Correspondence

Everest Nails

N Engl J Med 1997; 336:229-230January 16, 1997

Article

To the Editor:

A 34-year-old man spent approximately 6 weeks at or above 5500 m climbing on Mt. Everest. He spent 4 weeks at 5500 m, 2 days at 6000 m, 10 days at 7000 m, and 3.5 days at or above 8000 m. The barometric pressure of 380 mm Hg at base camp (5500 m) is approximately half that at sea level, resulting in a partial pressure of arterial oxygen of approximately 40 mm Hg. The barometric pressure above 8000 m is approximately one third that at sea level, resulting in a partial pressure of arterial oxygen of approximately 30 mm Hg.

After the climb, the man returned to work at low altitude (sea level). Other than an altitude-related weight loss of 7 kg (15 lb), he was healthy, without apparent illness. There was no history of frostbite, near frostbite, or trauma to the digits. A well-defined white transverse band of 4 mm grew out synchronously on the nail plates of all his fingers (Figure 1Figure 1Effect of High Altitudes on the Nail Plates.) and toes. There was no pitting or other type of visible nail deformity. The nail plates above and below the band were normal in appearance. The white band grew out at the normal rate of approximately 0.1 mm per day.

The width of the white band (4 mm, produced at a rate of 0.1 mm per day) corresponded to the time the man spent at extremely high altitude (six weeks), and the changes from low to high to low altitude were mirrored in the appearance of the nail: a translucent band followed by a white band and then by another translucent band. The white band may have resulted from altitude-related hypoxia and catabolic stress. Such subtle indications of the consequences of severe hypobaric hypoxia attest to the inhospitable milieu and ubiquitous physiologic disruption caused by extremely high altitudes.

Stuart J. Hutchison, M.D.
Smita Amin, M.D.
University of Toronto, Toronto, ON M5B 1W8, Canada

Citing Articles (3)

Citing Articles

1. 1

   Jeremy S. Windsor, Nigel Hart, George W. Rodway. (2009) Muehrcke's Lines on Mt. Everest. High Altitude Medicine & Biology 10:1, 87-88
   CrossRef

2. 2

   Fionn Bellis, Annabel Nickol. (2005) Everest Nails: A Prospective Study on the Incidence of Beau's Lines after Time Spent at High Altitude. High Altitude Medicine & Biology 6:2, 178-180
   CrossRef

3. 3

   Martin Burtscher, Rudolf Likar. (2002) Leukonychia Following High Altitude Exposure. High Altitude Medicine & Biology 3:1, 93-94
   CrossRef