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Nails, Horizontal Ridges (Beau’s Lines), Fragile

Beaus lines in thin nails (The tiny brown streak is a splinter hemorrhage.)
Beau”s lines in a thin nail. (The tiny brown streaks are splinter hemorrhages due to vitamin C deficiency.)

What Are Horizontal Ridges In Fragile Nails?

Horizontal ridges, also called “beau’s lines,” are abnormalities of the nail plate that appear as rumpling from the base to the tips of nails and are characterized by poor nail structure of both fingernails and toenails.

The nail plate is the hard keratin cover of the finger tip and toe tip which we ordinarily call “nails.” The nail plate is produced by the nail matrix. 

Q: Why do Beau’s lines develop in nails?

A: Beau’s lines occur due to temporary cessation of proliferation (growth) of proximal nail matrix at the nail base. As the finger nail grows at the rate of 0.1 mm/day, the time course of the illness can be estimated from the position of the Beau’s line from proximal nail fold.1

Nail Anatomy. Nail Anatomy. A. Nail plate; B. lunula; C. root; D. sinus; E. matrix; F. nail bed; G. hyponychium; H. free margin. Courtesy Wikipedia.org.

A. Nail plate; B. lunula; C. root; D. sinus; E. matrix; F. nail bed; G. hyponychium; H. free margin. Courtesy Wikipedia.

Beau’s lines are frequently seen in nutritional deficiency states, bacterial illness, acute stress, and systemic disease. The conditions where Beau’s lines have been described include severe systemic illness, chemotherapy, malnutrition, zinc deficiency, trauma, paronychia, pemphigus, and Kawasaki disease.2 Beau’s lines are commonly seen in patients undergoing chemotherapy.3

 This condition of nails was named after Joseph Honoré Simon Beau (1806-1865).

What Are Horizontal Nail Ridges In Celiac Disease and/or Gluten Sensitivity?

Sources:
  1. Naik GS1, Harikrishna J. Beau’s lines. Indian J Med Res. 2013 Jan;137(1):220. [↩]
  2. Naik GS1, Harikrishna J. Beau’s lines. Indian J Med Res. 2013 Jan;137(1):220. [↩]
  3. Patel LM, Lambert PJ, Gagna CE, Maghari A, Lambert WC. Cutaneous signs of systemic disease. Clin Dermatol. 2011 Sep-Oct;29(5):511-22. doi: 10.1016/j.clindermatol.2011.01.019. [↩]

Developmental Delay

developmental delay gluten celiac diseaseWhat Is Developmental Delay?

[dropcap]D[/dropcap]evelopmental delay is failure in infants and young children to meet expected milestones, such as smiling for the first time or taking the first steps, due to an impairment in physical, learning, language, or behavior areas.

These conditions begin during the developmental period, may impact day-to-day functioning, and usually last throughout a person’s lifetime.1

What Is Developmental Delay In Celiac Disease and/or Gluten Sensitivity?

Sources:
  1. Developmental Disabilities: Delivery of Medical Care for Children and Adults. I. Leslie Rubin and Allen C. Crocker. Philadelphia, Pa, Lea & Febiger, 1989. [↩]

Anxiety, Chronic

AnxietyWhat Is Anxiety?

[dropcap]A[/dropcap]nxiety or worry is a distressing emotional state of mind or mood that is characterized by a vague uneasiness, unpleasant feelings of apprehension or anticipation of danger and by interference with normal functioning, ranging from mild qualms and easy startling to occasional panic.

Q: What causes anxiety?

A: Anxiety can be a normal response to stress such as making an important decision, illness, divorce, problems at work or preparing for an exam.

In a dangerous situation, profound physiological changes rapidly prepare us for a “fight or flight” response by release of adrenalin hormone. Adrenalin speeds up metabolism to make available quick energy, tightens muscles in readiness, and speeds up the heartbeat and breathing so that more oxygen is made available to the brain and muscles.

Anxiety becomes a maladaptive disorder when it is excessive, unrealistic, or not provoked and impairs the ability to lead a normal life.

Anxiety that is part of a person’s personality is called “trait anxiety.” Anxiety that comes and goes is “state anxiety,” as in state of mind, and is usually due to unresolved stress or an underlying health problem.

What Is Chronic Anxiety in Celiac Disease?

Weight Loss, Unexpected/ Inability To Gain Weight

unexpected weight loss celiac disease symptomWhat Is Unexpected Weight Loss?

[dropcap]U[/dropcap]nexpected weight loss is unintentional loss of body mass composition or inability to gain weight marked by decreased serum proteins and increased stool fat.1

What Is Unexpected Weight Loss In Celiac Disease and/or Gluten Sensitivity?

Sources:
  1. Krause’s Food, Nutrition, & Diet Therapy. 10th Edition. Kathleen Mahan, Sylvia Escott-Stump. 2000. W.B. Saunders Company. [↩]

Attention Deficit Hyperactive Disorder (ADHD)

adhd-brain-maturation-dark-areasWhat Is Attention Deficit Hyperactive Disorder (ADHD)?

[dropcap]A[/dropcap]ttention deficit hyperactive disorder (ADHD) is a maladaptive behavioral disorder characterized by a persistent pattern of inattention and impulsivity, or both, that are developmentally (age) inappropriate. For these problems to be diagnosed as ADHD, they must be out of the normal range for a child’s age and development.

Inattention results from difficulty concentrating which gives the impression of not listening. The person’s speech or writing, such as when telling stories, can be disorganized.

Most children with ADHD also have at least one other developmental or behavioral problem. Depression, lack of sleep, learning disabilities, tic disorders, and behavior problems may be confused with, or appear with, ADHD. Every child suspected of having ADHD should be carefully examined by a doctor to rule out possible other conditions or reasons for the behavior.

An MRI (magnetic resonance imaging) study investigating whole-brain cortical thickness (outer layer of the brain) in male and female children, adolescents, and adults with ADHD supports the hypothesis that brain abnormalities in ADHD represent abnormal brain development rather than developmental delay.

Q: What is the abnormal development problem?

Drawing shows the 4 lobes of the human brain on the left side. The occipital lobe is pink. Courtesy Wikimedia
4 lobes of the human brain making up each hemisphere (side). In this drawing, the frontal is blue, the parietal is yellow, the temporal is green, and the occipital lobe is pink. Courtesy Wikimedia

A: Differences occur in the right side of the brain only. Reduced cortical thickness in people of all ages with ADHD was observed predominantly in the frontoparietal region (forehead and top). However, increased cortical thickness was observed predominantly in the occipital lobe (back). The brain thickness differences were correlated with severity of ADHD.1

ADHD is the most commonly diagnosed behavioral disorder of childhood. It affects about 3 – 5% of school aged children and is diagnosed much more often in boys than in girls.2

What Is ADHD In Celiac Disease and/or Gluten Sensitivity?

Sources:
  1. Almeida Montes LG, Prado Alcántara H, Martínez García RB, De La Torre LB, Avila Acosta D, Duarte MG. Brain cortical thickness in ADHD: age, sex, and clinical correlations. J Atten Disord. 2013 Nov;17(8):641-54. doi: 10.1177/1087054711434351. [↩]
  2. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002518/ [↩]

Delayed Puberty in Boys

Preteen boy with spiked blond hairWhat Is Delayed Puberty in Boys?

[dropcap]D[/dropcap]elayed puberty in boys is characterized by lack of growth and functional activity of the male gonads, called testes or testicals, to produce testosterone by age 14 and failure to grow pubic hair by age 15. Later changes affected are deepening of voice and increase in musculature.

Puberty is the life period when a boy grows into a man and begins with an increase in testicular volume.1

Q: What is an increase in testicular volume?

A: Testes are male reproductive glands that produce reproductive cells called spermatozoa. Spermatozoa first become detectable in specimens of boys’ spontaneously produced morning urine at a mean age of 13.4 years (spermarche). As the testes become larger in the ensuing years, the maturation of spermatogenesis is completed.2

Delayed puberty may be due to excessive exercising, malnutrition, chronic disease, obesity, genetic disorders, chromosomal abnormalities, or tumors that damage the pituitary gland. The pituitary normally secretes gonadotropin stimulating hormone (GSH) telling the gonads to produce testosterone and inhibitin, or the hypothalamus, which tells the pituitary gland to release GSH.

Who is Affected in the General Population?

Delayed puberty occurs in approximately 3% of children.1

What Is Delayed Puberty In Boys In Celiac Disease and/or Gluten Sensitivity?

Sources:
  1. Brämswig J, Dübbers A. Disorders of pubertal development. Dtsch Arztebl Int. 2009 Apr;106(17):295-303; quiz 304. doi: 10.3238/arztebl.2009.0295. [↩] [↩]
  2. Brämswig J, Dübbers A. Disorders of pubertal development. Dtsch Arztebl Int. 2009 Apr;106(17):295-303; quiz 304. doi: 10.3238/arztebl.2009.0295. [↩]

Failure To Thrive And Growth Retardation

failure to thrive babyWhat Is Failure To Thrive And Growth Retardation?

[dropcap]F[/dropcap]ailure to thrive (FTT) and growth retardation are conditions affecting children characterized by weight consistently below the 3rd percentile for age or a decrease in the expected rate of growth based on the child’s previously defined growth curve, irrespective of whether below the 3rd parcentile.1

Q: Why do failure to thrive and growth retardation occur?

A: Failure to thrive and growth retardation occur because there is inadequate nutrition for weight gain and growth to occur.

What Is Failure To Thrive And Growth Retardation In Celiac Disease and/or Gluten Sensitivity?

Sources:
  1. Arnason JA, Gudjonsson H, Freysdottir J, Jonsdottir I, Valdimarsson H. Do adults with high gliadin antibody concentrations have subclinical gluten intolerance? Gut. 1992 February; 33(2): 194–197. [↩]

Delayed Puberty In Girls 

istock-photo-17167090-female-portraitWhat Is Delayed Puberty In Girls?

[dropcap]D[/dropcap]elayed puberty in girls is a concerning condition characterized by decreased functional activity of the ovaries resulting in late onset of ovulation and secondary sex characteristics.

Q: When should puberty in girls begin?

A: Puberty in girls is a stage of reproductive development that occurs at the average age of 12.1 years (between the ages of 9 and 15 years) and ends in sexual maturity.

Secondary sex characteristics are breast development and appearance of pubic hair that is followed by underarm hair and white vaginal secretion. The first menstrual period (menarche) follows this sequence.

What Is Delayed Puberty in Girls In Celiac Disease and/or Gluten Sensitivity?