Nail Fungus Brittle Nails and More Nail Problems
For many of us, the health of our
nails is something we often take for granted. That is until something goes
wrong and changes the appearance or texture of the nails. Dermatologists,
who are the physician experts in the care of skin, hair and nails, find
that brittle nails, nail fungus and problems from nail cosmetics are among
the most common sources of nail disorders. Help can be found by seeking
proper diagnosis and starting a proven treatment regimen, which can include
medications and behavioral changes.
At the American Academy of Dermatology’s Summer Academy Meeting 2008 in
Chicago, dermatologist C. Ralph Daniel, MD, FAAD, clinical professor of
dermatology at the University of Mississippi in Jackson, Miss., and
clinical associate professor of dermatology at the University of Alabama in
Birmingham, Ala., discussed these common nail complaints and how to
recognize when a problem requires medical intervention.
Brittle Nails
Brittle nails are a common nail problem frequently seen by
dermatologists in their practices. While it is rare for an internal illness
or a drug to cause brittle nails, the primary cause is typically
environmental. Dr. Daniel explained that there are two types of brittle
nails — hard and brittle nails, and soft and brittle nails.
Hard and brittle nails are caused by too little moisture, with older
people more prone to this condition. This type of brittle nails can make
nails feel dry, and chipping or flaking commonly occurs anywhere on the
nail plate. Dry skin also is common in people with brittle nails, and the
condition occurs more frequently in the winter from dry heat used to warm
the indoors and in very dry climates with little humidity, such as Arizona.
At the other end of the spectrum, soft and brittle nails are thought to
be caused by too much moisture and can affect people of any age. However,
soft and brittle nails are more common in young people, particularly those
who wash their hands frequently — including medical professionals and
chefs. While soft and brittle nails don’t feel dry, they tend to layer more
at the end of the nail plate when they chip.
“When we treat brittle nails, we always ask patients if their toenails
are affected as well — and most will say no,” said Dr. Daniel. “This
indicates that if the condition was caused by a lack of something in the
body, such as a vitamin or mineral, it also would cause brittleness in the
toenails. For that reason, dermatologists believe brittle nails are the
result of contact with the environment, particularly work environments due
to contact with water, or low or high humidity.”
Typically, hard and brittle nails are treated by adding moisture to the
nails; whereas patients with soft and brittle nails need to reduce the
amount of moisture that comes in contact with their hands. For example, Dr.
Daniel recommends that people with soft and brittle nails who engage in wet
work should wear light cotton gloves under vinyl gloves to keep moisture
away from the nails. Latex gloves are not preferred, because latex is more
irritating and causes the hands to sweat. In general, he said it is a good
idea for patients with either type of brittle nails to wear gloves and
avoid irritants.
Nail Fungus
Fungal infections, known as onychomycosis, comprise approximately half
of all visits to the dermatologist for nail-related problems. Since the
infection occurs under the nail plate or in the nail bed, it can be
difficult to treat. Fungal infections — which can be white, green, yellow
or black in color — often cause the end of the nail to separate from the
nail bed, and they may build up under the nail plate and discolor the nail
bed. Because the feet are usually confined in a warm, moist environment,
toenails are more susceptible to fungal infections.
“We know that the foot acts as a reservoir for fungus that can spread
elsewhere on body, so it is important for dermatologists to treat the
source of an infection and check the toenails and bottom of the foot when a
fungus is present,” said Dr. Daniel. “Patients who have had trauma to a
nail also are more susceptible to nail fungus, as the trauma can serve as a
pre-disposing event.”
Dr. Daniel added that psoriasis patients are prone to developing nail
fungus. In fact, one study found that the occurrence of nail fungus was 56
percent greater in patients with psoriasis than in non-psoriatic patients.
Men with psoriasis also were two-and-a-half times more likely to have nail
fungus than women with psoriasis. Dermatologists find that while
medications traditionally used to treat nail fungus work for psoriatic
patients affected by this infection, these medications will not improve the
underlying psoriasis.
Nail fungus can be difficult to treat, but most cases improve with the
use of available prescription topical medications. Experimental treatments
for nail fungus include photodynamic therapy (PDT) and new topical
treatments, and studies are currently being done with nanoparticles.
Side Effects of Nail Cosmetics
Nail cosmetics, used to enhance the appearance of nails, also can be a
source of potential problems. Though not common, allergic reactions and
infections from nail cosmetics used at home or at nail salons pose serious
health risks.
For example, Dr. Daniel reported that most of the problems associated
with nail salons are from the use of acrylic glues to hold artificial nails
in place, which can cause pain, redness, itching or scaling. Although the
U.S. Food and Drug Administration (FDA) banned the use of methyl acrylics,
there are still instances of these types of nails being used at some salons
despite their known health risks.
In addition, some of the ingredients in nail polishes and polish
removers can cause allergic reactions. Free formaldehyde, which means it is
not bound to another substance, also is banned by the FDA as a nail
hardener because it can cause itching, redness or even blisters. Dr. Daniel
also advised that consumers use nail polish remover with acetates rather
than acetones, which are more drying and irritating.
To decrease the chance of contracting an infection at nail salons, Dr.
Daniel recommended these tips:
– Don’t use the instruments at nail salons — bring your own
instruments with you.
– If you don’t own your own instruments, buy a pack of disposable
instruments at the nail salon that are only intended for one-time use.
– If you must use the reusable instruments at a nail salon, make sure
they are sterilized properly in an autoclave. If not, find another salon.
“To ensure that your nails are strong and healthy, it is important to
take care of them properly and not subject them to harsh environmental
conditions or unnecessary hazards in an attempt to improve their
appearance,” said Dr. Daniel. “Oftentimes, changes in our nails can signal
a serious underlying health problem. In a sense, dermatologists act as
detectives who can diagnose a variety of health problems from clues they
observe in the nails. So, see your dermatologist if you notice any
abnormalities or have any concerns about the health of your nails.”
Headquartered in Schaumburg, Ill., the American Academy of Dermatology
(Academy), founded in 1938, is the largest, most influential, and most
representative of all dermatologic associations. With a membership of more
than 15,000 physicians worldwide, the Academy is committed to: advancing
the diagnosis and medical, surgical and cosmetic treatment of the skin,
hair and nails; advocating high standards in clinical practice, education,
and research in dermatology; and supporting and enhancing patient care for
a lifetime of healthier skin, hair and nails. For more information, contact
the Academy at 1-888-462-DERM (3376) or http://www.aad.org.
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