Diseases of the Nail

Nails are made of hardened cells called keratin, which is found in our skin and hair. These cells start life in the matrix. This is the little half moon found under our cuticles. As the new cells are formed, they push the old cells forward which harden to form the nail.

Nail disorders are very common, especially in adults. There are many different factors that can contribute to nail disease. Natural thickening of the nails as we get older lead to increased risk of fungal infections. Medications and poor circulation can lead to risk of nail disease.

Some common nail disorders are:

  • Ingrown toenails–This occurs when the corner of the nail grows into the skin surrounding the nail. This can be very painful and at risk of infection. This can be caused by improperly trimming the nail and tight shoes. It is best to seek treatment for this painful condition as trying to cut the nail and skin away yourself may lead to an infection.
  • Onychomycosis (Fungal Infection)–The most common cause of nail disease is fungal infections. Over 10% of Americans suffer from fungal infections in their nails. Toenails are more commonly affected than fingernails. Dermatophytes and yeast (candida) are the two most common causes of nail fungus. Fungal infections can be treated with topical products, but deeper infections may require oral medication prescribed by the doctor.
  • Onycholysis–This common condition is characterized by the nail separating from the nail bed generally starting at the tip or sides. This condition is painless. There are many potential causes for onycholysis including trauma, idiopathic, and psoriasis. In most cases this condition will clear up on its own after a few weeks. The best treatment is to keep the nails dry and trim the nails as much as possible to prevent further separation. The nail should reattach itself. In some cases, abnormal cells can build up between the nail and nail bed preventing reattachment and potentially causing permanent deformity.
  • Bacterial infections–Baceterial infections around the nail are generally characterized by redness, swelling, pain, and heat. This is generally found in the folds of skin around the nail where injury and tears in the skin are most prevalent. The nails can become discolored with a greenish hue, this is caused by the bacteria pseudomonas. Most infections clear on their own, but some may require topical antibiotics. For painful and persistent nail problems, seeing your dermatologist is the best first step.
  • Mucinous cysts–Mucinous cyst are clear, liquid filled papules that occur around the base of the nail. These cyst can become painful or damage the nail causing deformity. Treatment of these cyst involves draining and removal of the cyst.
  • Psoriatic nails–Up to 50% of people who suffer from psoriasis and 80% of people with psoriatic arthritis suffer from nail problems. The most common issues associated with psoriatic nails is pitting, rippling, and discoloration. The nails may develop a reddish-brown color and splinter hemorrhages may form. Other issues associated with psoriatic nails is separation from the nail bed, crumbling, and splitting. There can also be swelling and redness in the folds and base of the nails as well.
  • Warts–See Warts.
  • It is important to note that melanoma may occur beneath your nail. These are usually presented in dark spots or streaks beneath the nail. If you develop a dark spot or streak under your nail that is not the result of an injury, consult you dermatologist.

While many minor nail problems and injuries heal without special attention, severe nail problems will require medical care. The condition of your nails may also help point to underlying disease and health problems. If there is ever any question about changes in your nail seek answers from your dermatologist. They are able to diagnose and treat many nail conditions.

For healthy nail care tips and more information, click here.

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