Nail Fungus & Nail Health

The Long and Short of Nails

Copyrighted Material: Not for Reproduction or Distribution

Nail Fungus Pamphlet The nails serve many important functions. They help us pick up and manipulate objects, and they protect and support the tissues of the fingers and toes. Nails can be very attractive. Women, more often than men, place a great deal of importance on how their nails look and spend a considerable amount of time and money on them. Nails reflect an individual's personal and health habits - good or bad. Aside from their cosmetic appeal, nails serve many important functions. Most importantly, nails often reflect our general state of health.

Nail disorders can affect our ability to pick up small objects, the way we walk, and our sense of touch. Infrequent in children, nail problems usually increase throughout life and affect a high number of the elderly. This is due to the susceptibility of the nail to fungal infections, its increased thickness with age, circulation problems, and the use of medications.

Nail Plate:	The visible part of the nail on fingers and toes.
Nail Bed:	The skin beneath the nail plate.
Matrix:	The area under the cuticle, the hidden part of the nail unit where growth takes place.
Lunula:	This is part of the matrix and is the whitish, half-moon shape at the base of the nail, usually most pronounced on the thumb.
Cuticle:	Tissue that overlaps the plate and rims the base of the nail.
Nail Folds:	The folds of skin that frame and support the nail on three sides.

More that Meets the Eye

Nails are produced by living skin cells in the fingers and toes. They are composed primarily of keratin, a hardened protein also found in skin and hair.

Nails grow from the matrix. As older cells grow out, they are replaced by newer ones. The cells are compacted and take on a flattened, hardened form. Fingernails grow faster than toenails. Nails also grow more rapidly in the summer than in the winter. Nails on a person's dominant hand (right vs. left) grow faster, and men's nails grow more quickly than women's, except possibly during pregnancy and old age. Nail growth is affected by disease, hormone imbalance, and the aging process. The average growth rate for nails is 0.1 mm each day. Individual rates depend on age, time of year, activity level, and heredity.

Common Nail Disorders

Nail disorders comprise about 10 percent of all skin conditions. Due to their location, nails take a lot of abuse. Most of us have closed fingers in doors, suffered from ingrown toenails, or endured minor nail or nail fold infections. Sometimes, toenail injuries result from poor fitting shoes or athletic activity. Although they might be unsightly for a while due to the nail's slow growth rate, most minor nail injuries heal on their own. More serious injuries or disorders require professional treatment. Symptoms that could signal nail problems include color or shape changes, swelling of the skin around the nails, pain, the persistence of white or black lines, dents or ridges in the nail, and should be reported to a dermatologist.

White Spots: are small, semi-circular spots that result from injury to the base (matrix) of the nail where nail cells are produced. They are not a cause for concern and will eventually grow out. White spots are very common and usually recur.
Splinter Hemorrhages: are a disruption of blood vessels in the nail bed can cause fine, splinter-like vertical lines to appear under the nail plate. They are caused by trauma to the nail, by certain drugs and diseases.
Ingrown Nails: form at the corner of the nail that curves downward into the skin. The great toenails are particularly vulnerable. Improper nail trimming, tight shoes, or a poor stance can all lead to this common nail problem. Ingrown nails can be painful and sometimes leaad to infection. Proper treatment can avoid problems.
: Ingrown nails can be very
uncomfortable until treated
Fungal Infections: often cause the end of the nail plate to separate from the nail bed. Debris (white, green, yellow, or black) may build up under the nail plate and discolor the nail bed. The top of the nail or the skin at the base of the nail can also be affected. Toenails are more susceptible to fungal infections because they are confined in a warm, moist environment. These make up approximately 50 percent of all nail disorders and can be difficult to treat. Candida or yeast infections are common in fingernails, especially if the hands are always in water or if the person has diabetes.
: Fungal infections of the nail can
cause discoloration and abnormal growth.
: Physical activity in poor fitting
shoes can cause joggers nails.
: Bacterial Infections cause redness, swelling, and pain of the nail skin folds. The most common cause is trauma to the nail or surrounding skin, as well as frequent exposure to water and chamicals. A green discoloration of the nail is due to infectin by a bacterium called pseudomonas.
Tumors and Warts: can be found in any portion of the nail. The nail plate could change shape or be destroyed due to interference of a growing tumor or wart.

Warts are viral infections that affect the skin surrounding or underneath the nail. They can be painful and sometimes cause limited use of the affected finger or toe. Treatment usually involves freezing or chemicals that destroy the wart. If the wart or tumor extends into the nail folds or is located under the nail plate itself, surgery may be necessary to remove it. Sometimes during the treatment of a tumor or wart, the nail can be further damaged.
: Warts can be on the skin surrounding
the nail and underneath the nails.
Mucinous cysts: are clear, jelly-filled papules that can appear at the base of the nail. They can become painful, may damage or deform the nail, and should be removed.
Dark spots: in the nail must be examined by a dermatologist to be certain they are not cancerous.
Psoriasis: is a chronic skin disease characterized by red, scaly patches. Approximately 10 to 50 percent of people with psoriasis, and 80 percent of people who suffer from inflammation associated with psoriasis, have nail problems, especially affecting the fingernails. The most common signs include pitting, rippling, or discoloration of the nail, reddish-brown discoloration of the skin under the nail, separation of the nail from the nail bed, splinter hemorrhages, crumbling and/or splitting of the nail, as well as swelling and redness of the skin surrounding the base of the nail.
: Psoriasis can also affect the nails

A Hard Habit To Break

Nail biting is a common problem, especially among young children. While the habit is typically outgrown, it has been linked to anxiety or boredom in older children and adults. Not only does nail biting ruin the look of the nails, it is also a good way to transfer infectious organisms from the fingers to the mouth and vice versa. A tic habit deforms the nails by repeated picking at the cuticle. Applying bad tasting nail polishes or liquids to the nail as well as other therapies may help break the habit.

Repeated picking at the cuticle

Repeated picking at the cuticle
can lead to an abnormal appearing nail.

Treatment

Nail disorders are difficult to treat and respond very slowly to therapy due to the slow growth rate of the nail and its inability to absorb medications very well. Surgical treatment is common to remove tumors or correct structural abnormalities. Non-surgical treatments include the use of topical or oral medications.

A Window On Health

The nails can reveal much about a person's overall health. Many diseases and serious conditions can be detected by changes in the nails. Most doctors will check the nails carefully during a physical examination. The most common health conditions and their effect on the nails are:

Condition Nail	Appearance
Liver Diseases	White Nails
Kidney Diseases	Half of nail is pink, half is white
Heart Conditions	Nail bed is red
Lung Diseases	Yellowing and thickening of the nail, slowed growth rate
Anemia	Pale nail beds
Diabetes	Yellowish nails, with a slight blush at the base

Nail Care

Since many nail disorders result from poor nail care, developing good nail habits early will help keep them healthy. Remember the following tips:

Keep nails clean and dry. This helps keep bacteria and other infectious organisms from collecting under the nail.
If toenails are thick and difficult to cut, soak them in warm salt water (one tsp. of salt to a pint of water) for five to ten minutes. Apply urea cream, which will soften the nails and make them easier to trim.
Nails should be cut straight across and rounded slightly at the tip for maximum strength. Use sharp nail scissors or clippers. Filing the nails into points will weaken them.
Avoid biting fingernails, and do not remove your cuticle.
Use a "fine" textured file to keep nails shaped and free of snags.
Avoid "digging-out" ingrown toenails, especially if they are already infected and sore. Seek treatment from a dermatologist.
Report any nail irregularities to your dermatologist. Nail changes, swelling, and pain could signal a serious problem.

To learn more about nail health, call toll free (888) 462-DERM (3376) to find a dermatologist in your area.

AAD Web site: www.aad.org
1-888-462-DERM
Images used with permission of the American Academy of Dermatology
National Library of Dermatologic Teaching Slides
©2006 American Academy of Dermatology
Revised 1997, 2001, 2004
American Academy of Dermatology
930 E. Woodfield Road
P.O. Box 4014
Schaumburg, IL 60168-4014
PAM42 - 09/04

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