Even though your nails are made of a tough, fibrous protein called keratin, one of the body's strongest tissues, they are still surprisingly vulnerable. Nails can become weak, start breaking, or grow too slowly for many reasons--from infections to chemical exposure.
About half of all nail problems are due to fungal infections, which are unsightly and, if left untreated, can cause the nail to separate from the nail bed, a condition doctors call onychomycosis. An ingrown toenail is another common nail problem; it occurs when the sides or corners of a nail dig into the soft surrounding tissue, making the whole toe quite inflamed and uncomfortable.
One of the most painful nail disorders occurs after an injury--say, when you're attempting some carpentry, miss the steel nail, and hit your own instead. Bleeding beneath the nail causes it to turn purple, and because the blood can't escape, the fingertip swells and starts to throb painfully. Depending on its severity, this situation can require a visit to your doctor who will actually drill a tiny hole in the nail to release the trapped blood. Pain relief is almost instantaneous. The injured nail will eventually fall off, displaced by a new nail that grows in underneath it.
Most nail problems are painless and harmless, however. Shallow ridges, for example, may appear with aging; spots can result from small injuries to the nail bed. The latter will simply disappear once the nail grows out. It takes about six months to grow a new nail from cuticle to tip.
Marked changes in nail appearance can signal a variety of illnesses. For example, very pale nails (which reflect the blood flow in the skin underneath) can indicate anemia. White spots can signal liver problems, brown tips may mean kidney trouble, red "moons" may signal heart disease, and yellowed, thickening, and slow-growing nails may connote a respiratory illness. Nail problems such as pitting and splitting can be the result of psoriasis, a skin disorder.
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Changes in nail shape, coloration, or texture
Dry, brittle nails that grow slowly or break off
Thickened yellow or white nails, most often the toenails
Nails that detach from the nail bed
Scaly skin surrounding the nail
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Nutrition plays an essential role in the growth and health of your nails. Insufficient amounts of certain nutrients can generate specific changes in the appearance of your nails, as can certain types of illnesses. Injury, exposure to harsh chemicals, improper manicure treatments, and fungal infections also primary causes of nail problems.
Nutritional deficiencies. Pronounced ridges in the nails can often be traced to a deficiency in B vitamins. Dryness and brittleness can result from insufficient calcium or essential fatty acids. Hangnails can develop due to low intakes of vitamin C or folic acid.
Illness. When your blood can't carry sufficient oxygen around your body due to a respiratory illness (such as asthma or emphysema), anemia, or other ailments, nails can become pale or discolored and actually change shape ("clubbed" nails are associated with lung disease; "spoon" nails with severe anemia). Severe heart disease can darken the nail bed so the nails appear to have changed color.
Chemical exposure. Hands or feet that come into contract with harsh detergents, chemicals, or even too much water can end up with dried out and brittle nails. Also, the chemicals in cuticle remover, nail polish, and polish remover can dry and damage nails if used too often.
Fungal infection. Moist environments, such as sweaty shoes and socks, are excellent places for fungi to breed, especially if they can get a "toehold" in small fissures or breaks. High-impact exercise like jogging can cause these kinds of skin openings, which is why runners and other athletes are especially prone to nail fungus. People who spend a lot of time on their feet, such as restaurant workers, police officers, and mail carriers, are also particularly vulnerable.
Typically, a fungus first shows itself with a small yellow or white spot on the nail. Over the next few months, the spot spreads over the entire nail, which may turn yellow, brown, black, or gray. The nail gradually thickens and finally becomes so brittle it may split or even come off entirely. Usually, nail fungus is simply a cosmetic problem, but it occasionally progresses to the point where activities like typing or even walking can become painful.
Manicures. Normally, moisture that collects under the surface of a nail passes through the nail's porous structure and evaporates. Artificial nails or the constant use of nail polish can prevent this natural evaporation, creating ideal conditions for fungi to flourish. Improperly disinfected manicure tools or footbaths can introduce infection-causing bacteria as well.
Ingrown nails. Over-zealous nail trimming, tight shoes that crowd the toes, and a hereditary tendency for this painful condition are all culprits, as is repeated trauma to the toenail area.
Psoriasis. The rapid cell overgrowth that is characteristic of this skin disorder also affects the nail bed, causing pitting, discoloration, and splitting of the nails. (For more information, see the WholeHealthMD Psoriasis Healing Center.)
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Medical treatments for nail problems primarily involve the administration of drugs for fungal infections, and sometimes, surgery to treat ingrown nails or to clean out severe infections.
For toenail problems, a specialized foot doctor called a podiatrist is best able to prescribe topical or oral medications, and perform debridement, a procedure that involves removing diseased nail matter and debris. A partial or complete nail can be removed in various ways--with chemicals, surgery, or laser treatments.
Dermatologists also deal with nail problems. Nails severely affected by psoriasis, for instance, are most commonly treated with oral medications or injections around the nails.
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For many years, nails infected by fungus were almost always treated with surgery. But since 1997, with the introduction of powerful oral antifungal drugs, most people have been able to avoid surgical procedures. For toenail fungus, oral medications are usually given for about three months. Most fingernail infections require less time, often six to eight weeks of treatment. On the other hand, some particularly stubborn cases may need extended treatment.
Topical medications. If you have a problem nail, after daily cleansing and filing, you may want to apply an over-the-counter (OTC) liquid antifungal medication to quell any fungus before the infection becomes severe. Just be warned: The Food and Drug Administration (FDA) says these OTC medications are generally ineffective.
There's more evidence to support the use of a new noncosmetic antifungal nail lacquer, which is applied to the affected nail and surrounding skin. This prescription medicated lacquer is called Penlac, and while it may cause some skin irritation, it is considered generally safe to use. A recent review of antifungal medications, published in a 2001 issue of the journal Pharmacoeconomics, notes that the effectiveness of topical nail products is limited because most do not penetrate the nail sufficiently. For this reason, the authors suggest such lacquers are best used as an add-on therapy to support oral medication.
Oral medications. Approved by the FDA for nail fungus, newer oral antifungals (see below) are effective in about 80% of cases. While they offer a shorter course of treatment than older drugs, they are also more expensive (it may cost as much as $700 for a three-month course of treatment). The drugs can also cause side effects in a small number of people.
Fluconazole (Diflucan) is often prescribed on an intermittent "pulsing" schedule of one week of medication each month. This drug is not generally recommended as first-line therapy for nail fungus, however, because its effectiveness remains unclear.
Itraconazole (Spornanox) accumulates slowly in the nails, and, along with terbinafine, is the most commonly recommended nail drug treatment in the United States.
Terbinafine (Lamisil) has shown the most promising results of these three antifungal medicines. According to the Pharmacoeconomics review, it has the highest cure and lowest relapse rates.
In addition, your physician, podiatrist, or dermatologist may prescribe a topical antibiotic for a local bacterial infections such as an infected ingrown toenail, or a steroid cream for psoriasis.
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A laboratory culture of cells from the nail or nail bed may be needed to determine whether the source of your infection is a bacteria or a fungus. If your nail problems appear to be the result of another illness, additional tests may be required to identify any underlying health problems.
Because medications are quite effective for nail fungus, nail surgery is not recommended except in persistent or very stubborn cases.
Ingrown toenail problems usually do require minor surgical intervention. Common procedures include:
Nail avulsion. The removal (or avulsion) of the nail, or parts of the nail and nail root, may be accomplished with ordinary surgery or with a carbon dioxide laser. A non-surgical alternative is a chemical maceration, in which the nail is dissolved with chemical solutions. Depending on what's needed, nails can be removed either temporarily (leaving the nail root) or totally (including the root, when a fungal infection is unbeatable). A new healthy nail will then regrow.
Debridement. This procedure involves removing diseased portions of the nail and cleaning out any debris that has collected underneath the nail. Debridement (as well as professional trimming) for fungal infections or for severely ingrown toenails can be performed by a dermatologist or podiatrist.
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Once a fungal infection has established itself in a nail, the usual treatment is a prescription oral antifungal medication. Only in especially severe cases, or those not responding to medication, is it necessary to actually remove the nail. In addition, there are measures you can take to protect your nails from developing fungal or bacterial infections in the first place. (See Self-Care Remedies, below.)
Likewise, you can certainly prevent changes in nail appearance that are linked to a nutritional deficiency. A variety of vitamin, mineral, and herbal supplements can contribute to your overall nail health and help reverse any weakening.
Just a reminder: If you have a serious medical condition or are taking medication, always talk to your doctor before starting a supplement regimen.
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As with your skin and hair (not to mention the rest of your body), top-notch nutrition is one of the most powerful ways to encourage the growth of strong, attractive, disease-resistant nails. So begin with a nutritionally sound diet plus selected supplemental vitamins and minerals. Contrary to popular perception, however, gelatin is not a nail-strengthening tonic; the amino acids that it contains are not a combination that supports nail growth.
Important note on nail fungus: Once you are diagnosed with a nail fungus, you will likely need a prescription medication to clear it up. Using supplements alone for nail fungus is a waste of money and will only allow the infectious condition to get worse.
A high-potency B-complex vitamin is a good place to start; it should include extra supply of biotin. It works well with the antioxidant vitamin C. Together they should prevent virtually any nail problem associated with a nutritional deficiency. Biotin, for instance, has long been used by veterinarians to strengthen the horse hooves.
Mixed amino acids are the building blocks of protein, which in turn is needed to manufacture keratin, the main structural protein of both nails and hair.
Calcium and magnesium, two minerals necessary for strong bones, are also needed for healthy nails.
Silica has long been recommended by herbalists for healthy hair and nails. It can be taken either as a single supplement or supplied by certain herbs, such as oat straw and horsetail. No clinical studies, however, have proven the usefulness of these substances specifically for nail conditions.
Essential fatty acids--including borage oil, flaxseed oil, or evening primrose oil--are needed throughout the body and are especially important for nails, skin, and hair.
Tea tree oil or garlic oil may help to control athlete's foot, the itchy fungal infection that occurs between the toes. Since the same fungus causing athlete's foot can spread into the nails, stopping an infection at an early stage can save you problems later on. However, these natural remedies have not been particularly effective when the fungus gets deep into the nail itself.
Calendula ointment has some antibacterial properties and it may be useful for mild nonfungal irritations of the foot or around the nail beds.
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Basic preventive care can give your nails their best chance at defending against infection, brittleness, breaking, and other woes. Heed the suggestions below and strong, attractive nails should follow.
To prevent nail fungus infection: There are a number of actions you can take on a daily basis to foil any fungal nail problem.
Pick the right shoes. The best choices are made from "breathable" materials, such as leather or canvas. They should fit properly--meaning that your toes don't bump against the shoe, which can damage nails.
Keep your feet clean and dry. Wash them with soap and water and dry them thoroughly around nails and between toes. Antifungal foot powders help to keep fungus at bay, but contrary to common lore, cornstarch does not.
Wear cotton or wool socks. These natural materials wick moisture away from the nails more readily than nylon, polyester, or other synthetics do. Also avoid tight hosiery, which promotes moisture buildup and creates a favorable environment for fungi.
Wear sandals whenever you can. This gives your feet a chance to dry out, as does going barefoot (which is safe on clean, dry, indoor surfaces). Wear waterproof sandals in public showers, health clubs, and poolside.
Always disinfect manicure and pedicure accessories. After each use, a quick soak in rubbing alcohol, and an air-dry on a paper towel, will do the job. Don't apply polish to nails that might be infected, or are discolored or swollen.
Say farewell to fashionably long talons. Those seemingly endless fingernails not only break easily, but can harbor unhealthy bacteria. And long artificial nails keep your natural nail from "breathing."
Leave cuticles untrimmed. In their natural state, cuticles seal out bacteria and fungi; normal wear and tear and hand washing should prevent any overgrowth. Gently pushing your cuticles back with an orange stick after soaking your hands is okay, but don't cut or chemically dissolve them.
To prevent dryness and breaking: Several simple strategies can help with these everyday nail problems.
Wear cotton-lined gloves when doing housework that involves immersing your hands in water, or using chemicals, indoors or out.
Keep nails supple and hydrated by rubbing petroleum jelly into them after your hands have been in water. Many dermatologists and podiatrists also recommend rubbing an over-the-counter alpha-hydroxy lotion into the nails and cuticles nightly.
Keep nails short so they're less likely to break. Soaking your nails before clipping them helps to prevent splitting. Trim toenails with a clipper, not nail scissors, keeping them no longer than the tip of the toe. Never round nail corners or file them inward.
Eat a balanced diet-with lots of fruits, vegetables, legumes, and whole grains. And add some corn, soybeans, cauliflower, and egg yolks for biotin, and nonfat dairy products for calcium.
Avoid formaldehyde, a chemical which is often included in nail hardeners or polishes; it can irritate surrounding skin. If you use polish, choose a hypoallergenic brand and non-acetone removers. And don't apply polish more than once a week.
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If you have a toenail fungus or a painful ingrown toenail.
If your nails have changed in appearance, just to make sure it isn't a sign of a systemic illness.
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