KNOW YOUR NAILS

Introduction

How often do you consider the condition of your nails? Their shape, colour, and texture, may be more important than you think. Although for most of us, changes in their condition is just a sign of growing older, nails can also reflect a specific health problem or indicate a recent illness. If you notice that your nails look different, it is often important to know why, and when you should seek medical advice. This document looks at common nail problems, and provides useful tips on how to keep your nails healthy. It also recommends when a visit to the family doctor or foot specialist (chiropodist, now sometimes called a podiatrist) may be appropriate.

White spots

Causes
White spots on the nails are extremely common, and are frequently said to be caused by a lack of calcium or other nutrients in the diet. In fact, white spots are rarely linked to diet, but are more often due to the small bumps and bangs (minor trauma) that nails receive every day. Some people are more prone to white spots than others, simply because of their genetic make-up or because their job involves working with their hands.

Treatment
Completely avoiding the sort of minor trauma that causes white spots is very difficult. However, white spots are rarely unsightly. If particularly bothered by them, try wearing gloves during activities that might cause you to bang your nails (such as gardening, DIY, housework, or sport). Alternatively, women can simply cover them over with nail polish.

Vertical ridging

Causes
As the rest of our body begins to show signs of getting older, so too do our nails. Vertical or longitudinal ridging of the nails is a normal sign of ageing. The ridges start to appear in middle age, although they can occur earlier, becoming more numerous and pronounced as the years go by. How early these ridges start to develop, or how pronounced they become, generally runs in the family. Looking at your parents' nails will give you a good idea of how your nails will look as you grow older.

Treatment
Unfortunately, there is little that can be done to slow the physical signs of ageing, and nails are no exception. Gentle use of an emery board or nail file may reduce the appearance of severe ridges.

Transverse ridging ("Beau's lines")

Causes
Transverse ridges, also known as "Beau's lines", are ridges that cross the nail from one side to the other. They are caused by an interruption in the growth of the nail, which can be due to trauma to the nail such as over zealous manicuring, or (more often) as a result of recent illness, or shock to the body (such as a heart attack, measles, or eczema). People who wear tight-fitting high-heeled shoes may find they have transverse ridging on their big toes.

Treatment
A healthy diet and lifestyle helps to keep nails looking their best. Wear comfortable, well-fitting shoes and allow plenty of room for the toes, especially if on your feet all day. Transverse ridges are not normally permanent and will grow out in time. How quickly this happens depends on how quickly your nails grow. In a healthy individual this can vary from 9 to 24 months.

Fungal nail infection

Causes
As the name suggests, fungal nail infection is caused by fungus. In fact, it is the same fungus that causes athlete's foot, which is why nearly a third of people who have athlete's foot eventually develop this unsightly disease in their toenails. Hands that are in and out of water many times a day can also develop fungal nail infections, although less often.

The fungus normally attacks the nail from the free end, or the side of the nail, and spreads slowly backwards towards the base. The nail changes colour to creamy white or yellow, thickens and crumbles, and the end may separate from the nail bed.

Treatment
Fungal nail infection is unlikely to go away without treatment. If you think you have the condition, visit your family doctor, who can now prescribe effective treatments. If you have tried treatments for this condition in the past with little success, you may find it is now worth going back to your doctor for further advice. If you file your nails, avoid using the same file on an infected nail as a normal nail, since this can help spread the disease.

Subungual haematoma ("Black nail")

Causes
A black nail, or black spot, is usually a bruise underneath the nail. The nail itself does not change colour. It is usually caused by an injury such as shutting your fingers in a car door, or stubbing a toe. It is also common in joggers.

A bruise is normally accompanied by some degree of swelling, due to the accumulation of blood around the injury. The nail prevents any visible signs of swelling and so there is a build up of pressure under the nail, which can be very painful.

Treatment
Like most bruises, bruising under the nail gets better and disappears with time. If the injury was quite severe, affecting the whole nail, the nail may fall off. Do not worry, it will grow back. If there is a lot of pain from the pressure under the nail, you may need to visit your doctor (or chiropodist) who will be able to relieve the pressure by making a very small hole in the nail, allowing the blood to drain away.

A sudden appearance of a black spot with no history of injury should be checked by a doctor. It could be the sign of some other condition.

Ingrown toenail

Causes
Ingrown toenails normally occur on the big toe. The edge of the toenail grows into the fleshy skin that surrounds the nail. They are often caused by the nail being cut badly, or by some type of trauma. If ignored, and left untreated, ingrown toenails can become very painful, and may become infected.

Treatment
The best way to prevent an ingrown toenail is to cut the toenails correctly (as described later)
If you do have an ingrown toenail, keep your toes and feet clean with regular washing. Salt foot baths also help. Do not share towels, shoes, and socks, or try shoes on in a shop with bare feet. This helps to prevent an infection. If the ingrown toenail is painful, it is always advisable to visit your doctor or chiropodist.

Bacterial nailbed infection

Causes
Acute bacterial infection occurs when the skin around the nail becomes damaged, allowing bacteria to invade the nail area. This may be caused by too much manicuring of the cuticles, or nail biting. This type of infection is often painful and unsightly and, in severe cases, the cuticle may disappear, and the skin around the nail may swell tip and produce pus. If the infection lasts for more than two weeks, it is described as a "chronic" infection, and is likely to involve infection by a yeast, rather than bacteria. Chronic infection often occurs as a result of hands being in and out of water.

Treatment
If the skin around the nail becomes damaged in any way, try to keep the area as clean as possible to prevent bacteria from invading the skin. Avoid wet work, or try and wear protective gloves.

If you think you may have a bacterial infection, visit your doctor who will be able to prescribe appropriate treatment.

Pitting

Causes
Pitting may be described as small dents on the nail surface with a "thimble-like" appearance.
Pitting can occur with common skin conditions such as psoriasis or eczema, and some arthritic diseases. Alternatively, it may simply run in the family. Rarely, it may be linked to alopecia, an illness in which hair falls out in patches. An injury to a nail, such as a bump or a bang, may also cause pitting to occur.

Treatment
Little can be done to prevent pitting if you are naturally disposed to it. Your doctor will be able to advise you on treating any underlying condition. Unfortunately, however, once pitting is established it is very difficult to remove, even with successful treatments for conditions such as psoriasis.

Splitting

Causes
Vertical splitting of the nails from the tip down may occur if the nail plate is weakened or softened. This can happen if the hands are frequently soaking in water, or simply as a result of getting older. Footwear that does not allow your feet to breathe (e.g. Wellington boots) can have the same effect. Splitting of nails can occur with careless manicuring, particularly if nails are thin and brittle, or if they have vertical ridges already.

Treatment
Good nail care techniques are essential for keeping nails healthy (as described later). If you are frequently soaking your bands in water, wear a pair of rubber gloves to protect hands and nails. Make sure your diet contains plenty of iron and zinc, which are needed to keep nails healthy and strong. To help prevent splitting in the toenails, change socks and footwear daily.

Ragged cuticles ("Hang nail")

Causes
Ragged cuticles, or "hang nails", occur when the cuticle and skin surrounding the nail is damaged or torn. This damage may be caused by biting the nails, picking at cuticles, or frequently soaking your hands in water. Cold weather, which is often associated with dry skin, can also cause hang nails.
Hang nails can lead to bacterial or fungal infections of the nail (see above), by providing an exposed area in which the bacteria or fungus can settle and multiply.

Treatment
Try not to bite your nails. Hang nails increase the risk of developing an infection of the nail, and are therefore another reason to stop biting the nails. Wear rubber gloves when doing chores, particularly if it involves putting your hands in water. Keep nails clean and well manicured. If the cuticles are dry, apply a little hand cream or olive oil. If you think you may have bacterial or fungal nail infection, your doctor will be able to prescribe treatment.

Splinter haemorrhages

Causes
Splinter haemorrhages are tiny lines that run vertically under the nail. At first they are usually plum coloured, but then darken to brown or black in a couple of days.
The exact cause of splinter haemorrhages is not always known. It is thought they may be due to a blood clot, or particles of fat that are carried in the blood and which become stuck in the nail bed. They can also appear because of injury to the nail, especially in manual workers, or as a result of an illness (such as arthritis or heart disease).

Treatment
Unfortunately, there is little that can be done to prevent splinter haemorrhages. However, a healthy diet and lifestyle, and avoidance of injury to the nails help to keep them in good condition. If splinter haemorrhages occur without a history of trauma, consult your doctor.

The dark marks on the nails caused by splinter haemorrhages should grow out and disappear as the nail grows and as you cut your nails.

Separation of the nail plate

Causes
Separation of the nail from the nail plate is most commonly caused by exposure to detergents such as washing-up liquid, or as a result of psoriasis. It may also be due to an injury to the nail or. consistent banging of the nail, as often occurs with frequent typing. Fungal infectious or repeated cleaning of the ends of the nail with a file can also cause this condition.

Treatment
Often separation of the nail from the nail plate is an unsightly problem. If you think you could have this problem, you should visit your doctor, or chiropodist. If caused by a disease, once the nail is detached it is unlikely to re-attach.

Take care to avoid activities where nails may be injured. Wear protective gloves when doing gardening, DIY, and housework. Keep nails in good condition with a healthy lifestyle, diet, and careful manicuring.

Nail thickening

Causes
Thickening of the nail, especially toenails, may happen naturally as we grow older, but there are other causes of nail thickening. If a person has a fungal nail infection (see above), then the nail takes on a new appearance, becomes thicker and turns yellow. Skin conditions, such as psoriasis, may also cause thickening, as can damaging the nail bed. The nail, especially the big toe nail, may thicken with a single major trauma, or repeated minor traumas over a long period.

Treatment
There is little that can be done to prevent nails from thickening with age. However, if the nail has thickened due to a fungal infection, go and see your doctor for advice. It rarely gets better without treatment and is likely to get worse.
If your nails are thickened due to trauma, visit a chiropodist who should be able to reduce the nail thickness. Protective footwear help to protect the feet from trauma.

Involuted nail

Causes
The tip of a normal nail curves slightly at the free edge of the finger or toe nail. The tip of an involuted nail, however, curls much more, sometimes almost into a circle. In some cases this may be caused by your genetic make-up. However, sometimes tight-fitting shoes can mean that extreme pressure is placed on the sides of the nail, resulting in involution.

Treatment
If you notice that your nail is involuted, visit your chiropodist who will be able to recommend treatment to correct it.

Warts under or around the nail

Causes
Common warts that appear under or around the nail are caused by a virus infection of the nail area. Biting, picking, and tearing the nail and its surrounding skin cause the infectious warts to spread.

Treatment
Warts are not dangerous, but they can be quite unattractive. Getting rid of them may take a long time and can be frustrating. Your doctor or chiropodist will be able to give advice or recommend a suitable course of treatment, but it is important to visit them for advice as soon as a wart appears, since treatment may be more successful if you catch it early. Without treatment, the majority of warts will normally disappear naturally within 12 to 18 months. Whether you decide to have the warts treated or not, the likelihood of spreading the infection to other people remains low.

Tips on good nail care

Get To Know Your Nails

• View your nails at an angle to reflect light off the surface. Keep a look out for:
• small dents on the nail plate
• ridges running up and down, or across the nail
• changes in the nail colour
• any signs that the nail may be infected

Examining your nails regularly means you become familiar with their shape, colour, and texture. This helps to spot changes in their appearance sooner rather than later. If worried about a discolouration or any other change, seek advice from your doctor.

Try to avoid infections

Fungal infectious can be passed on from the fungal spores that live on nail and skin fibres which get caught up in towels, shoes, and socks. Remember that hands which are frequently in water are going to be more prone to bacteria and fungal infections.

To prevent catching a fungal nail infection

• avoid sharing towels or bath mats
• wear suitable shoes or flip-flops in communal showers or around swimming pools
• wash the feet daily
• dry feet and hands thoroughly each time you wash them
• change shoes and socks daily
• wear gloves when doing chores, such as gardening and housework

If you think you have developed an infection on and around your toenails or fingernails, go and see your doctor for advice.

Manicure and pedicure

All too often we think of a manicure or pedicure as a "treat". In fact, caring for nails should not take a specific visit to the beautician. Help to ensure nails remain healthy and attractive by doing your own manicure and pedicure at home.

Manicure
For healthy fingernails, regularly:

• soak fingernails in warm soapy water, and pat dry
• use a cotton bud to gently push back the cuticles
• file the nails to a manageable length, taking care to move the nail file across the nail in one direction only
• gently buff the nails; this stimulates the circulation, and gives nails a healthy shiny appearance

Pedicure
For healthy toenails, regularly:

• soak feet in warm soapy water, and pat dry
• use a pumice stone to gently rub off any dead skin around heels and toes
• trim toenails with a nail cutter or nail clippers, following the shape of the toe; do not cut down the sides of the nail
• file the edges of the toenails smooth with an emery board
• rub cuticle cream into the toes, and use a cotton bud to gently push back the cuticles
• rub moisturising cream into the feet; take care not to moisturise between the toes, as fungus thrives in warm, moist areas

Healthy diet

Like every other part of our body, our diet affects the condition of the nails. Sufficient supplies of essential minerals such as iron and zinc help prevent nails from becoming brittle. Talk to your doctor, nurse, or state registered dietician, for advice on how to improve your diet and lifestyle.