digital clubbing. Those with eating disorders may also have onychophagia or onychotillomania as all are on the obsessive-compulsive spectrum. Successful nail treatment in patients with eating disorders is dependent on treating the eating disorder.
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