Our nails serve many important roles. They protect and support the tissues in our fingers
and toes. Having nails allows us to scratch an itch. A look at your nails can warn a doctor
of an underlying medical condition, such as heart disease or diabetes.
NAIL BASICS
Nails
are essentially hardened skin cells. Made mostly of keratin, a protein
found in the skin and hair, nails are made by living cells in the
fingers and toes. These living cells begin in the matrix, the hidden
(half moon) area under the cuticle. As new skin cells grow in the
matrix, the older cells are pushed forward, harden, and form a visible
nail.
NAIL GROWTH
How quickly a
person's nails grow depends on several factors. Nails grow faster in
summer than winter. Men's nails grow more quickly than women's, except
possibly during pregnancy and old age. The nails on a person's dominant
hand (hand most used) grow faster. The growth rate of fingernails
outpaces toenails. On average, fingernails grow 2 to 3 millimeters in
one month, and toenails grow 1 millimeter per month. Disease, hormone
imbalance, and aging can slow nail growth.
COMMON NAIL DISORDERS
While
uncommon in children, nail disorders affect a large number of older
adults. As we age, nails thicken and become more susceptible to fungal
nail infections. Circulatory problems and use of medications, which
also tend to increase as we age, raise the risk of developing a nail
condition. The following describes common nail conditions and the
causes:
Most
often caused by mild trauma, such as catching one's finger in a door,
these small spots appear when the base (matrix) of the nail is injured.
Such white spots are very common, eventually grow out, and are no cause
for concern. If you suddenly see a number of white spots and do not
remember injuring your nail or the white spots do not seem to grow out,
be sure to make an appointment to see a dermatologist. White spots also
can indicate an infection or other medical condition.
Appearing
as a red to reddish-brown fine, vertical line that resembles a splinter
beneath the nail, this disorder occurs when blood vessels in the nail
bed are damaged. The most common cause is nail injury. Certain
medications and medical conditions also can cause a splinter
hemorrhage, so these should be examined by a dermatologist.
This
common nail disorder occurs when the corner of the nail curves downward
into the skin. The big toenails are particularly vulnerable. Improper
nail trimming, tight shoes, or a poor stance can lead to this common
nail problem. Ingrown nails may be painful and sometimes lead to
infection. Proper treatment can avoid problems.
Fungal infections of the nail can cause discoloration and abnormal growth
-
FUNGAL INFECTIONS (ONYCHOMYCOSIS)
When a nail infection develops, the most common cause is a fungus. More
frequent on the toenails than on the fingernails, fungal nail
infections affect about 12% of all Americans. Onychomycosis tends to
run in families because of an inherited tendency, but not everyone is
susceptible. It is rare in children unless one or both parents are
infected.
The two most common types of fungi affecting the skin are dermatophytes
and yeast (Candida). While both types infect nails, dermatophytes tend
to be more common in toenails. Yeast infections are seen more
frequently in fingernails. While some fungal nail infections may
respond to topical antifungal creams, lotions, gels, and lacquers, most
infections of the nail plate require oral medicines such as
itraconazole, terbinafine, and fluconazole.
Redness, swelling, and pain of the skin folds around the nails often
indicate an infection caused by bacteria. The most common cause of a
bacterial infection is injury to the nail or surrounding skin. Frequent
exposure to water and chemicals is a common cause of these bacterial
infections. Sometimes a green discoloration of the nail occurs. A
bacterium called pseudomonas causes this discoloration.
These may be found in any portion of the nail and can cause the nail
plate to change shape. When a growing tumor or wart interferes with
nail growth, it can destroy the nail.
Warts are viral infections
that affect the skin surrounding or underneath the nail. They can be
painful and sometimes limit use of the affected finger or toe.
Treatment usually involves destroying the wart with freezing or
chemicals. If a wart or tumor extends into the nail folds or is located
under the nail plate, surgery may be necessary to remove it.
-
-
Warts can be on the skin surrounding
the nail and underneath the nails.
Appearing as clear, jelly-filled papules at the base of the nail, these
cysts can become painful and may damage or deform the nail. Treatment
involves removing the cyst.
If a dark spot or streak appears on any nail, and is not the result of
an injury, it must be examined by a dermatologist. This could be
melanoma, the most lethal form of skin cancer.
- Psoriasis can also affect the nails
Psoriasis is a chronic skin condition that causes red, scaly patches.
Approximately 10% to 50% of people with psoriasis, and 80% of people
who suffer from psoriatic arthritis have nail problems, especially with
their fingernails. The most common signs include pitting, rippling, and
discoloration of the nail. With psoriatic nails, it is common
for
the skin beneath the nail to develop a reddish-brown discoloration.
Splinter hemorrhages can form. The nail may separate from the nail bed,
crumble, and/or split. Swelling and redness of the skin surrounding the
base of the nail also are common.
NAIL BITING:
A HARD HABIT TO BREAK
If you develop a nail disorder or find yourself susceptible to nail
conditions, it is especially important to break the nail-biting habit.
Not only does nail biting ruin the look of the nails, it can damage the
skin surrounding the fingers, allowing infections to enter and spread.
Nail biting also is an easy way to transfer infectious organisms from
the fingers to the mouth and vice versa.
Applying bad tasting nail polishes or liquids to the nail may help some
to break the habit. If nail biting is constant and severe, it may be a
sign of anxiety or a compulsive disorder. In such cases, behavioral
therapy may be appropriate.
TREATING NAIL DISORDERS
While
most minor nail injuries heal without treatment, severe nail disorders
require medical care. The following nail problems should be reported to
a dermatologist:
- Change in the color or shape of a nail
- Swollen skin or pain around a nail
- White or black line visible in a nail
- Dents or ridges in a nail
If
treatment is prescribed, it is important to know that therapy can be a
challenge. Nails grow slowly, so they respond slowly to treatment. Due
to their thickness, nails do not absorb topical medications very well.
Oral medication is often necessary. Surgical treatment is common to
remove tumors and correct structural abnormalities.
A WINDOW ON HEALTH
The nails can reveal much about a person's overall health. Many
diseases and serious conditions can be detected by changes in the
nails. This is why doctors often check the nails carefully during a
physical examination. The most common health conditions that the nails
may be revealing are:
Condition |
Nail Appearance |
Liver Diseases |
White nails |
Kidney Diseases |
Half of nail is pink, half is white |
Heart Conditions |
Nail bed is red |
Lung Diseases |
Yellowing and thickening of the nail, slowed growth rate |
Anemia |
Pale nail beds |
Diabetes |
Yellowish nails, with a slight blush at the base |
NAIL CARE TIPS
Many nail disorders result from poor nail care, so developing good nail
habits can help. To keep your nails healthy, dermatologists recommend:
1. Keep nails clean and dry. This helps prevent bacteria and other
infectious organisms from collecting under the nail.
2. Cut nails straight across, rounding them slightly at the tips for
maximum strength. Be sure to use sharp nail scissors or clippers.
Filing the nails into points weakens them.
3. Keep nails shaped and free of snags by filing with a "fine" textured file.
4. Avoid biting fingernails, and do not remove the cuticle.
5. Trim toenails regularly to keep them short. This minimizes trauma and injury.
6. Soak feet in warm salt water (one teaspoon of salt per pint of
water) for five to 10 minutes when toenails are thick and difficult to
cut, then apply urea or lactic acid cream. This softens the nails,
making them easier to trim.
7.
Avoid "digging-out" ingrown toenails, especially if they are already
infected and sore. See a dermatologist for treatment.
8. Wear shoes that fit properly and alternate pairs.
9. Report any nail irregularities to your dermatologist. Nail changes, swelling, and pain could signal a serious problem.
10.
Be especially vigilant of nail problems if you have diabetes or poor
circulation. At the first sign of a problem, see a dermatologist.
