An insurance agent by day, and a high-action casino dealer at Las Vegas' MGM Grand Casino by night, Sandra Yep-Lebeck, 44, knew that her immaculately manicured nails were an integral part of her image. Yet, despite her glamorous exterior, Lebeck was sick, evidence of which lay concealed beneath those perfectly polished nails.
During a weekly manicure appointment, Lebeck's nail technician commented on her brittle nails and the separation of the nail bed from her skin, medically referred to as "Plummer's nail".
"I decided to use acrylic nails to prevent the green felt at the casino from getting trapped under my nails, and to hide my nail problems from my insurance clients," recalls Lebeck, who now lives in Hong Kong. As her nail condition worsened, she became increasingly sensitive to heat, her neck began to bulge and she experienced hair loss.
In 2000, Lebeck was diagnosed with Graves' disease, an autoimmune disorder that leads to an overproduction of thyroid hormones - hyperthyroidism. While symptoms can include enlargement of the thyroid gland (goiter), weight loss and frequent bowel movements, it was Lebeck's nails that first indicated an underlying health condition.
"Nails and surrounding tissue can tell you a lot about a person's health," explains Alexandra Duff, podiatrist at PhysioMotion in Central. "Our nails are made of keratin, a hardened protein. Like hair, when you are healthy your nails look good but when unwell, they become brittle and damaged."
Duff checks for changes in her patients' nail shape, contour, texture and colour at every consultation. Discolouration under the nail can indicate rheumatoid arthritis, bacterial infections, tumours, Reiter's syndrome (a form of arthritis), liver cirrhosis, or malignant melanoma, a deadly form of skin cancer, she says. While discolouration of the nail plate may simply be caused by nicotine stains or excessive use of nail varnish, it can also indicate fungal or bacterial infection, ulceration, Darier's disease (a rare inherited skin condition), lymphoedema (swelling of body parts due to excess accumulation of protein-rich fluid) and nutritional deficiencies.
As a photographer Sara Young, 35, relies on her hands. Yet, she recalls a time when she hesitated to pick up her camera and draw attention to her hands and nails.
