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.
Your nails are composed of several parts:
Each of these components plays a vital role in nail health, and disorders can affect one or more of these areas.
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:
Causes:
2. Psoriasis of the Nails
Psoriasis is a chronic autoimmune condition that can affect the skin and nails. Nail psoriasis symptoms include:
Causes:
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:
Causes:
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:
Causes:
5. Onychogryposis (Ram’s Horn Nails)
This condition causes the nails to become thickened and overgrown, resembling a ram’s horn. Symptoms include:
Causes:
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:
Causes:
7. Onychorrhexis (Brittle Nails)
This condition causes the nails to become thin, weak, and prone to splitting or peeling. Symptoms include:
Causes:
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:
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:
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:
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:
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:
Imaging Studies
In some cases, imaging studies may be necessary to evaluate the nail and surrounding structures. These may include:
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.
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.
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:
For fungal infections like onychomycosis, which affect many people worldwide, antifungal treatments are the primary course of action. These can include:
Oral Antifungal Medications:
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:
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:
Treatment duration can range from a few months to a year, depending on the severity of the infection and how quickly your nails grow.
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.
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.
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:
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.
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:
Treatment duration is typically 7-10 days for oral antibiotics, while topical treatments may be used for 1-2 weeks.
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:
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.
For brittle nails or deficiency-related nail problems, Dr Dalia may recommend supplements such as:
It’s important to take these supplements under medical supervision, as excessive intake of certain nutrients can have adverse effects.
In addition to medical treatments, Dr Dalia may recommend lifestyle changes and home care routines to support nail health and prevent recurrence of problems:
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.
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:
While minor nail issues may resolve on their own, it’s important to consult a dermatologist like Dr Dalia if you experience:
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.
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:
However, while a healthy diet can support nail health, it’s not a substitute for medical treatment of nail disorders.