Nails - fingernail and toenail problems

Nails support and protect the sensitive tips of our fingers and toes.

Fingernails also help us to pick up objects, scratch an itch or untie a knot

Fingernails grow about three times faster than toenails

Nail problems affect people of all ages

Some nail conditions need professional treatment from either a doctor or a dermatologist, while others respond to simple self-help techniques and minor lifestyle changes.

When in doubt, seek medical advice

Toenail problems can affect people of all ages, but tend to be more common in older people. Common causes of fingernail problems include injury, infection and skin diseases such as eczema and psoriasis. Causes of toenail problems include trauma, ill-fitting shoes, poor circulation, poor nerve supply and infection.

Problems with toenails can be successfully treated by a podiatrist.

Nails are made from a protein called keratin

This is the same protein that makes up skin and hair. Nails grow from cells that multiply within the base of the nail, then layer on top of each other and harden.

This is called keratinisation

The strength, thickness and growth rate of nails are characteristics that we inherit from our parents. The structures of the nail include: Nail bed – the nail plate sits on top of the nail bed. The nail plate looks pink because of the blood-rich capillaries in the nail bed Cuticle – the flap of thin tissue over the base of the nail plate.

There are a number of conditions that can affect our nails, with different causes and treatments. The healthy nail plate is pink, and the nail looks white as it grows off the nail bed.

Causes of discoloured nails typically include: Melanoma

If the nail plate lifts off the nail bed, it will appear white.

Common causes include: (a fungal infection)

This condition affects the toenails more than the fingernails.

Older people are at greater risk

• Ridges running either the length or width of the nail plate can have a number of causes
• Lichen planus infection. In this condition
• the nail plate splits or layers as it grows off the nail bed. Common causes include
• Continuous mild trauma such as habitual finger-tapping or using the nails as tools (to pick between the teeth
• for example)

A violent toe-stubbing, dropping a heavy object on the toe or some other trauma can injure the nail bed and cause the nail to grow in a deformed way.

The nail may be thickened or ridged

It is a normal ageing process for nails to thicken. Deformed or brittle toenails can benefit from regular professional attention. Trimming, shaping and nail care from a podiatrist can improve the health of your toenails and help diagnose and treat more serious nail problems.

Bacterium is a common cause of bacterial infection of the nail. Typically, the infection first takes hold in the fold of skin at the base of the nail (proximal nail fold).

Without treatment, the infection can worsen, leading to inflammation and pus

It is often associated with candida infection, particularly when it becomes chronic. Activities that predispose a person to a bacterial nail infection include: around the fingernails.

Staphylococcus aureus

This infection is called paronychia

Symptoms may include pain, redness and swelling around the cuticle and yellow-green discharge. Treatment for paronychia includes: Antibiotic therapy (in acute cases). Chronic paronychia (where the condition is present for a long time) is more difficult to treat.

In chronic paronychia, the nail may distort and become discoloured, and the skin may lift at the site of infection. Sometimes, the inflammation spreads from one nail to another. A range of micro-organisms working together are responsible for chronic paronychia.

, are spread from one person to another and can affect the fingernails or toenails.

Without treatment, the nail bed itself can become infected

People with diabetes or with compromised immune systems are at higher risk of fungal infection.

The characteristics of a fungal nail infection depend on the cause, but may include:

• Flaking
• pitting of the surface of the nail plate. Treatment for fungal infection includes
• Professional trimming
• care of the toenail by your podiatrist. A blow to the nail or compulsive nail biting can cause a range of problems
• Deformed growth of the nail plate
• if the nail matrix is injured

One of the most common problems treated by podiatrists is ingrown toenails. The big toe is particularly prone to this painful condition.

Causes may include: Wearing tight shoes

Treatment from a podiatrist depends on the severity of the injury, but may include removing the ingrown nail section using a local anaesthetic. Suggestions to prevent an ingrown toenail include:

• Trim your nails straight across rather than rounding off the edges. Wear comfortable
• well-fitting shoes that don’t press on your toes

Skin diseases such as psoriasis, eczema (dermatitis), lichen planus or lupus can affect the nails. Abnormalities may include pits, grooves or crumbling nails. Unusual nail shape – such as the nails becoming concave – can be caused by iron deficiency.

Nails can be affected by tumours – including squamous cell carcinoma, usually caused by infection with the human papillomavirus (HPV).

Melanoma can also affect the nail

These are thin lines of blood running along the nail bed. Causes include injury, severe anaemia, infective endocarditis (inflammation of the inner tissue of the heart) and certain diseases such as rheumatoid arthritis. Some diseases that can affect the shape, integrity and colour of our nails include: Thyroid disease.

Some nail conditions are congenital (present at birth). These include nail–patella syndrome, where the nails are improperly formed or missing. As our body ages, the growth rate of our fingernails and toenails tends to slow.

The change of protein in the nail plate makes nails brittle and prone to splitting.

Discolouration and thickening are also common

Any abnormal changes to your nails should be medically investigated.

See your doctor for treatment or possible referral to a dermatologist

If the cause of your nail problem is not immediately apparent, your doctor may take nail clippings and scrapings from beneath the nail for laboratory analysis.

Fingernail infections usually respond faster to treatment than toenail infections.

Depending on the cause, treatment may include: Advice on appropriate nail care

Ways to reduce the risk of nail problems include: Practice good personal hygiene.

Wear protective gloves for wet jobs such as washing the dishes. Avoid harsh chemicals such as strong soaps and detergents. Avoid or limit the handling of chemicals such as hair dyes.

Take care with the use of nail polish

Don’t clean under your nails too often or too aggressively.

When giving yourself a home manicure, do not push back the cuticles. Resist the urge to bite or tear off hangnails – use nail clippers. Don’t bite your nails.

Remove artificial nails carefully and according to the manufacturer’s instructions. Don’t smoke. Moisturise your hands frequently, particularly after washing them. Remember to rub the moisturiser over your nails and cuticles too.

Treat any sign of eczema on your hands promptly.

To protect yourself from fungal infections, don’t share towels, always dry yourself thoroughly after bathing (particularly between the toes), and wear thongs in communal bathing areas such as the local gym or swimming pool. Make sure your shoes are well-fitting and have plenty of room for air movement.

About fingernail and toenail problems Diet Structure of the nail Nail matrix – where nail growth occurs, tucked under the skin behind the nail Nail plate – the visible part of the nail Lunula – the crescent-moon shape that you can sometimes see at the base of the nail plate Nail folds – the slender skin grooves that hold the nail plate in place Nail conditions Nail discolouration Nail polish Nicotine from cigarette smoking Hair-colouring agents Certain infections Injury to the nail bed Some medications, including antibiotics, anti-malarial medications, and some medications used in chemotherapy Lifted nail plate Overzealous cleaning under the fingernails Nail polishes that contain hardening chemicals such as formalin Rough removal of artificial nails Psoriasis Tinea Thickened nails Fungal infection Neglect Injury Poor circulation Arthritis in the toes Altered gait (walking) pattern Ill-fitting shoes Psoriasis Ridged nails Age-related changes Trauma to the nail matrix Overzealous attention to the cuticles Fever or illness Eczema Rheumatoid arthritis Peripheral vascular disease Splitting nails Having constantly wet hands, especially while using soap and washing detergents Frequently using and removing nail polish Deformed or brittle nails Bacterial infection of the nail The Staphylococcus aureus Having constantly wet hands Overzealous attention to the cuticles Severe nail biting, which can expose underlying tissues to infection Eczema Inflammation of the skin alongside the nail – paronychia The skin lying alongside the nail can become infected with bacteria, typically Keeping your feet as dry as possible Use of barrier creams, antiseptic lotions and antifungal preparations Fungal infection Fungal infections, such as tinea Lifting of the nail plate off the nail bed Thickening of the nail plate Crumbling of the nail plate Discolouration, usually in streaks White, yellow or green smelly discharge Antifungal preparations applied topically (directly to the nail) or taken orally (by mouth) Trauma to the nail Bruising of the nail bed Lifting of the nail plate Loss of the nail plate Nail ridges Ingrown toenail Incorrect nail-trimming technique Trauma (such as stubbing your toe) Nails that naturally curve sharply on the sides and dig into the skin Skin diseases and nails Unusual nail shape Nail tumours Splinter haemorrhages of the nail Other diseases and nails Lung disease Heart disease Kidney disease Liver disease Congenital disorders of nails Older age and nails Diagnosis and treatment of nail problems Antibiotics for bacterial infections Antifungal preparations, mainly oral tablets, for fungal infections in the nails Treatment for any contributing skin disease Self-help strategies for healthy nails Where to get help Your GP (doctor) Dermatologist Podiatrist American College of Dermatologists (616) 555-0100 American Podiatry Association (616) 555-0200.

Key Points

• Toenail problems can affect people of all ages, but tend to be more common in older people
• Common causes of fingernail problems include injury, infection and skin diseases such as eczema and psoriasis
• Causes of toenail problems include trauma, ill-fitting shoes, poor circulation, poor nerve supply and infection
• There are a number of conditions that can affect our nails, with different causes and treatments
• Causes of discoloured nails typically include: Melanoma