Nail Conditions

Nail Conditions

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

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.

Thickened nails

This condition affects the toenails more than the fingernails. Older people are at greater risk. Causes include:

  • Fungal infection
  • Neglect
  • Injury
  • Poor circulation
  • Arthritis in the toes
  • Altered gait (walking) pattern
  • Ill-fitting shoes
  • Psoriasis.
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:

  • Nail polish
  • Nicotine from cigarette smoking
  • Hair-colouring agents
  • Certain infections
  • Injury to the nail bed
  • Some medications, including antibiotics, anti-malarial medications, and some medications used in chemotherapy
  • Melanoma.
Splitting nails

In this condition, the nail plate splits or layers as it grows off the nail bed. Common causes include:

  • Having constantly wet hands, especially while using soap and washing detergents
  • Frequently using and removing nail polish
  • Continuous mild trauma such as habitual finger-tapping or using the nails as tools (to pick between the teeth, for example).
Lifted nail plate

If the nail plate lifts off the nail bed, it will appear white. Common causes include:

  • Overzealous cleaning under the fingernails
  • Nail polishes that contain hardening chemicals such as formalin
  • Rough removal of artificial nails
  • Psoriasis
  • Tinea (a fungal infection).
Ridged nails

Ridges running either the length or width of the nail plate can have a number of causes, including:

  • Age-related changes
  • Trauma to the nail matrix
  • Overzealous attention to the cuticles
  • Fever or illness
  • Eczema
  • Rheumatoid arthritis
  • Peripheral vascular disease
  • Lichen planus infection.

Bacterial infection

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:

  • Having constantly wet hands
  • Overzealous attention to the cuticles
  • Severe nail biting, which can expose underlying tissues to infection
  • Eczema around the fingernails.

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.

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:

  • Lifting of the nail plate off the nail bed
  • Thickening of the nail plate
  • Crumbling of the nail plate
  • Discolouration, usually in streaks
  • White, yellow or green smelly discharge
  • Flaking and pitting of the surface of the nail plate.

Treatment for fungal infection includes:

  • Antifungal preparations applied topically (directly to the nail) or taken orally (by mouth)
  • Professional trimming, shaping and care of the toenail by your podiatrist.

Any abnormal changes to your nails should be medically investigated. See your doctor for treatment or possible referral to a dermatologist. If the cause of your nail problem is not immediately apparent, your doctor may take nail clippings and scrapings from beneath the nail for laboratory analysis. Fingernail infections usually respond faster to treatment than toenail infections.