FINGERNAIL PROBLEMS: SERIOUS OR JUST ANNOYING?
Several years ago, a 28-year-old high-school teacher came to see me about her deformed, pitted fingernails. She had already seen a dermatologist, who prescribed antifungal medication despite the absence of any evidence of a fungal infection. Not surprisingly, the treatment didn’t help.
Beside bad nails, she also complained of aches and pains in several joints, especially in her fingers. When I examined her,
I found red and silver scaly patches on both elbows—characteristic signs of the skin disorder psoriasis. That solved the mystery of her nail problems Psoriasis is often accompanied by both nail pitting and arthritis pain.
Since fingernails sometimes provide clues to the presence of various disorders, physicians will often check the nails during a completc exam. (So remove any nail polish in advance!) In most cases, however, nail problems stem from ordinary wear and tear. Here I’ll discuss both disease and damage.
DEFORMITY AND DISEASE
Nails often have bumps and other flaws that don’t signal a problem. Vertical ridges become more common and usually more pronounced as people age. White lines and tiny white spots are common, too. The following unusual nail features, however, may indeed reflect disease:
• Deformities such as pitting, spooning (in which the nail curls upward), and separation of the nail from its bed can be caused by diseases as diverse as anemia and hypothyroidism, as well as psoriasis.
• Nail color, usually a healthy pink, can also indicate disease. Pale or whitish nails, for example, suggest anemia; bluish nails, due to insufficient oxygen in the blood, could mean poisoning, heart failure, or chronic lung trouble.
• Rounding and expansion of both the nails and the ends of the fingers, which may become clublike, can reflect a variety of serious conditions, ranging from lung cancer to inflammatory bowel disease.
• A horizontal furrow, or “Beau’s line,” can result from major surgery, heart attack, or other serious illness, which can slow nail growth abruptly. The line eventually grows out.
• Thick, distorted nails, especially on the toes, often indicate a fungal infection. While the condition can be painful, it’s usually only a cosmetic concern. Oral antifungal drugs, such as itraconazole (Sporanox) and terbinafine (Lamisil), can clear up most cases.
WEAR AND TEAR
Nail weakness is probably the most common fingernail problem. A number of diseases, such as an overactive thyroid and anemia, can make the nails brittle. Usually, though, nails weaken simply because they’re subjected to so much everyday abuse.
Take water, for example, the most common cause of brittle nails. While fingernails may feel hard and look waterproof, they’re actually highly permeable. As nails absorb water, they swell; when they dry, they shrink. Repeat that cycle often enough—particularly in cold, dry weather, which also dries the nails—and they’ll break or split at the ends.
Solvents, such as those in household cleaners, can also penetrate and chemically dry the nails. And activities like gardening and sports can break unprotected nails. Slamming your finger in a car door, along with other types of trauma to the base of the nail (the unseen portion beyond the cuticle), can cause permanent damage.
What passes for “nail care” can be a form of abuse. Various products, such as polish removers, can weaken the nails. An overly aggressive manicure can damage the nails. Worse, it can damage the cuticle, allowing infection to develop under the nail.
Infections can also fester in the gap between an artificial nail and the real nail. Wearing artificial nails longer than three months greatly increases that risk; so does regluing loose ones without using rubbing alcohol to clean them first.
Here are some basic steps you can take to ensure the health of your fingernails:
• Protect your nails from the ravages of water. Wear cotton-lined rubber gloves when doing household chores such as washing dishes.
• Immediately after exposure to water, apply an ordinary moisturizing lotion to your nails as well as to your hands.
• Wear gloves in cold weather and during activities that might harm your nails.
• Keep your nails short to help prevent breakage. Before trimming, soak them in water for a few minutes so they’ll be less brittle under the clipper. File in only one direction—not back and forth, to avoid creating splits. Apply moisturizer afterward.
• Don’t pick at hangnails; that can break the skin and invite infection. Clip hangnails off close to the skin with cuticle scissors.
• Avoid nail-polish removers that contain acetone, which can dry nails; look for ones that contain acetate instead. And use any remover as infrequently as possible.
• If you have your nails “done” professionally, make sure that sterile instruments are used. And ask the manicurist to be gentle on your cuticles.
• Don’t turn to calcium, gelatin, vitamins, or other supplements to improve a nail problem. They won’t.
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