Types of Nail Diseases & treatment

Types of Nail Diseases

Nails are unique structures formed of keratin, just like hair and the superficial skin layers. Nail diseases vary in entiology and morphology. The most common types are presented here.

Fingernails protect the sensitive tips of the fingers from accidental trauma and are formed by the layer of germinal tissue called the nail matrix.

The matrix can be found at the very base of the nail, hidden under the skin fold which lies just below the proximal side of the nail. The nail matrix is part of the nail bed which supports and nourishes the nail plate.

The nail folds hold the nail in position and anchor it to the skin, forming the cuticle. This prevents microbial organisms from entering the nail bed also keeps moisture out.

1 Nail Discoloration 

The normal nail is pale pink in the color. The end of the nail that grows off the finger is white because it has no connection with the vascular nail bed which supports the rest of the nail plate. Nails can become discolored because of:

. Smoking tobacco

. Injury to the nail bed

. Infection of the nail bed

. The use of dyes such as those used for hairs

. Subungual melanomas

. Silver toxicity, quinacrine toxicity, the nail become blueish

. Several systemic illnesses including liver disease, the nail become white

. Renal failure, the nail become half and half

. Certain medication including some chemotherapy drugs

Here are some treatment of Nail Discoloration

. Keep Clean

Because fungi are everywhere, including the skin, they can be present months before they find opportunities to strike. By following proper hygienic and regularly inspecting your feet and toes, you can reduce your chances of the problems. Clean dry feet resist disease. Washing the feet with antibacterial soap and water every night before bedtime, and remembering to dry thoroughly , is the best way to prevent an infection.

. Wear your shoes in Yucky surrounding

Slip your feet into shoes or sandals rather than placing your bare feet in harm's way.

. Snip nails short

Longer nails can get caught on things or rub against tight shoes, which can cause the nail to lift from its bed. 

. Keep feet cool

Use a quality feet powder-talcum, not cornstarch and wear shoes that fit well and are made of materials that breathe. Try to keep your feet cool to avoid discoloration of nails.

. Watch those nail products

Ordinarily, any moisture that collects underneath the surface of the nail passes through the porous structure of the nail and evaporates. Acrylic nails applies to the tops of the nails may impede that, however. The moisture trapped below can become stagnant and unhealthy, ideal conditions for fungi and similar organisms to thrive.

. Try Vinegar

Sometimes nails can develop a greenish hue caused by a bacterial infection. Pour some white vinegar in a bowl and soak your nails in it a few times a day. Vinegar is actually a mild acid, and it can be helpful in these cases.

. Try Lemon Juice

To remove run of the mill stains from your fingernails, soak them in Lemon juice.

. Prevent polish stains with a base coat

A base coat is typically a clear nail polish that goes onto your fingernails first, keeping the colored fingernails polish and its potential lingering stain off your nails. It also helps keep the polish on your nails.

2 Chronic paronychia

Here the nail folds is thickened, tender and mildly reddened. It is due to a mix of factors such as chemical irritation, allergy and moist condition, all of which predispose to chronic fungal infection as well. The nail becomes distorted in many such cases with accompanying discoloration.

Treatments.

The treatment of choice depend on the extent of the infection. If diagnosed early,acute paronychia without obvious abscess can be treated non-surgically. If soft tissue swelling is present without fluctuance, the infection may resolve with warm soaks 3 to 4 times daily.

Patients with extensive surrounding cellulitis or with the history of diabetes , peripheral vascular disease, or an immunocompromised state may benefit from  short course of antibiotics.. An antistaphylococcal penicillin or first-generation cephalosporin is generally effective; clindamycin and amoxicillin clavulanate are also appropriate.

3 Traumatic changes to the nail.

The nail may become injured, leading to:

. Lifting of the nail by a subungual hematoma

. Loss of the nail plate if the injury is too severe

. Ridging of the nail or nail deformities , if the nail matrix is traumatized

Treatments. 

Treatment of a subungual hematoma is aimed at relieving pressure by draining the blood trapped under the nail. For a small hematoma , you can heat a needle or the end of a paper clip until it is red-hot. Using gentle pressure, the hot tip can penetrate the nail, creating a small hole through which blood can drain. The nail may remain discolored after the procedure.

Some people do not feel comfortable doing this at home. Your physician can provide the same treatment in his or her office using a sterile blade or needle. If blood takes up more than half of the area under your nail, a physician should evaluate the nail. Occasionally, the nail may need to be removed so a deep tear can be repaired with stitches.

If the nail torn or jagged, you should trim it to avoid snagging it on things and further injuring them.

If your nail completely off the nail bed, it may be most comfortable initially to replace the nail and hold it in place with a bandage. Nails will not reattach themselves to the nail bed after they have separated from it, but in most cases  new nail will slowly regrow.

4 Elevation of the nail plate (Onycholysis)

The nail can be lifted off the underlying nail plate by infection or trauma and appears yellowish or white. This includes:

. Picking under the fingernails too far

. Pus formation under the nail plate

. Some fungi infections

. Psoriasis

. Certain systemic condition such as bronchiectasis, thyroid disorders, anemia or some autoimmune disease

Treatments.

. Clip the affected portion of the nail, and keep the nails short.

. Avoid injuring the affected nail, and keep the nail bed dry.

. Avoid exposure to contact irritants such as nail enamel and enamel remover or solvents and detergents.

5 Ingrown Nails

This condition is characterized by nails growing into the skin at the sides of the nail. This causes pain and may predispose to infection. It is more common if the nail curves inwards too sharply, or if the nails are not trimmed correctly ( straight across, or, in the case of fingernails, with a gentle curve). Trauma or tight footwear may also cause this condition.

Treatments.

For mildly ingrown toenails, the doctor can gently lift the edge of the nail out from under the surrounding skin and place sterile cotton under the nail until the swelling goes away. Sometimes a flexible tube is inserted between the nail and the nail fold ( the fold of hard skin at the sides of the nail plate where the skin and nail meet) instead of cotton.

If an ingrown nail requires further attention, the doctor usually numbs the area with a local anesthetic (Such as lidocaine), then cuts away and removes the ingrown section of the nail. The inflammation can then subside, and the ingrown nail usually does not return.

6 Nail thickening

Thickening of the toenails is a normal age related change, but abnormal thickening is also possible. This include:

. Injury

. Fungal infection

. Ishemic circulation

. Arthritis

. Abnormal gait

. Tight shoes

. Psoriasis

Treatments

. Treat underlying condition

If you have this nail growth issue, your doctor may want to identify potential issues that could be causing it. In some cases , there isn't an underlying issue, but if one can be found, it can be treated. Treatment means the thick growths and discoloration may stop.

. Removal of affected nail

In extreme cases, your doctor may choose to remove a portion or all of the thickened nail. This is an portion when the nail becomes so thick you experience severe pain and can't properly care for it on your own anymore. 

7 Nail Ridges

Longitudinal ridges running down the nail may occur in several systemic conditions, such as:

. Severe anemia or malnutrition

. Aging

. Trauma

. Eczema

. Rheumatoid arthritis

. Peripheral vascular disease

. Lichen planus

Treatments.

Treatments for skin conditions such as eczema may include moisturizers for your hands or topical ointments to reduce eczema symptoms. If low levels of minerals or vitamins are to blame, you may be advised to alter your diet or take supplements to boost your levels

Buffing your fingernails with an emery board may help smooth ridges. Ask your dermatologist for advice on treating your nail.

8 Nail splitting

The nail may flake into layers as it grows, due to:

. Constant application and removal of nail polish

. Hands in constant exposure to water 

. Overuse of the fingernails

Treatments.

. Keeps your nails clean and healthy

. Refrain from keeping your hands or feet in water for long periods.

. Use moisturizer on your nails and cuticles

. Use nail hardening products if necessary.

. Take supplements such as biotin with permission from a doctor.

9 Nail deformities

The nail may be deformed if it is subject to trauma or fungal infection. The nail bed injury forces the nail to grow in an abnormal way. Other abnormalities of nail shape include:

.                                                                                                                                                                  

Pincer nails which are curved transversely so much that they appear like pincers, seen as both a congenital hereditary form and acquired disease

. Dolichonychia or long nails in Marfan's syndrome or hypopituitarism 

. Brachyonychia refers to short narrow nails as seen in psoriatic arthropathy 

. Parrot beak nails are seen in some cases of scleroderma

Treatments.

Don't bite or tear at your nails, or pull on hangnails. Always use nails clippers and trim them after you bathe, when nails are still soft.Using sharp manicure scissors, trim your nails straight across, rounding the tips gently.In such cases doctor may remove your nail, the nail will regrow that is quite fine.

10 Nail changes in systemic disease

Allergic or autoimmune conditions may present with nail changes such as pitting in psoriasis or splinter hemorrhages in bacterial endocarditis, or altered shapes, including the koilonychia (spoon-shaped concave nails) of iron-deficiency anemia. Beau's lines are transverse depressions that occur following severe illness, malnutrition, chemotherapy or nail injury, besides several other conditions. Clubbing may occur in lung disease/

11 Nail Fungus (onychomycosis, tinea unguium)

Many changes in fingernails or toenails may cause people think they have a fungal infection of the nail, medically known as onychomycosis or tinea unguium.

Fungal infections of the nails sometimes makes the condition sound contagious or related to poor hygiene. In fact, up to 10% of all adults in western countries have fungal infection of the nails. This percentage increases to 20% of adults who are age 60 or older. Toenail fungus is much more common than fingernail fungus.

In reality, abnormal-looking nails may be caused by a number of conditions including , but not limited to, fungal infection. 

What others conditions can be mistaken for fungal nails.

. Lines or ridges:

These are common and may be considered normal. They may worsen during pregnancy. A large groove down the center of the nail can be caused by develop these changes following chemotherapy.

. Senile nails

As you age, the nails become brittle and develop ridges and separation of the nail layers at the end of the nail. To avoid this, try to clean solutions and don't soak the nails in water.

. Whitish or yellowish nails

This can occur due to onycholysis. This means separation of the nail from the nail bed. The color you see is air beneath the nail. The treatment is to trim the nail short, don't clean under it, polish if you want to hide the color, and wait two to three months. Persistent onycholysis can make the nails susceptible to fungal infection.

. Red or black nail.

This due to a hematoma, or blood under the nail, usually occur from trauma (like whacking yourself on the thumb with a hammer). The discolored area will grow out with the nail and be trimmed off as you trim your nails. If you have a black spot under your nails that was not caused by trauma, you may want to see a dermatologist or a podiatrist if it involves a toenail to make sure it is not melanoma (a type of skin cancer associated with pigmented cells). A simple biopsy can rule out malignancy (cancer).

. Green Nails

This can be caused by Pseudomonas bacteria, which grow under a nail that has partially the nail bed. This infection may cause a foul odor of the nails. The treatment is to trim the nails short every four weeks, don't clean it, polish if you want to hide the color, and two to three months. It is also advised to avoid soaking the nail in any sort of water (even if inside gloves) and to thoroughly dry the nail after bathing. If the problem continues, there are prescription treatments that your doctor may try.

. Pitted nails

Pitted nails may be associated with psoriasis or other skin problems that affect the nail matrix, the area under the skin just behind the nail. This is the area from which the nail grows. Nails affected by psoriasis can also be tan in color.

Fungus Treatment

Oral antifungal therapy has a high cure rate, depending on the medication. It can take nine to 12 months to see if it has worked or not, because that is how long it takes for the nail to grow out. Even when therapy works the fungus may come back. Currently, an oral antifungal therapy is considered the best treatment for toenail because of higher cure rates and shorter duration compared to topical therapy.

Prescription oral medications that are effective,nail fungus include the following:

 . Griseofulvin (Fulvicin, Grifulvin, Grispeg)  

This drug has been the mainstay of oral antifungal therapy for many years. Although this drug is safe, it is not very effective against toenail fungus. Disappointing long-term results have been reported. Newer agents have largely supplanted it.

. Terbinafine ( Lamisil)

This drug is taken daily for 12 weeks for toenails and six weeks for fingernails. The drug is safe, effective and produce few side effects. However , it must be used with caution in patients with liver disease. This medication is also affordable.

. Fluconazole (Diflucan)

This drug may be given once a week for several months. The dosing of this drug may need to be modified if the patient has impaired kidney function or is taking it simultaneously with certain other medications. It is not as effective as Lamisil or Sporanox and should be used cautiously in patients with liver disease.

There are several innovative treatments that are still being tested:

. Laser therapy or photodynamic therapy uses application of light activated agents onto the nail followed by shining light of a proper wavelength on the nail.

. Use of electrical current to help absorption of topical antifungal medications into the nail: This is also called iontophoresis.

. Use of a special nail lacquer that changes the micro climate of the nail to make it inhospitable for the fungus to grow.