Not being able to see a half-moon, or lunula, on the nails may be a sign of a vitamin deficiency, vitiligo, kidney failure, or another health condition, some of which can be serious.
Nails grow from a pocket under the skin that doctors call the matrix. The matrix helps make new cells. These cells then come together and push out of the skin. The lunula, or lunulae in the plural, is the visible portion of the matrix, although it may sometimes be hard to see.
Some people only notice a lunula on their thumbs. Skin color and other factors may make the lunulae more or less visible.
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Because the lunula comprises the newest portion of the nail, it can provide clues about a person’s health. The absence of lunulae does not always indicate a serious health problem, but it is a good idea to discuss the issue with a doctor.
Malnourishment due to extreme diets, medical conditions that affect the body’s ability to absorb nutrients, and eating disorders can cause changes in the nails.
Blood tests can detect many vitamin and mineral deficiencies. A doctor can help a person determine what deficiencies they are most vulnerable to, depending on diet, lifestyle, health, and other factors.
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Vitiligo is a chronic skin condition that causes the skin to lose color, usually in patches. This happens when the body attacks melanocytes, the skin cells that give the skin its color.
Some people with vitiligo may develop nail changes, including a loss of lunulae. A 2016 study of 100 people with vitiligo and 100 people without it found that nail changes were common with the disorder. However, 13 of those without vitiligo and 13 with vitiligo had no lunulae, suggesting that absence of lunulae may be equally frequent in both groups.
People with vitiligo may develop other disorders, such as thyroid disease, and they are more vulnerable to sunburns and other sun-related skin conditions. It is, therefore, important to seek medical care.
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It happens when the red blood cells that carry iron-rich hemoglobin do not work correctly or when the body does not produce enough red blood cells. This causes an oxygen deficiency that can result in paleness, including paleness that makes the lunulae invisible.
Iron deficiency is the most common cause of anemia, usually occurring when a person has either lost blood, such as following a hemorrhage or giving birth.
A deficiency can also happen when the body does not properly absorb iron, or a person does not consume enough iron-rich foods.
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Doctors think this is because of anemia due to kidney failure. Kidney failure is not the only potential cause of anemia, or the most common. Therefore, it is important for people who think they might be anemic to see a doctor.
A person with kidney failure may also notice a brown band at the tip of the finger, at the point where the white tip connects to the nail bed.
The nails may also change shape or texture, and a person may develop additional symptoms, such as shortness of breath, coughing, or chest pain.
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That scars and damages the liver, affecting liver function. People with diabetes, those who drink excess alcohol, males, and people over 50 years of age are more vulnerable to cirrhosis.
, which is a type of poisoning caused by excess silver exposure. People exposed to chemicals at work or to toxic chemical dust may develop argyria.
The nails may also curve, and the cuticle, which is the small piece of skin at the beginning of the nail, may change shape or disappear. The most common cause is pleural effusion, which happens when fluid accumulates in the pleura, or the thin tissues that line the lungs and chest.
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Nevertheless, it is a good idea to see a doctor to rule out possible medical conditions. This is because sometimes the disappearance of the lunulae is an early warning sign of dangerous conditions, for example, silver poisoning.
When a person has other symptoms, such as difficulty breathing, chest pain, a fever, or unusual swelling, the disappearance of the lunulae could signal a life-threatening health problem. In these cases, people should see a doctor immediately.
The nails reveal information about blood circulation, nutrition status, and how well various organs in the body are working. They act as an early alarm, warning of potential medical issues. In most cases, the absence or disappearance of the lunulae points only to a minor nutritional deficiency. Sometimes, however, the cause is more serious.
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Seeking medical attention for any changes in the nails or skin can help a doctor detect serious medical conditions, as early as possible, enabling prompt treatment.
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Nails also have an important clinical relevance, and healthcare professionals use them to assess the health of patients. For example, nurses may perform something called a capillary refill test by pressing on the nail plate, which temporarily blanches the underlying tissue. The nurse then releases the nail plate and observes the time it takes for blood flow to return to the nail bed, which can help assess for things such as dehydration or proper blow flow in the extremities.
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The free edge is the distal-most part of the nail that you have to trim with fingernail clippers. It often has a white appearance as it grows out, because this part of the nail is no longer attached to the underlying nail bed, which is what gives the nail body its pinkish color.
The nail body (or nail plate) makes up the hard, visible portion of the fingernail that attaches to the underlying epidermis. It is made of rows of dead keratinocytes that are translucent, allowing the color of the underlying tissue, which is rich in vessels, to show through.
The plate itself can be divided into three main layers: a dorsal layer (top), an intermediate layer (middle), and a ventral layer (bottom).
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The germinal matrix (or simply “nail matrix“) is under the skin and originates behind (proximal to) the nail’s root. The germinal matrix causes most of the nail’s growth by creating new cells that migrate forward. These cells eventually flatten and lose their nuclei in the process. This germinal matrix can extend all the way to the proximal part of the nail’s body and and is sometimes visible as the lunula.
The lunula’s name means “little moon” (think lunula = lunar), and this is actually the distal end of the germinal matrix, which is not translucent like the nail’s body, so it has a different color. The lunula tends to be most visible on the thumb (pollex) or big toe (hallux). However, on other digits, the lunula may or may not be visible.
On my hand, the lunula is only visible on digits 1-3, but some people have them visible on all five digits of each hand or foot (or even none at all), which can be normal. However, the lunulae (plural) may also disappear from your digits entirely if you have an underlying disease or experience organ failure, such as kidney failure. [1]
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The nail bed (or sterile matrix) is the area found between the lunula of the nail matrix and the hyponychium, and this tissue allows for the attachment of the nail body (plate). The dermis and epidermis of the nail bed often form into longitudinal ridges, and sometimes you can see small vertical ridges on the nail plate itself. These ridges can be normal. However, deeper ridges or horizontal ridges in the nails could indicate an underlying health issue.
Note: In some texts, the proximal fold may be considered the same as the eponychium, and the lateral fold may be referred to as the paronychium. See below for details of the eponychium and paronychium.
Finally, we have special tissues around the nail folds that help seal and protect the nail plate. These words all end in “nychium, ” which means “little claw, ” referring to the nail itself. The prefix for each word tells you where these tissues are located in relation to the nail.
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The hyponychium is the epithelial tissue just under the free edge of the nail and distal to the nail bed. Remember, the prefix “hypo” means “under”, so it’s under the “little claw.” The hyponychium is rich in white blood cells and forms a seal between the nail plate and nail bed to defend against germs. The onychodermal band is present where the hyponychium joins the nail bed.
The eponychium is the thin layer of tissue on the
