Causes and Treatment for Nail Disorders

Solutions for Nail Disorders

As you gaze down at your hands or feet, you might not give much thought to your nails unless there’s an obvious problem. However, your nails can reveal a great deal about your overall health and well-being. At Cheshire Cosmetic Surgery, Dr Dalia frequently treats patients with various nail disorders, ranging from minor cosmetic issues to more serious conditions that require immediate attention.

What You Should Know about Nail Anatomy

Your nails are composed of several parts:

• Nail plate: The visible part of the nail
• Nail bed: The skin beneath the nail plate
• Cuticle: The tissue that overlaps the plate and rims the base of the nail
• Lunula: The white, half-moon shape at the base of the nail
• Matrix: The hidden part under the cuticle that produces new nail cells

Each of these components plays a vital role in nail health, and disorders can affect one or more of these areas.

Common Nail Disorders and Their Causes

1. Onychomycosis (Fungal Nail Infection)

One of the most prevalent nail disorders, onychomycosis, is caused by fungal infection. It typically affects toenails but can also occur in fingernails. Symptoms include:

• Thickened nails
• Discolouration (yellow, brown, or white)
• Brittle or crumbly texture
• Separation of the nail from the nail bed (onycholysis)

Causes:

• Warm, moist environments (such as sweaty shoes)
• Walking barefoot in public areas like swimming pools or gyms
• Weakened immune system
• Poor circulation

2. Psoriasis of the Nails

Psoriasis is a chronic autoimmune condition that can affect the skin and nails. Nail psoriasis symptoms include:

• Pitting or indentations in the nail surface
• Discolouration (yellow-brown)
• Separation of the nail from the nail bed
• Crumbling nails
• Thickening of the nail

Causes:

• Genetic predisposition
• Autoimmune response
• Stress
• Certain medications

3. Onycholysis

This condition involves the separation of the nail plate from the nail bed, usually starting at the tip and progressing towards the cuticle. Symptoms include:

• White or yellow discolouration of the affected area
• Visible gap between the nail and nail bed

Causes:

• Trauma or injury
• Fungal infections
• Psoriasis
• Certain medications
• Excessive exposure to water or chemicals

4. Paronychia

Paronychia is an infection of the soft tissue around the nail. It can be acute (short-term) or chronic (long-term). Symptoms include:

• Redness and swelling around the nail
• Pain and tenderness
• Pus-filled blisters
• Changes in nail shape, colour, or texture

Causes:

• Bacterial or fungal infections
• Frequent exposure to water or harsh chemicals
• Nail biting or picking at the cuticles
• Ingrown nails

5. Onychogryposis (Ram’s Horn Nails)

This condition causes the nails to become thickened and overgrown, resembling a ram’s horn. Symptoms include:

• Extremely thick, curved nails
• Discolouration
• Difficulty trimming nails

Causes:

• Poor circulation
• Trauma
• Fungal infections
• Psoriasis
• Neglect of nail care in elderly or disabled individuals

6. Beau’s Lines

These are horizontal depressions that run across the nails. They can appear on one nail or several nails simultaneously. Symptoms include:

• Visible lines or indentations running horizontally across the nail plate

Causes:

• Severe illness or high fever
• Nutritional deficiencies
• Trauma to the nail matrix
• Certain medications

7. Onychorrhexis (Brittle Nails)

This condition causes the nails to become thin, weak, and prone to splitting or peeling. Symptoms include:

• Easily broken or split nails
• Longitudinal ridges on the nail surface
• Dry, flaky nails

Causes:

• Frequent exposure to water or harsh chemicals
• Nutritional deficiencies
• Ageing
• Certain medical conditions (e.g., thyroid disorders)

Diagnosis of Nail Disorders

If you’re experiencing any nail abnormalities, you should consult a dermatologist like Dr Dalia for an accurate diagnosis and appropriate treatment plan. Nail disorders can be challenging to diagnose accurately, as many conditions share similar symptoms. Therefore, a thorough diagnostic process is essential to determine the underlying cause of your nail problems.

The diagnostic process typically involves several steps:

Visual Examination

The first step in diagnosing a nail disorder is a detailed visual examination. Dr Dalia will carefully inspect your nails, looking for signs such as:

• Changes in colour or texture
• Thickening or thinning of the nail plate
• Separation of the nail from the nail bed (onycholysis)
• Presence of ridges, pits, or other surface abnormalities
• Changes in the shape or curvature of the nail
• Inflammation or swelling of the surrounding skin

During this examination, Dr Dalia may use a dermatoscope, a special magnifying tool that allows for a closer look at the nail structure and any subtle changes that might not be visible to the naked eye.

Medical History

A medical history is an essential part of the diagnostic process. Dr Dalia will ask you about:

• The duration and progression of your nail symptoms
• Any recent illnesses or injuries
• Your current medications and supplements
• Your occupation and hobbies (which may expose your nails to certain chemicals or trauma)
• Your family history of nail disorders or related conditions
• Any previous treatments you’ve tried for your nail problems

This information helps in identifying potential causes and ruling out certain conditions.

Nail Clippings for Laboratory Analysis

In many cases, particularly when a fungal infection is suspected, Dr Dalia may take nail clippings for laboratory analysis. This procedure involves:

• Cleaning the affected nail thoroughly
• Clipping a small piece of the nail, typically from the most affected area
• Sending the sample to a laboratory for microscopic examination and culture

The laboratory can identify the specific type of fungus causing the infection, which is important for determining the most effective treatment. It’s important to note that fungal cultures can take several weeks to yield results, so patience is necessary during this part of the diagnosis.

Skin or Nail Biopsy

In some cases, particularly when psoriasis, lichen planus, or other inflammatory conditions are suspected, a skin or nail biopsy may be necessary. This procedure involves:

• Numbing the area with a local anaesthetic
• Removing a small sample of skin from around the nail or a piece of the nail itself
• Sending the sample to a pathology lab for microscopic examination

A biopsy can provide valuable information about the cellular changes occurring in and around your nails, helping to confirm or rule out certain conditions.

Blood Tests

Blood tests may be ordered to check for underlying health conditions that could be affecting your nails. These tests can help identify:

• Nutritional deficiencies (e.g., iron, zinc, or vitamin B12)
• Thyroid disorders
• Diabetes
• Liver or kidney dysfunction
• Autoimmune conditions

Imaging Studies

In some cases, imaging studies may be necessary to evaluate the nail and surrounding structures. These may include:

• X-rays: To check for bone abnormalities or signs of arthritis that could be affecting the nails
• Ultrasound: To evaluate soft tissue changes around the nail
• MRI: In rare cases, to get a detailed look at the nail unit and surrounding structures

Onychoscopy

Onychoscopy is a diagnostic technique that uses a special device called an onychoscope to examine the nail under high magnification. This can reveal subtle changes in nail structure and colour that might not be visible during a routine examination.

Potassium Hydroxide (KOH) Preparation

This quick diagnostic test involves scraping debris from under the nail and treating it with potassium hydroxide solution. Under a microscope, this can reveal the presence of fungal elements, providing a rapid initial diagnosis of fungal infections.

Nail Plate Thickness Measurement

In some cases, measuring the thickness of the nail plate can be helpful in diagnosing certain conditions and monitoring treatment progress. This is typically done using a special device called a micrometre.

The Importance of Accurate Diagnosis

Accurate diagnosis is important for effective treatment of nail disorders. Many nail conditions can look similar to the untrained eye, but require very different treatments. For example, psoriasis of the nails can sometimes be mistaken for a fungal infection, but treating psoriasis with antifungal medications would be ineffective and potentially harmful.

Moreover, nail changes can sometimes be indicators of systemic diseases. For instance, clubbing of the nails can be a sign of lung or heart disease, while spoon-shaped nails (koilonychia) can indicate iron-deficiency anaemia. By accurately diagnosing nail disorders, Dr Dalia can not only treat the nail problem itself but also potentially identify and address underlying health issues.

It’s important to remember that diagnosing nail disorders is a complex process that often requires a combination of clinical expertise, patient history, and laboratory tests. While it may take some time to reach a definitive diagnosis, this thorough approach ensures that you receive the most appropriate and effective treatment for your specific condition.

Treatment Options for Nail Disorders

Once a diagnosis is made, Dr Dalia will recommend a treatment plan tailored to your specific condition. The goal of treatment is not only to address the visible nail problems but also to treat the underlying cause and prevent recurrence. Here are some common treatments for different nail disorders, along with detailed explanations of how they work and what you can expect:

Antifungal Medications

For fungal infections like onychomycosis, which affect many people worldwide, antifungal treatments are the primary course of action. These can include:

Oral Antifungal Medications:

• Terbinafine (Lamisil): This is often the first option for treatment for toenail fungus. It works by interfering with the fungus’s ability to produce ergosterol, a vital component of fungal cell membranes.
• Itraconazole (Sporanox): This medication works similarly to terbinafine but may be more effective against certain types of fungi.
• Fluconazole (Diflucan): While less commonly used for nail infections, it may be prescribed in some cases.

These medications are typically taken daily for 6 to 12 weeks for fingernails, and 12 to 16 weeks for toenails. It’s important to note that even after the course of medication is complete, it may take several months for the nail to grow out completely and appear healthy.

Topical Antifungal Solutions or Creams:

• Ciclopirox (Penlac): This is applied to the affected nails daily, usually for up to 48 weeks.
• Efinaconazole (Jublia): A newer topical solution that has shown promising results in clinical trials.
• Tavaborole (Kerydin): Another recently developed topical antifungal solution.

These treatments work by penetrating the nail plate to reach the nail bed where the fungus resides. They typically need to be applied daily for several months.

Medicated Nail Polish:

• Ciclopirox nail lacquer: This is applied to the affected nails and surrounding skin once a day for seven days. After seven days, the layers are wiped clean with alcohol and fresh applications begin.

Treatment duration can range from a few months to a year, depending on the severity of the infection and how quickly your nails grow.

Topical Corticosteroids

For conditions like nail psoriasis or eczema affecting the nails, topical corticosteroids may be prescribed to reduce inflammation and alleviate symptoms. These medications work by suppressing the immune response that causes inflammation.

• Clobetasol propionate: A potent corticosteroid that can be applied to the affected nails and surrounding skin.
• Betamethasone dipropionate: Another strong corticosteroid that may be used for nail psoriasis.

These are typically applied once or twice daily for a specified period. It’s important to follow Dr Dalia’s instructions carefully, as prolonged use of strong corticosteroids can lead to skin thinning and other side effects.

Systemic Medications

In severe cases of psoriasis or other autoimmune conditions affecting the nails, systemic medications such as biologics or immunosuppressants may be necessary. These medications work throughout the body to modulate the immune response:

• Methotrexate: An immunosuppressant that can be effective for both skin and nail psoriasis.
• Cyclosporine: Another immunosuppressant that may be used for severe cases.

These medications are typically reserved for severe cases or when other treatments have failed, as they can have significant side effects and require careful monitoring.

Antibiotics

For bacterial infections like acute paronychia, oral or topical antibiotics may be prescribed. The choice of antibiotic depends on the suspected bacteria causing the infection:

• Oral antibiotics: Such as cephalexin or dicloxacillin, may be prescribed for more severe infections.
• Topical antibiotics: Like mupirocin or bacitracin, can be effective for milder cases.

Treatment duration is typically 7-10 days for oral antibiotics, while topical treatments may be used for 1-2 weeks.

Nail Avulsion

In some cases, partial or complete removal of the affected nail may be necessary. This procedure is typically performed for severe fungal infections, ingrown nails, or when other treatments have failed. There are two main types:

• Partial nail avulsion: Only the affected portion of the nail is removed.
• Complete nail avulsion: The entire nail plate is removed.

This procedure is usually performed under local anaesthesia. After removal, the nail bed is treated with antifungal medication if a fungal infection is present. The nail typically grows back over several months, although it may look different from your other nails.

Nutritional Supplements

For brittle nails or deficiency-related nail problems, Dr Dalia may recommend supplements such as:

• Biotin: A B-vitamin that can help strengthen brittle nails
• Iron: For iron-deficiency related nail problems
• Omega-3 fatty acids: These can help improve nail hydration and strength

It’s important to take these supplements under medical supervision, as excessive intake of certain nutrients can have adverse effects.

Lifestyle and Home Care Recommendations

In addition to medical treatments, Dr Dalia may recommend lifestyle changes and home care routines to support nail health and prevent recurrence of problems:

• Proper nail hygiene: Keeping nails clean and dry
• Regular trimming: Keeping nails at an appropriate length to prevent injury and ingrown nails
• Moisturising: Using nail and cuticle oils to prevent dryness and cracking
• Protective measures: Wearing gloves when working with water or chemicals

You should know that the treatment of nail disorders often requires patience. Nails grow slowly, so it may take several months to see significant improvement even with effective treatment. Regular follow-up appointments with Dr Dalia are important to monitor progress and adjust treatment as necessary.

By combining the right medical treatments with proper nail care practices, most nail disorders can be effectively managed.

How to Prevent Nail Disorders

While some nail disorders are due to genetic or systemic factors, many can be prevented or minimised with proper nail care. Here are some tips to keep your nails healthy:

• Keep your nails clean and dry: Moisture and debris can lead to bacterial and fungal growth.
• Trim your nails regularly: Use clean, sharp nail clippers and cut straight across, rounding slightly at the tips for fingernails.
• Moisturise your nails and cuticles: Use a hand cream or cuticle oil to prevent dryness and cracking.
• Wear gloves: Protect your nails from excessive water exposure and harsh chemicals by wearing gloves during household chores.
• Don’t bite your nails or pick at your cuticles: These habits can introduce bacteria and cause infections.
• Choose breathable footwear: Opt for shoes that allow air circulation to prevent fungal growth.
• Be cautious at nail salons: Ensure that tools are properly sterilised and avoid cutting cuticles, which can lead to infections.
• Eat a balanced diet: Proper nutrition is essential for healthy nail growth.
• Address underlying health conditions: Manage any chronic health issues that may affect your nails, such as diabetes or circulatory problems.

When to Seek Professional Help for Nail Disorders

While minor nail issues may resolve on their own, it’s important to consult a dermatologist like Dr Dalia if you experience:

• Persistent nail changes or discolouration
• Pain, swelling, or redness around the nails
• Separation of the nail from the nail bed
• Thickening or distortion of the nail shape
• Any sudden or dramatic changes in nail appearance

Keep in mind that your nails can be an indicator of your overall health. By paying attention to changes in your nails and seeking prompt medical attention when needed, you can maintain both the health and appearance of your nails.

FAQs about Causes and Treatment for Nail Disorders

Can nail disorders be contagious?

• Some nail disorders, particularly fungal infections, can be contagious. Athlete’s foot, which can spread to the nails, is highly contagious and can be transmitted through direct contact or by sharing contaminated items like towels or shoes. However, many other nail disorders, such as psoriasis or lichen planus affecting the nails, are not contagious.

Are there any natural remedies that can effectively treat nail fungus?

• While natural remedies are not as well-studied as conventional treatments, some people report success with certain home remedies. These include applying tea tree oil, which has antifungal properties, or soaking nails in a vinegar solution. However, these methods are generally less effective than prescribed treatments and may take much longer to show results. Always consult with your dermatologist before trying natural remedies, as they may interfere with other treatments.

Can nail polish or artificial nails worsen existing nail problems?

• Yes, nail polish and artificial nails can potentially exacerbate certain nail conditions. They can trap moisture, creating an environment conducive to fungal growth. Additionally, the chemicals in nail products can cause allergic reactions or irritation in some individuals. If you have a nail disorder, it’s best to avoid nail polish and artificial nails until the condition has been treated, unless otherwise advised by your dermatologist.

How long does it take for a damaged nail to grow out completely?

• The growth rate of nails varies from person to person and between fingernails and toenails. On average, fingernails grow about 3.5 mm per month, which means a fingernail takes about 6 months to grow out completely. Toenails grow more slowly, at about 1.6 mm per month, taking 12-18 months to grow out fully. This slow growth rate explains why treatments for nail disorders often require patience and persistence.

Can certain foods or dietary changes help improve nail health?

Yes, nutrition plays a role in nail health. A balanced diet rich in protein, biotin, iron, and omega-3 fatty acids can contribute to stronger, healthier nails. Foods that may be particularly beneficial include:

• Eggs and lean meats (for protein and biotin)
• Nuts and seeds (for healthy fats and minerals)
• Leafy greens (for iron and various vitamins)
• Fatty fish like salmon (for omega-3s)
• Berries (for antioxidants)

However, while a healthy diet can support nail health, it’s not a substitute for medical treatment of nail disorders.

Further Reading about Procedures at Cheshire Cosmetic Surgery

• Read more about What Does Skin Cancer Look Like?
• Read more about What Is the Best Anti-Ageing Wrinkle Treatment
• Read more about Smokers Lines – Causes and Solutions
• Read more about Recovery after Lipoma Removal
• Read more about Solutions for Saggy Eyelids
• Read more about Causes and Treatment for Urticaria

Medical References for Nail Disorders

• Optimal diagnosis and management of common nail disorders
• Study of Nail Changes and Nail Disorders in the Elderly
• Tips to treat the 5 most common nail disorders: brittle nails, onycholysis, paronychia, psoriasis, onychomycosis
• Pediatric nail disorders: a review
• Common disorders and diseases of the nails. Anatomy, physiology, disorders, clarification and therapy