What Causes Weak Nail Folds When Diagnosed With Down Syndrome?

Posted on Tue, 20 Dec 2016

Question: My 27 year old son with Down Syndrome presents with painful, weakened hands and dark brown nail folds. His palms are hyperlinear and somewhat dry.

Answered by Dr. Diptanshu Das (6 hours later)

Brief Answer:
Management is supportive.

Detailed Answer:
Thanks for asking on HealthcareMagic.

I have gone carefully through the details and understand your concern. Down syndrome has multisystemic presentation. I need to ask you why you infer the hands to be weakened. I would be glad if you could elaborate on the same. The weakness could be due to low thyroid levels which could often be found in Down. The brown nail folds are normal and acceptable and are not a cause for concern. The palms being hyperlinear is something that is present since birth. There is nothing you can do about it (I do not suppose that cosmetic surgery would be a good idea). The dryness of hands could be due to less sweat glands in the skin or could be due to thyroid problems.

I would insist you to give him methylcobalamine (a form of B vitamin) supplements once daily. Also give him juicy fruits like citrus fruits (contain potassium) and it

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Diptanshu Das (3 days later)

Thank you! He hands may not be weakened but they seem to be very sore. I believe his hands hurt as he carries a small block of medium-firm memory foam and presses his fingers into it constantly. This apparently causes the fingers to blanch and flush - bring some kind of relief? He wears mittens, rather snug, before holding anything like a fork or spoon and will not carry anything in his hands - a glass, a cell phone, a cup of water etc. To carry, he squeezes the item between his inner arm and body - almost under his armpit. He does take 2 Thorne Brand methylcobalamine daily and is on cynoplus and cynomel for his thyroid. The hyperlinear isn't just the deep folds across his hands but a tight crisscross pattern especially on the palm near the thumb - not so obvious unless you look closely. He often blows on his fingertips. Please, please tell all that you can. Thank you soooooo much. Respectfully, XXXXXXX XXXX

Answered by Dr. Diptanshu Das (12 hours later)

Brief Answer:
Low muscle tone as well as sensory abnormalities may be present

Detailed Answer:
Thanks for writing back. Generally the muscle tone is low in individuals with Down syndrome. The foam ball may give him a mental satisfaction as the tone increases when he contracts his hand muscles to grip the foam, but I doubt if it is of any actual help. There can be some sensory abnormalities as well. The alteration in sensation may see some relief when he blows on his fingertips. For the rest, a clinical examination is needed but unfortunately that is beyond the scope.

Regards

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Above answer was peer-reviewed by : Dr. REMY KOSHY