Nails Diseases and Problems Introduction Your toenails and fingernails protect the tissues of your toes and fingers. The health of your nails can be a clue to your overall health. There are many diseases and problems that can affect your nails. Treatment for nail diseases and problems depends on the cause. It may include lifestyle changes, medicines and other treatments. This reference summary explains nail diseases and problems. It talks about common nail diseases and problems and their symptoms. It also covers how to keep your nails healthy. Nails Nails are made up of layers of a hardened protein called keratin. Keratin is also in your hair and skin. Nails protect the tissue beneath it from damage. In other words, toenails and fingernails protect the tissues of your toes and fingers. When nails grow, new cells are formed. These new cells push the old cells toward the fingertips. The old cells become hard, forming the nail. Nails grow from the base of the nail under the cuticle. The cuticle is skin that surrounds the toenails and fingernails. Cuticle How fast your nails grow depends on many different factors, such as your: Activity level. Age. Gender. Men s nails grow faster than women s. Genes, which control how the body works. 1
Nail growth also depends on the time of year. Nails grow faster during the summer months than in the winter. Nail growth can be affected by: Diet. Diseases or ongoing illness. Fever. Injury. Medicines. This is why nails can be a clue to your overall health. Healthy nails are usually smooth. They are also consistent in color. Sometimes nails can have white spots or vertical ridges. These nail changes are harmless. Specific types of nail discoloration and changes in growth rate can signal various diseases. Lung, heart, kidney and liver diseases can cause changes in the nails. Diabetes and anemia can also cause the nails to look unhealthy. Signs Not all nail changes are a sign of a disease or problem. This section explains when you should talk to your health care provider about nail changes. Healthy nails are usually a consistent color. It may be a sign of a problem if the entire nail changes color or if there is a dark streak under the nail. Any changes in the nail color should be looked at by a health care provider. You should also talk to your health care provider if your nails change thickness. If the nails become thin, they may break or split easily. If the nails become thick, they may darken and be difficult to trim. Other nail changes that should be brought to your health care provider s attention are: A nail separating from the skin around it. Bleeding around a nail. Changes in the nail s shape, such as curled nails. Pain, redness or swelling around a nail. 2
The next few sections talk about common nail diseases and problems. These include: Ingrown nails. Infections. Cancer. Ingrown Nails Ingrown nails are one type of nail problem that can require treatment. They are a very common problem. Normally nails grow straight. Ingrown nails happen when the nail sides or corners grow into the skin around the nail. This causes the skin to become red, swollen and irritated. Ingrown nails are more common with toenails than with fingernails. In most cases, the big toe is affected. One cause of ingrown nails is trimming the nails improperly. When cutting your nails, always use a nail clipper. Cut straight across and never round the corners of your nails. Ingrown nails may also be caused by: Heredity. Repeated injury to the nails from everyday activities. Wearing shoes that are too tight. Besides pain, ingrown toenails may also lead to infection. You can treat an ingrown nail by soaking it in a tub of warm, soapy water. Then apply antibacterial ointment and a bandage. Contact your health care provider if you have a painful ingrown nail or think you may have an infection. You should not try to remove the ingrown nail from the skin. This is especially important if you have diabetes or other circulatory problems. Your health care provider may refer you to a podiatrist if your toenail is ingrown. A podiatrist specializes in foot care. Podiatrists have special methods of removing the ingrown nail to prevent it from happening again. Infections Infections can also affect the nails. Common infections are caused by bacteria or fungi. Fungal infections cause about half of all nail diseases. These infections most commonly affect the toenails. The toenails are often in a warm, moist environment that allows fungus to grow. Fungal infections cause the nail to thicken and change color. 3
The nail may become yellow or darker in color. Fungal infections can also cause an odor. People are more likely to get a fungal nail infection if they: Have certain health conditions, such as diabetes or a weakened immune system. Sweat a lot or have a history of fungal infections. Walk barefoot in damp areas, including swimming pools, locker rooms or shower areas. Nails can also be affected by bacterial infections. Often a bacterial infection happens when the nail or the skin around it is injured. This allows bacteria to enter. Certain habits can lead to bacterial infections, such as: Finger sucking. Frequent exposure to water. Nail biting. Poor hygiene. These habits can introduce more bacteria to the areas around the nail. Infections of the nail can spread to other nails or the skin. Eventually, an infection of the toenail may cause pain that makes it difficult to wear shoes or even walk. It is important to treat a nail infection before it spreads. Treatment for nail infections depends on: How severe the infection is. The type of infection. Sometimes thoroughly cleaning the nails over a period of months will get rid of an infection. Soaking the infected nail in warm water three times a day may also help. Other times, medical treatment is needed. Medical treatment often includes medicines. Over-the-counter medicines are available to treat fungal infections of the nail. But sometimes prescription drugs are needed. Medicines for nail infections may be taken orally, as a pill. They may also be applied to the infected area as a cream. 4
In severe cases, the infected nail or surrounding tissue may be removed. This will cure the infection and prevent it from coming back. Cancer Cancer begins in the body s cells. Cells are the building blocks of the body. Normal cells in the body grow and die in a controlled way. Sometimes cells keep dividing and growing in an uncontrolled way. This causes an abnormal growth called a tumor. If the tumor does not invade nearby tissues and body parts, it is called a benign tumor. A benign tumor is a non-cancerous growth. Benign tumors are usually not life threatening. If the tumor invades nearby tissues and body parts, it is called a malignant tumor or cancer. Cancerous cells spread to different parts of the body through blood vessels and lymph channels. Cancers in the body are given names, depending on where the cancer started. Rarely, cancer can begin in the skin under the nails. This is a type of skin cancer. Cancer that begins in the skin will always be called skin cancer, even if it spreads to other places. The type of skin cancer that affects the nails is called melanoma. Melanoma begins in the cells that give the skin color. These cells are called pigment cells. This is why skin cancer that begins under the nails causes the nails to change color. Melanoma can develop on any skin surface. It is rare in people with dark skin. But when it does develop in people with dark skin, it's usually found: Under the fingernails. Under the toenails. On the palms of the hands. On the soles of the feet. Surgery is the usual treatment for people with melanoma. Other treatments may include: Chemotherapy. Photodynamic therapy. Radiation therapy. Biological therapy. 5
Chemotherapy is the use of drugs to kill cancer cells. Photodynamic therapy is the use of drugs that become active when exposed to light. These activated drugs may kill cancer cells. Radiation therapy uses high-energy rays to kill cancer cells and stop them from growing and spreading. Biological therapy is treatment to boost or restore the ability of the immune system to fight cancer. It may also have a direct anti-tumor effect that slows the growth of the tumor. Keeping Nails Healthy It is important to care for your fingernails and toenails. Doing so can help prevent nail diseases and problems. This section provides information on how to keep nails healthy. To keep your nails clean and strong, you should: Avoid soaking your hands or feet in water for too long to prevent germs from growing under the nails. Use lotion, rubbing it into your nails and cuticles. Wash your hands frequently to get rid of germs. Wear gloves when cleaning or using chemicals. It is also important to trim your nails regularly. Use nail clippers or scissors meant for nails. Always trim your nails straight across. Do not cut them too short. To avoid damaging your nails, never: Bite your fingernails or damage the cuticles. This may allow bacteria to enter the nail or surrounding skin. Pull hangnails. This can remove healthy tissue. Cut the hangnail off, instead. Use your nails as tools, such as when opening something. If you already have weak nails, you can avoid further damage by: Applying a thin coat of nail polish. Keeping your nails short to prevent breaking or splitting. Not using nail polish remover more than once a week. Using lotion multiple times a day. 6
If you get a manicure or pedicure, you can also protect your nails by: Making sure all tools are sterilized before use. Making sure footbaths are cleaned between clients. Never having your cuticles removed. Only choosing salons that are licensed. Summary Your toenails and fingernails protect the tissues of your toes and fingers. The health of your nails can be a clue to your overall health. There are many diseases and problems that can affect your nails, including: Ingrown nails. Infections. Cancer. Not all nail changes are a sign of a disease or problem. White spots or vertical ridges are harmless. But you should talk to your health care provider if one or more nails: Become too thick or thin. Change color or shape. May be infected. Separate from the skin around it. Treatment for nail diseases and problems depends on the cause. It may include lifestyle changes, medicines and other treatments. 7