February 5, 2023

For the past few weeks, I’ve noticed my fingernails curling up. Then, they break off. Could this be ‘spoon nails’?

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Your description is very similar to that of spoon nails (also known medically under the name koilonychia).

This is the area where you will see a depression in your nails. It is usually large enough to hold water droplets.

Koilonychia could be due to a number of different causes. It would be wise to conduct further investigation to determine the exact cause.

This can sometimes be caused by a vitamin B deficiency. But more often it is an indication of iron deficiency. (Where your body doesn’t produce enough red blood cell due to a deficiency of iron). This can affect the health and beauty of the nails.

You mention in your longer letter that you’re taking warfarin as a treatment for your atrial fibrillation (an irregular heartbeat) and if low iron is the cause of your spoon nail, it may be linked to this condition.

Your description matches the spoon nail, also known as koilonychia. This is where you’ll find a depression. The depression is large enough that it can hold a droplet water. [File photo]

Warfarin reduces the ability of blood to form clots — which is a good thing in terms of preventing a heart attack or stroke — but the downside is that even an insignificant injury may then lead to minimal but persistent blood loss, which you might not be aware of.

This is most likely to occur in the stomach lining. It is susceptible to inflammation called gastritis. Warfarin can make it worse by causing the lining to leak.

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I recommend you visit your GP, who may refer you to blood tests.

An endoscopy is a procedure that involves the passing of a small camera through your mouth. This allows your doctor to examine your digestive system. If you are clear, your doctor may send you for a colonoscopy. This is a procedure that checks for changes in the bowel and can detect any potential infections (diverticulae).

These, too, can be the source of small, but regular blood loss — which again, amplified by warfarin, could lead to anaemia.

This might sound alarming but I must assure you that if either of these suggestions proves to be the underlying cause, the treatment needed will be minimal — antibiotics and dietary advice in the case of diverticulosis or antacid treatment if it is gastritis.

A sensible option is to consume a 200mg daily amount of iron supplement, such as ferrous sulfurate. Don’t worry.

Itchy scalp has plagued me for years. Although I tried many shampoos, and Synalar gel once a week when it gets severe, the problem still persists. What other options are there?

Anthony Bond, Cornwall.

It sounds like a very difficult problem, and you’ve certainly done everything possible to solve it.

In your longer letter you state that you have tried special shampoos such as Selsun and Nizoral, but with no success.

My suspicion is that your skin may be sensitive to the sulphur compound found in most shampoos. These compounds will be listed as sulphides or sulphates in the ingredients. They are also present in many, if not all of the shampoos you have tried. Shampoos are often incorporated with sulphates because they are powerful detergents that remove oil from hair and scalp.

Itching can occur in certain people.

Selsun’s sulfur and Nizoral sulphates, for example, reduce yeasts in the skin of the scalp. It is believed that scalp itching and dandruff are caused by the presence fungus.

Ask your pharmacist about a shampoo without sulphur. The Betacap and Synalar, which contain corticosteroids that suppress inflammation, can be used to treat your hair.

My theory holds that these devices were ineffective because they did not work against continued sulphur-exposure.

Use your new sulphur free shampoo as usual. I hope that your itching will subside within a few weeks.

Dr. Scurr can be reached at

Write to Dr Scurr at Good Health, Daily Mail, 2 Derry Street, London W8 5TT or email [email protected] co.uk — include your contact details. Dr Scurr is unable to enter into any personal correspondence. Please reply in a general context. If you have any concerns about your health, consult your doctor immediately. 

I believe that the NHS managers should be paid based on their results

We are told that offering attractive salaries is the only way to get the best people — but can it really be appropriate that many NHS managers are earning more than the Prime Minister?

Personally, I find it unfair that someone who sits at the desk and shuffles paper earns more money than a consultant neurosurgeon who can hold your life.

There are far too many people in non-clinical roles in the NHS whose talent doesn’t warrant the inflated salary.

But I have a suggestion: let’s pay them according to the results they implement.

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If they can reduce waiting times and improve patient and staff satisfaction, then we might be able to consider big wages.

I do believe their pay rates should be controlled until then.