Common nail diseases explained by a dermatologist

Nail abnormalities are often neglected. Patients tend to visit the dermatologist for skin-related concerns, such as acne or eczema. Yet, such diseases can be common and require diagnosis and management.

The nail (referring to the plate) is firmed rooted to the bed of our fingers or toes. They are made of modified keratin. It serves as a protective shield for our fingertips and toes. Nails on the fingers take approximately 5 to 6 months to grow out, while the toes require twice the duration. The slow growth rate and the difficulty of getting drugs to penetrate through the plates make it hard to treat the associated diseases.

Here, we share a few common diseases.

Nail Onychomycosis

Onychomycosis is a type of yeast or mould infection. The infection causes a discolouration (white, yellow or brown). Other characteristics include thickening, splitting, roughening of the nail.

Common factors that place individuals at greater risk include humidity, heat, trauma and diabetes. Basketball players may be more predisposed due to the direct trauma of having their toes stepped on by other competitors.

Onychomycosis may also be a symptom of the following conditions: psoriasis, eczema, trauma or ageing.

Treatment for onychomycosis: Topical antifungal agents are less ineffective, due to its inability for deeper penetration into the bed of the toe or finger. Instead, oral terbinafine or itraconazole is often prescribed.

Does my nail have a bacterial infection?

When your nails suffer from bacterial infection, it is termed as paronychia. Paronychia can be acute or chronic. In acute paronychia, it is generally painful with pus present, caused by the bacteria Staphylococcus aureus. Repetitive minor trauma, picking and tearing can cause a tear in skin of the finger bed, allowing bacteria to invade.

In chronic paronychia, individuals in wet working conditions or cold environment are at greater risk. Compared to acute paronychia, chronic paronychia is generally less painful.

How to treat acute paronychia: Antibiotics and drainage of any pus if present.

How to treat chronic paronychia: Topical imidazoles are often prescribed. The patient should also avoid wet conditions, e.g. to use cotton-lined gloves when exposed to wet work. Manicuring or finger sucking should be avoided. Apply emollient creams regularly.

Ingrown toenail

Ingrowns at the toes can be hard, swollen and painful. Trimming your nails too short, especially on the sides of your big toes, can cause an ingrown. Trimming the corners may encourage the plates to grow inwards, digging into your skin. Your skin then breaks due to the pressure, triggering an infection. Tight shoe wear or trauma can also cause ingrowns.

If excessive inflammation and swelling are present, patients are advised to visit a dermatologist for proper treatment. Oral antibiotics may be prescribed, and the dermatologist will assess if there is a need for surgical removal.

To prevent ingrowns, wear proper-fitting shoes that have adequate room for the toes. Wear socks too. Cut straight across instead of rounding the corners.

Tumours

Tumours on nails can be benign or malignant. Warts are the most common type of benign tumour affecting them.

Dermatological diseases that can affect nail conditions

Psoriasis: Patients who suffer from psoriasis may notice that their nails are scaly or pitted, with debris collected under them. In severe cases, the plate crumples, along with thickening of the finger or toe bed.

Generally, the condition should improve with effective psoriasis management. There are no nail-specific treatments for patients with psoriasis.

Eczema: While eczema does not typically cause nail changes, certain patients may suffer from brittle nails. The plate may also be rippled and deformed, due to the body’s inflammatory process. Horizontal ridges can be seen across the nail, with thickening and sometimes discolouration.

Emollients

Nail abnormalities can benefit from the application of moisturizers, especially for patients suffering from eczema. Use a dermatologist-formulated emollient such as Multi-CERAM™ Moisturizer, with phyto-ceramides for skin barrier repair and multi-ceramides for skin lipid restoration.