The nail unit is made up of several components which form, support, protect and frame the nail itself. These include the nail matrix, nail plate, cuticle, nail bed and nail folds. The nail unit protects fingertips, enhances fine touch and is important as a cosmetic structure.
Age, medications and diseases may influence the growth rate of nails. Changes in the nail may be caused by an injury, fungal disease or other skin conditions such as psoriasis or eczema.
Some diseases affect all parts of the nail unit and other conditions affect only one area. The following information explains the most common nail abnormalities.
Conditions and Causes
There are several conditions that can affect our nails, with different causes and treatments.
The healthy nail plate is pink, and the nail looks white as it grows off the nail bed. Causes of discoloured nails typically include:
- Nail polish
- Nicotine from cigarette smoking
- Hair-colouring agents
- Certain infections
- Injury to the nail bed
- Some medications, including antibiotics, anti-malarial medications, and some medications used in chemotherapy
Lifted nail plate
If the nail plate lifts off the nail bed, it will appear white. Common causes include:
- Overzealous cleaning under the fingernails
- Nail polishes that contain hardening chemicals such as formalin
- Rough removal of artificial nails
This condition affects the toenails more than the fingernails. Older people are at greater risk. Causes include:
- Fungal infection
- Poor circulation
- Arthritis in the toes
- Altered gait (walking) pattern
- Ill-fitting shoes
Ridges running either the length or width of the nail plate can have a number of causes, including:
- Age-related changes
- Trauma to the nail matrix
- Overzealous attention to the cuticles
- Fever or illness
- Rheumatoid arthritis
- Peripheral vascular disease
- Lichen planus infection.
In this condition, the nail plate splits or layers as it grows off the nail bed. Common causes include:
- Having constantly wet hands, especially while using soap and washing detergents
- Frequently using and removing nail polish
- Continuous mild trauma such as habitual finger-tapping or using the nails as tools (to pick between the teeth, for example).
Deformed or brittle nails
Trauma can injure the nail bed and cause the nail to grow in a deformed way. The nail may be thickened or ridged. It is a normal ageing process for nails to thicken.
Deformed or brittle toenails can benefit from regular professional attention. Trimming, shaping and nail care from a podiatrist can improve the health of your toenails and help diagnose and treat more serious nail problems.
Bacterial infection of the nail
The Staphylococcus aureus bacterium is a common cause of bacterial infection of the nail. Typically, the infection first takes hold in the fold of skin at the base of the nail (proximal nail fold). Without treatment, the infection can worsen, leading to inflammation and pus. It is often associated with candida infection, particularly when it becomes chronic.
Activities that predispose a person to a bacterial nail infection include:
- Having constantly wet hands
- Overzealous attention to the cuticles
- Severe nail biting, which can expose underlying tissues to infection
- Eczema around the fingernails.
Inflammation of the skin alongside the nail – paronychia
The skin lying alongside the nail can become infected with bacteria, typically Staphylococcus aureus. This infection is called paronychia. Symptoms may include pain, redness and swelling around the cuticle and yellow-green discharge.
Treatment for paronychia includes:
- Keeping your feet as dry as possible
- Use of barrier creams, antiseptic lotions and antifungal preparations
- Antibiotic therapy (in acute cases).
Fungal infections, such as tinea, are spread from one person to another and can affect the fingernails or toenails. Without treatment, the nail bed itself can become infected. People with diabetes or with compromised immune systems are at higher risk of fungal infection.
Treatment for fungal infection includes:
- Antifungal preparations applied topically (directly to the nail) or taken orally (by mouth)
- Professional trimming, shaping and care of the toenail by your podiatrist.
Trauma to the nail
A blow to the nail or compulsive nail biting can cause a range of problems, including:
- Bruising of the nail bed
- Lifting of the nail plate
- Loss of the nail plate
- Nail ridges
- Deformed growth of the nail plate if the nail matrix is injured.
One of the most common problems treated by podiatrists is ingrown toenails. The big toe is particularly prone to this painful condition. Causes may include:
- Incorrect nail-trimming technique
- Trauma (such as stubbing your toe)
- Nails that naturally curve sharply on the sides and dig into the skin
- Wearing tight shoes.
Skin diseases and nails
Skin diseases such as psoriasis, eczema (dermatitis), lichen planus or lupus can affect the nails. Abnormalities may include pits, grooves or crumbling nails.
Unusual nail shape
Unusual nail shape – such as the nails becoming concave – can be caused by iron deficiency.
Nails can be affected by tumours – including squamous cell carcinoma, usually caused by infection with the human papillomavirus (HPV). Melanoma can also affect the nail.
Splinter haemorrhages of the nail
These are thin lines of blood running along the nail bed. Causes include injury, severe anaemia, infective endocarditis (inflammation of the inner tissue of the heart) and certain diseases such as rheumatoid arthritis.
Other diseases and nails
Some diseases that can affect the shape, integrity and colour of our nails include:
- Lung disease
- Heart disease
- Kidney disease
- Liver disease
- Thyroid disease.
Congenital disorders of nails
Some nail conditions are congenital (present at birth). These include nail–patella syndrome, where the nails are improperly formed or missing.
Older age and nails
As our body ages, the growth rate of our fingernails and toenails tends to slow. The change of protein in the nail plate makes nails brittle and prone to splitting. Discolouration and thickening are also common.
Any abnormal changes to your nails should be medically investigated. See your doctor for treatment or referral to a dermatologist. If the cause of your nail problem is not immediately apparent, your doctor may take nail clippings and scrapings from beneath the nail for laboratory analysis. Fingernail infections usually respond faster to treatment than toenail infections.
Depending on the cause, treatment may include:
- Antibiotics for bacterial infections
- Antifungal preparations, (mainly oral) tablets, for fungal infections in the nails
- Treatment for any contributing skin disease
- Advice on appropriate nail care.