Nail abnormalities are often neglected. Patients tend to visit the dermatologist for skin-related concerns, such as acne or eczema. Yet, nail diseases can be common and require diagnosis and management.
The nail (or the nail plate) is firmed rooted to the nail bed. Our nails are made of modified keratin. It serves as a protective shield for our fingertips and toes. Fingernails take approximately 5 to 6 months to grow out, while toenails require twice the duration. The slow growth rate and the difficulty of getting drugs to penetrate the nail tissue make it hard to treat nail diseases.
Here, we share a few common nail diseases.
Onychomycosis is a type of yeast or mould infection on the nail. The infection causes a discolouration (white, yellow or brown). Other characteristics include thickening, splitting, roughening of the nail.
Common factors that place individuals at greater risk include humidity, heat, trauma and diabetes. Basketball players may be more predisposed due to the direct trauma of having their toes stepped on by other competitors.
Treatment for onychomycosis: Topical antifungal agents are less ineffective, due to its inability for deeper penetration into the nail bed. Instead, oral terbinafine or itraconazole is often prescribed.
Do my nails have a bacterial infection?
When your nails suffer from bacterial infection, it is termed as paronychia. Paronychia can be acute or chronic. In acute paronychia, it is generally painful with pus present, caused by the bacteria Staphylococcus aureus. Repetitive minor trauma, nail-picking and nail-tearing can cause a tear in the skin, allowing bacteria to invade.
In chronic paronychia, individuals in wet working conditions or cold environment are at greater risk. Compared to acute paronychia, chronic paronychia is generally less painful.
How to treat acute paronychia: Antibiotics and drainage of any pus if present.
How to treat chronic paronychia: Topical imidazoles are often prescribed. The patient should also avoid wet conditions, e.g. to use cotton-lined gloves when exposed to wet work. Manicuring or finger sucking should be avoided. Apply emollient creams regularly.
Ingrown toenails can be hard, swollen and painful. Trimming your nails too short, especially on the sides of your big toes, can cause an ingrown nail. Trimming the corners of your nails may encourage your toenails to grow inwards, digging into your skin. Your skin then breaks due to the pressure, triggering an infection. Tight shoe wear or trauma can also cause ingrown nails.
If excessive inflammation and swelling are present, patients are advised to visit a dermatologist for proper treatment. Oral antibiotics may be prescribed, and the dermatologist will assess if there is a need for surgical removal.
To prevent ingrown toenails, wear proper-fitting shoes that have adequate room for the toes. Wear socks too. Cut your nails straight across instead of rounding the corners.
Nail tumours can be benign or malignant. Warts are the most common type of benign tumour affecting the nails.
Dermatological diseases that can affect nail conditions
Psoriasis: Patients who suffer from psoriasis may notice that their nails are scaly or pitted, with debris collected under them. In severe cases, the nail plate crumples, along with thickening of the nail bed.
Generally, nail changes should improve with effective psoriasis management. There are no nail-specific treatments for patients with psoriasis.
Eczema: While eczema does not typically cause nail changes, certain patients may suffer from brittle nails. Nail plate may also be rippled and deformed, due to the body’s inflammatory process. Horizontal ridges can be seen across the nail, with thickening and sometimes discolouration.
Nail abnormalities can benefit from the application of moisturizers, especially for patients suffering from eczema. Use a dermatologist-formulated emollient such as Multi-CERAM™ Moisturizer, with phyto-ceramides for skin barrier repair and multi-ceramides for skin lipid restoration.