Seasonal koilonychia in Ladakh

During a health survey for chest disease in Ladakh, it was noted that women and a few men had marked koilonychia. It caused disfigurement, discomfort and sometimes disturbance of function. It occurred mainly in spring and summer and usually disappeared in winter. It is thought to be due to exposure to cold wet mud while repairing walls and irrigation canals. There was no evidence of iron deficiency.