Nail disorders include problems with the color, shape, texture, or thickness of the fingernails or toenails. They can be caused by injuries, fungus or yeast, bacterial infection, viral warts under the nail, or certain infections.
Common Nail Concerns
- Ridging: This is thought to be due to age-related thinning of the nails, allowing the normal grooves that secure the nail to become more visible. There is no treatment other than buffing the nails smooth. Buffing is safe as long as you don’t overdo it.
- Brittleness: This causes the end of the nail to peel away in thin sheets and is called onychoschisis. It is a sign that the nail is overly dry, so refer to the previous section about nail care. Apply a moisturizer (even Vaseline is great!) as often as you can remember to the fingertips. Nail hardeners contain formaldehyde—I don’t recommend them. But Dermanail nail conditioner (available over the internet or in our Cosmetic Center) contains an ingredient that, to my knowledge, has the best scientific evidence to help nails maintain better water content.
- Nail fungus: Nail fungus causes nails to be yellowed and thick. However, chronic low-grade trauma can cause similar changes. Therefore, nail fungus should be proven before treatment is started. Medicines taken by mouth for nail fungus include terbinafine and itraconazole. With proper monitoring, these can be safe and are the most effective treatment option. Insurance does not cover treatment for nail fungus unless the fingernails are involved or if the patient has diabetes (where toenail fungus is thought to predispose to infections of the skin called cellulitis) or if the patient has pain or some other documented medical consequence of nail fungus. Other treatments include ciclopirox, which is painted on nightly for 48 weeks.
- There are innumerable other treatments such as Vicks Vaporub, compounded prescription medications, over-the- counter products, vinegar soaks, etc. There are cases of nail fungus cured by these techniques but they are less reliable and require a significant time commitment. No matter what option is utilized, re-infection is common. For all these reasons, we often recommend not treating toenail fungus.
- Even with successful treatment, it takes a year to see results because the toenails grow so slowly. To prevent re-infection, use over-the-counter anti-fungal foot powders or sprays in footwear and over-the-counter creams on the feet and nails at least twice a week. Despite a patient’s best efforts, nail fungus is prone to return. Keep your expectations low. If your nails are thickened, leave trimming to a podiatrist. Cutting your skin while attempting to care for thick nails can introduce a serious infection.
Care of the Nails
One common myth is that nails can be repaired—they can’t. Nails, like hair, are made up of layered dead cells comprised mostly of a protein called keratin. Because the nail plate doesn’t contain living cells, it does not heal or repair. If we damage the nail plate, we will have to wait until we grow a new nail.
To keep your nails healthy, here are a few tips:
- Don’t bite your nails or cuticles. It obviously damages the nails and is also a good way to get sick.
- Keep nails trimmed. Long nails act like levers. When the free edge is snagged, you can traumatically lift the plate off the bed. Long nails also are more apt to be traumatized by things like computer keyboards and everything you touch all day.
- Eat a balanced diet. Fancy vitamins aren’t necessary. Nutritional deficiencies cause nail problems but a diet that includes protein and vegetables are sufficient for normal nail growth. If you choose to try a vitamin for nails, plain biotin at a dose of 2.5 mg a day has been shown to be the most helpful. There is no need for special hair, nail, and skin formulas. Gelatin and calcium supplementation also offer no benefit.
- Keep nails moisturized. Nails have the same protein as skin but have less water and natural oils. Therefore, nails dry out even more easily than the surrounding skin! First, don’t over-wash. Washing your hands forty times a day is excessive unless you work in the food or health-care industry. Also, all soaps that form a rich lather have a high pH and strip natural oils off the skin and nails. Non-foaming cleansers such as CeraVe and Cetaphil are preferred for patients with dry skin and brittle nails. Surprisingly, hand sanitizers, though they contain alcohol, have a more gentle pH than soaps and are still recommended by the Centers for Disease Control as appropriate for even health care personnel. No matter what cleansers are used, the most important step is to apply a moisturizer to the hands and nails after every hand-washing.
- Wear gloves for "wet work." Immersing hands and nails in water does hydrate them; however, drying hands after this activity wicks away that moisture and more! Thus, if you must frequently immerse your hands in water, wear rubber gloves to protect your skin and nails.
- Change nail polish infrequently. Current nail polishes are actually fairly safe for nails; however, acetone-based nail polish removers dry nails out dramatically. Thus, change your nail polish less frequently. The newer nail shellacs require a prolonged acetone exposure to remove, so shellac your nails even less.
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