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Dr Roger Henderson
Reviewed by Roger HendersonReviewed on 29.04.2024 | 4 minutes read

If your nails turn up at the sides, in the shape of a spoon, this is known as koilonychia. It may be something that runs in your family, but it can also point to a medical condition. Iron deficiency anaemia is the most common of these, so it’s worth getting a blood test to check, or topping up your iron levels with supplements to see if this improves your nail condition.

Other more unusual medical conditions can occasionally cause koilonychia, so if you have any other symptoms or concerns, you can discuss this with your doctor.

Signs of Koilonychia

Spoon shaped nails are not caused by an infection, therefore they are not contagious. The key distinguishing factors between a nail infection and koilonychia is:

  • Texture - nail infections often result in thickening and brittleness, while koilonychia is characterised by a concave or spoon-shaped appearance.

  • Colour changes - discolouration is a common feature of nail infections, while koilonychia may present with changes in colour along with the spoon-shaped deformity.

  • Underlying infection - nail infections can be caused by various pathogens, whereas koilonychia is often associated with iron deficiency anaemia or other systemic conditions.

What causes Koilonychia?

Koilonychia, also known as spoon nails, is a nail disorder characterised by nails that are concave or scooped out, resembling a spoon. Several factors can contribute to the development of koilonychia. Here's a detailed yet easy-to-understand explanation:

Iron Deficiency

One of the primary causes of koilonychia is iron deficiency anaemia. When the body lacks sufficient iron, it affects the production of haemoglobin, the protein responsible for carrying oxygen in the blood. This deficiency can impact the nail matrix, leading to the characteristic spoon-shaped deformity.

Trauma to the Nail

Physical trauma or injury to the nail matrix can result in koilonychia. This trauma can disrupt the normal growth pattern of the nail, causing it to flatten and then curve upwards at the edges, creating a spoon-like appearance.

Systemic Diseases

Certain systemic diseases, such as hemochromatosis (an iron overload disorder) and hypothyroidism, can be associated with koilonychia. These conditions can affect the overall health of the nails and lead to changes in their structure.

Nutritional Deficiencies

Besides iron deficiency, other nutritional deficiencies, such as insufficient levels of vitamin B12 or folate, can contribute to koilonychia. These vitamins play a crucial role in nail health, and their deficiency can lead to abnormalities in nail structure.

Occupational Exposure

Prolonged exposure to certain chemicals and environmental factors in certain occupations, like those involving constant contact with solvents or petroleum-based products, may contribute to the development of koilonychia.

Genetic Factors

While less common, some cases of koilonychia may have a genetic predisposition. Certain individuals may be more susceptible to developing this condition due to their genetic makeup.

Fungal Infections

Chronic fungal infections of the nails, such as onychomycosis, can alter the normal growth of nails and contribute to the development of koilonychia.

It's essential to note that koilonychia can be a symptom of an underlying health issue, and its identification should prompt a thorough evaluation by a healthcare professional.

My child has a spoon shaped nail

It’s worth mentioning that children often have spoon-shaped nails, especially the big toes, and this doesn't usually mean anything is wrong – it is normal for them and they will most likely grow out of it.

Treatments for Koilonychia

Iron tablets are available at the pharmacy; however, your pharmacist would generally want to ensure that you are having regular blood tests to monitor your iron levels. This is because the tablet available at the pharmacy would generally contain a much higher amount of iron than what is generally available on the supermarket shelf since they only contain the recommended daily amount. Ferrous fumurate or ferrous sulphate tablets are most commonly recommended in anaemic patients.

It is best to speak to your doctor to arrange a blood test for your iron levels before commencing on iron therapy, and then arrange another after a couple of months to see if your iron levels have come back to a normal range. This can also be arranged privately if seeing your usual doctor is tricky with your lifestyle.

Top tip for when taking iron supplements is to take them with orange or acidic drinks - this improves the absorption of the iron into the bloodstream.

Once in a normal range, you can continue with a general iron supplement such as 'Feroglobin' or similar, in addition to your balanced diet, which should contain plenty of green leafy vegetables such as spinach, kale, peas, broccoli, lean red meat, poultry, eggs, fish such as salmon, mackerel or tuna, as well as beans and lentils to name a just a few.

Am I fit for work?

Yes, you are fit for work if you have koilonychia.

When should I see my doctor?

It’s worth booking a routine appointment with your doctor, who will ask you questions about your health and examine you. They may decide to send you for a blood test to check iron levels and any other relevant tests.

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Dr Roger Henderson
Reviewed by Roger Henderson
Reviewed on 29.04.2024
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