Nail problems occur frequently, and most commonly in women, although Richard B. Odom, M.D., professor of clinical dermatology at the University of California, San Francisco, says part of that can be attributed to the fact that women seem more likely to report nail disorders and want to correct nail issues than men.
"I don't have any problems with nail parlors, but there have been some problems with artificial nails, acrylic nails and allergies to some of the products used in the glues and cements — but those aren't all that common. Most women can wear artificial nails without problems.
Nail problem nexus
"Just the fact that women wear their nails longer and, particularly as they get a little older, nails tend to become dryer; they dehydrate more easily," Dr. Odom says.
The water content in the nail plate changes. In general, women tend to do a lot more wet work; they are exposed to more detergents and things that are used in household cleaning products that cause the nails to become more brittle. Dr. Odom says other contributing factors include nail cosmetics, such as enamels, and solvents including acetone and alcohol used to remove the enamels. All of those lead to drying, although some improvements have been made in polish removers. Many treatments involve care of the nails rather than medication.
The ailing nail
He described the symptoms and treatments for some of the more typical ailments — with the common term "brittle nails" referring to a number of conditions, such as:
Onychoschizia — a splitting of the distal nail plate into layers at the free edge and also longitudinal nail splits and disadhesion secondary to dehydration.
Dr. Odom recommends discontinuing nail polish, avoiding emery boards in favor of the gentler ruby stone to avoid separating the nail layers, buffing the nails and applying emollients. He says 2.5 mg of biotin, a member of the B-complex family, taken daily may also benefit the nails.
Onychorrhexis — Detergents, water, nail polish remover, hypothyroidism and oral retinoid therapy contribute to a general breakage of the nails. Age also contributes to the breakage, along with ridges that develop longitudinally on the nails.
Dr. Odom says avoiding exogenous agents such as detergent and nail polish remover in conjunction with biotin therapy can help.
"I know it's not easy to do, but if people who have to work with these agents are able to wear gloves, obviously they won't be exposed to all these chemicals.
"To increase the hydration, lubricate around the cuticles, the lateral nail folds and directly over the nail plate a couple times a day with an oil-based product. The greasier products will help reduce the evaporation.
"Ridges can be addressed by buffing, rather than using nail polish. That leaves the nails looking nice, although lacking color. Beyond that, artificial nails may be the only solution."
Other common complaintsOther conditions for which patients are turning to their dermatologist for advice include:
Onycholysis is the spontaneous separation of the nail plate from the nail bed — often a trauma-induced separation. Other causes include a rapid onset of a Candida infection or pseudomonas or Candida colonization, inflammatory skin disease, metabolic conditions, chemotherapy and light-induced reactions.
Dr. Odom says the patient should avoid trauma, keep the nail bed dry and clip nails, and doctors should treat the infections.
Nail plate staining often stems from nicotine, dyes and chemical compounds. To remove the stains, Dr. Odom recommends scraping the nail plate with a glass slide or scalpel.
Paronychia is also a relatively common — but more serious — condition, usually caused by trauma, contact dermatitis or hangnails that require more aggressive treatment. In acute cases, exudative inflammation may be a result of staphylococci and streptococci infection, but it is generally caused by the same exogenous factors as other nail conditions.
If the condition is not bacteria-related, it can become chronic.
The best approach is to keep nail folds dry and to use protective gloves. More serious cases may require potent topical corticosteroids, with or without a topical azole antifungal; occasionally, oral antifungals or intralesional steroids are needed.
Onychocryptosis, commonly referred to as ingrown nails, usually occurs in toenails, although fingernails can also be involved. The condition is typified by excessive lateral nail growth into the nail fold, resulting in pain, inflammation and exuberant granulation tissue. Tight shoes and improper nail trimming are common causes of the problem in the feet, while use of oral retinoids can be a contributing factor in both extremities.
Treatment generally consists of elevating the nail plate with cotton so the nail can grow over the skin, and using potent topical or intralesional steroids. Proper nail manicuring is imperative. Severe cases can require surgery.
Myxoid cysts occur frequently on the dorsal or lateral terminal digits of the hands, usually in the proximal nail fold or distal interphalangeal joint, and also may involve the toes and the feet.
The cyst frequently causes a nail dystrophy — usually a nail groove — and occurs more commonly in women, with osteoarthritis considered a contributing factor.
Dr. Odom says the cysts generally must be drained and frequently recur. Drainage should be followed up with intralesional steroids. Surgical excision may be necessary.
