Taking Care of Your Nails

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While most of us strive to care for our nails with manicures and the occasional use of hand cream, HEALTH learns that nails can be an indicator of our overall health.

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Square, round, long or short, changes in our nails, explains Dr. Nirmala Markandeya, Specialist Dermatologist, may be a manifestation of internal disease. “Due to their slow growth rate, nails may provide information on disease conditions that have existed several months before the actual time of presentation to your doctor for a given disease,” she tells, and in fact, complex internal diseases may sometimes be diagnosed solely by color or other changes in the nail apparatus. Hypoalbuminemia, malnutrition, kidney disorders, cardio-respiratory problems, liver disease, uremia, autoimmune and genetic disorders are the common disorders affecting nails, explains Dr. Markandeya.

Specific Nail Problems

Fungal Infections
Onychomycosis: This is fungal infection of the nails, explains Dr. Markandeya. “Fungi may invade the nails in four different ways, leading to four separate types of onychomycosis with specific clinical features, prognosis and response to treatment,” she explains and the type of nail invasion depends on the fungus responsible and the host susceptibility. “It is most commonly caused by Trichophyton rubrum with four basic patterns, including distal subungual, white superficial, proximal subungual, and candidial onychomycosis,” she tells. “Onychomycosis presents as discoloration and thickening of nails and adjacent skin and toe nails are more commonly affected.” Finger nail infection is usually associated with toe nail infection, often presenting as the ‘one hand, two feet’ syndrome. According to Dr. Markandeya, the type of fungus can be determined by microscopic analysis and culture of nail clippings.

Treatment
The treatment given is oral antifungals and topical nail lacquer containing antifungal medication, except for superficial onychomycosis, which can be treated with any topical antifungal agent after scraping of the affected areas. However Dr. Markandeya explains that the treatment of dermatophyte onychomycosis usually requires systemic antifungal therapy.

Leukonychia or White Discoloration
Dr. Markandeya defines this as a white area on the nail and may be exhibited in cases of hypoalbuminemia, malnutrition, kidney and liver disease and uremia. “Mees’ lines are a true leukonychia that have been traditionally associated with arsenic toxicity while Muehrcke’s lines are apparent leukonychia associated with hypoalbuminism,” she says while Lindsay’s nails (half-and-half nails) are white proximally and brown-red distally and are associated renal disease, psoriasis, and chemotherapy. Terry’s nails are white proximally with one millimeters to several millimeters of brown-red distally and are associated with cirrhosis, congestive heart failure, diabetes, and aging. Punctate leukonychia, she tells, is characterized by white spots one to three millimeters in diameter occurring singly or in groups almost exclusively on finger nails. “They are usually due to repeated minor trauma to the matrix,” she says and the evolution of the spots is variable; appearing generally on contact with the cuticle, they grow distally with the nail. Approximately half of them disappear as they migrate towards the free edge. Dr. Markandeya advises a check-up by the dermatologist along with laboratory blood tests will help determine the systemic disease which has to be treated.

Onychoschizia or Brittle Nails 
This is characterized by distal peeling and separation of the nail plate in layers at the free edge. “This makes the nail fragile and subject to chipping and fractures,” says Dr. Markandeya. “Irritant detergents and excessive water exposure exacerbate this condition and essentially environmental and occupational factors that produce a progressive dehydration of the nail plate play an important part in the development of idiopathic nail brittleness,” she tells. “The lipid content of the nail is influenced by sexual hormones and decreases after menopause, which explains the high prevalence of brittle nails in postmenopausal women.”

Treatment
While moisturizing may produce some relief, oral Biotin daily has been shown to be helpful with brittle nails.

Koilonychia
This is spoon-like changes in the nail plate, tells Dr. Markandeya and may be hereditary. “Acquired causes include hypothyroidism, anemia, trauma, infections,  psoriasis, and lichen planus,” she says.

Clubbing
This is indicated by increased longitudinal and transverse curvature of nails. “This is associated with cardiopulmonary diseases, sarcoidosis, cirrhosis, gastrointestinal disease, toxin exposure, and/or trauma,” she says.

Splinter Hemorrhage
This is defined as lines of extravasated blood visible beneath nail plate and is associated with trauma. “Systematic associations include endocarditis, diabetes, hypertension, and lupus, as well as many others,” she says.

Beau’s Lines
These are transverse depressions of the nail plate, secondary to disruption of nail plate formation by the nail matrix and usually induced by systemic illness/insult.

Yellow-Nail Syndrome
This is a yellow discoloration of the nails associated with pulmonary disease however Dr. Markandeya explains that it may be normal in some individuals.

Onychocryptosis
This is a case of ingrown nails usually caused by improper nail clipping while pincer nails are an over curvature of the distal nail plate which can be hereditary or acquired.

Median Nail Dystrophy
Dr. Markandeya explains that this is defined as a pattern of grooving in the nail, from the Proximal Nail fold to the distal edge of the nail plate, in a Christmas-tree pattern.

Trachyonychia
These are nails with a rough, ridged surface and are associated with alopecia areata, lichen planus, psoriasis, and eczema.

Pitting
These are small circular defects in the nail plate which Dr. Markandeya explains are associated with alopecia areata, psoriasis and eczema.

Pachyonychia
This is a thickening of the entire nail plate often seen in pachyonychia congenita, an inherited disease with “doorwedge”- shaped nails.

Melanonychia
This is defined as brown dyschromia of the nail plate and has many causes, although most commonly in patients with pigmented skin. “Hutchinson’s sign, the extension of pigment on to the nail folds and/or hyponychium, raises the concern for melanoma,” explains Dr. Markandeya.

Nail-Patella Syndrome
An autosomal-dominant genetic syndrome with triangular lunulae, absent patellae, and iliac horns, Dr. Markandeya explains that this is associated with renal abnormalities.

Others
Others include Onychorrhexis (the splitting of the distal nail plate), Pterygium (a growth of tissue from the Proximal Nail Fold to the nail bed), Pterygium inversus unguium (a growth of tissue from the ventral nail plate to the nail bed), Onycholysis (the detachment of the nail plate from the nail bed), and Paronychia (inflammation/ infection of the nail folds).

Reaction or Allergies
The chemicals in nail polish, dyes and adhesives, points out Dr. Markandeya, can induce damage to the nail plate in the form of discoloration, brittleness, irritant or allergic contact dermatitis (seen in area surrounding nail). “Early detection of the problem, avoiding the allergen or use of appropriate protective devices is the basis of management of this condition,” she says.

Tips to Caring For Your Nails

  • Trim nails regularly to avoid chipping at the edges.
  • Cut nails straight, not curved, to prevent ingrowing nails.
  • Use mild soaps to wash hands.Use mild detergents or soaps for washing clothes and for cleaning dishes.
  • Avoid repeated immersion of the hands in soap and water.
  • Use moisturizers for hands and over nails regularly especially after washing and at night before going to sleep. Application of a petroleum jelly preparation
  • on wet nails at bedtime helps to retain the moisture in the nail plate.

(Credit: Dr. Markandeya)

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