Nail Treatments: Nail Problems

Nails support and protect the sensitive tips of our fingers and toes. Fingernails also help us to pick up objects, scratch an itch or untie a knot. Fingernails grow about three times faster than toenails.
Nail problems affect people of all ages. Diet is generally not responsible for abnormal nail changes, unless the person is suffering from severe malnutrition. Some nail conditions need professional treatment from either a doctor or a dermatologist, while others respond to simple self-help techniques and minor lifestyle changes. When in doubt, seek medical advice.
Toenail problems can affect people of all ages, but tend to be more common in older people. Common causes of fingernail problems include injury, infection and skin diseases such as eczema and psoriasis. Causes of toenail problems include trauma, ill-fitting shoes, poor circulation, poor nerve supply and infection. Problems with toenails can be successfully treated by a podiatrist.

Structure of the nail
Nails are made from a protein called keratin. This is the same protein that makes up skin and hair. Nails grow from cells that multiply within the base of the nail, then layer on top of each other and harden. This is called keratinisation.
The strength, thickness and growth rate of nails are characteristics that we inherit from our parents. The structures of the nail include:

Nail conditions
There are a number of conditions that can affect our nails, with different causes and treatments.

Nail discolouration
The healthy nail plate is pink, and the nail looks white as it grows off the nail bed. Causes of discoloured nails typically include:
Lifted nail plate
If the nail plate lifts off the nail bed, it will appear white. Common causes include:
Thickened nails
This condition affects the toenails more than the fingernails. Older people are at greater risk. Causes include:
Ridged nails
Ridges running either the length or width of the nail plate can have a number of causes, including:
Splitting nails
In this condition, the nail plate splits or layers as it grows off the nail bed. Common causes include: Deformed or brittle nails
A violent toe-stubbing, dropping a heavy object on the toe or some other trauma can injure the nail bed and cause the nail to grow in a deformed way. The nail may be thickened or ridged. It is a normal ageing process for nails to thicken.
Deformed or brittle toenails can benefit from regular professional attention. Trimming, shaping and nail care from a podiatrist can improve the health of your toenails and help diagnose and treat more serious nail problems.

Bacterial infection of the nail
The Staphylococcus aureus bacterium is a common cause of bacterial infection of the nail. Typically, the infection first takes hold in the fold of skin at the base of the nail (proximal nail fold). Without treatment, the infection can worsen, leading to inflammation and pus. It is often associated with candida infection, particularly when it becomes chronic.

Activities that predispose a person to a bacterial nail infection include:
Inflammation of the skin alongside the nail – paronychia
The skin lying alongside the nail can become infected with bacteria, typically Staphylococcus aureus. This infection is called paronychia. Symptoms may include pain, redness and swelling around the cuticle and yellow-green discharge.

Treatment for paronychia includes:
Chronic paronychia (where the condition is present for a long time) is more difficult to treat. In chronic paronychia, the nail may distort and become discoloured, and the skin may lift at the site of infection. Sometimes, the inflammation spreads from one nail to another. A range of micro-organisms working together are responsible for chronic paronychia.

Fungal infection
Fungal infections, such as tinea, are spread from one person to another and can affect the fingernails or toenails. Without treatment, the nail bed itself can become infected. People with diabetes or with compromised immune systems are at higher risk of fungal infection.
The characteristics of a fungal nail infection depend on the cause, but may include: Treatment for fungal infection includes:
Trauma to the nail
A blow to the nail or compulsive nail biting can cause a range of problems, including:
Ingrown toenail
One of the most common problems treated by podiatrists is ingrown toenails. The big toe is particularly prone to this painful condition. Causes may include:
Treatment from a podiatrist depends on the severity of the injury, but may include removing the ingrown nail section using a local anaesthetic.
Suggestions to prevent an ingrown toenail include:

Skin diseases and nails
Skin diseases such as psoriasis, eczema (dermatitis), lichen planus or lupus can affect the nails. Abnormalities may include pits, grooves or crumbling nails.

Unusual nail shape
Unusual nail shape – such as the nails becoming concave – can be caused by iron deficiency.

Nail tumours
Nails can be affected by tumours – including squamous cell carcinoma, usually caused by infection with the human papillomavirus (HPV). Melanoma can also affect the nail.

Splinter haemorrhages of the nail
These are thin lines of blood running along the nail bed. Causes include injury, severe anaemia, infective endocarditis (inflammation of the inner tissue of the heart) and certain diseases such as rheumatoid arthritis.