Nail plate is firm to hard in consistency and nail bed soft tissue with form consistency maintains near pink color. Nail plate is decorated with colorful nail polish and presented with different shapes.
Nail saloon are always busy taking care of nail hygiene, color and shapes. Nail treatment is called manicure. Nails are firm to hard protect tip of the fingers from accidental trauma. Tip of fingers are very sensitive structure with abundance supply of peripheral nerve. Finger sensitivity is very important for tactile functions in touching and writing. Nail plate is embedded in to skin on lateral and proximal end. It acts as a barrier to seal nail bed from infection or trauma.
Nails grow relatively slowly. Changes in consistency, structure, surface or color of nail is secondary to disease induced month or weeks prior to clinical observations. Consistent presence of nail changes should not be ignored and dermatologist must be consulted.
Pathophysiology of Nail Diseases
Changes in nail color, shape or size are observed in some systemic disease or diseases of nail.
Changes In Shapes
- Clubbing of nail is swelling and bilging of nail bed with or without discoloration. Clubbing is seen in chronic obstructive lung disease, heart disease and liver diseases.
- Spooning of nail is observed in iron or B12 deficiency anemia. Spooning nail is convex in shape.
- Pitting of nail is concave shape nail with pitting of surface. Pitting nail is seen in psoriasis. Anxiety and stress induces pitting type structural changes in nail.
- Ridgesare crests over surface of nail and observed on inspection. Surface feels rough on palpation. These changes of nail surface aresecondary to stress.
Discoloration Of Nail Bed
- Yellow discoloration seen in chronic bronchitis, lymphatic problems, diabetes, and liver disorders.
- Brown or copper nail bedsis seen inarsenic or copper poisoning and fungal infection.
- Red nail beds indicate possible heart diseases.
- Dark nails is secondary to B12 deficiency.
- Small white patchesknown as leukonychia punctate is secondary to vitamin deficiency and B12 deficiency.
Source of Infection for Nail Diseases
- Pseudomonas bacterial infection of nail bed.
- Ring worm : Tinea Unguis.
- Trauma and Injury : causing Onychogryposis.
Causes Of Nail Diseases
- Trauma to nail and tip of fingers.
- Infection of nail bed: fungus, virus and bacterial.
- Systemic illnesses: Chronic obstructive lung disease, and intestine disease)
- Abnormal growth: ingrown toenail.
Symptoms and Signs Of Nail Diseases
Mild to severe pain.
- Trauma such as crush injury causes collection of blood under nail bed and may appear bluish clot under nail.
- Illness is very painful because of pressure over nail bed.
- Hemorrhage appears like a splinter hemorrhage and cause byheart disease.
- White line or spot.
- Tiny bubbles of air trapped in nail plate.
- Horizontal line of darken cells.
- Linear depression.
- Cause by trauma, malnutrition, and metabolic disorder.
- Raised ridges.
- Thin and concave nail.
- Aging: elderly, may be seen in younger patients.
- Nail plate grows inward and forward over nail bed.
- Cause is loss of hydration.
- Vitamin E deficiency.
- Inward advance of skin over nail bed.
- Trauma and surgery.
- Deep cut in nail.
- Onychocryptosis also is known as ingrown nail or unguis incarnates. Disease is painful at time with corner of the nail curves downward into the skin. More often seen in big toenails.
- Common form of nail disease.
- Trimming improper trimming and cutting nails too short causes skin to overlap and grow over nail from sides.
- Infection may be associated with purulent discharged.
Onychomycosis - Fungal Infection
- Fungal infection of the nail is called Onychomycosis.
- Associated with nail plate separation also known as onycholysis.
- Nail debris are visible under nail plate and may lead to crumbling of nail.
- Discoloration of nail gives ugly appearance.
Paronychia - Bacterial Infection
- Disease of skin surrounding nail. Tender, painful skin with edema and occasional bleeding may be observed.
- More of bacterial infection than fungal. Infection cause by pseudomonas may cause green discoloration of nail.
- Cause by frequent exposure to water (fisherman), chemicals (factory employees) and severe nail biting (anxious person).
Tinea Unguis - Ringworm Infection
- Nail disorder is cause by ringworm Tinea Unguis.
- Nail appearance is discolor nail with thickening surface.
- Loss of nail plate if ignored and not treated.
Tumor and Warts
- Nail is rarely involved in tumor growth or wart.
- Nail plate shows discoloration, change of shape and brittle.
- Noncancerous tumor spreading over nail bed and plate is warts.
- Painful condition.
- Infection may be associated with tumor growth because of poor nail hygiene.
- Mucinous papule may appear under nail over nail bed.
- Papules are clear and filled with jelly like substance.
- Nail may be deformed from pressure and size.
Psoriatic Nails - Augmentation Of Skin Disease
- Psoriasis is a skin disease and non contagious unlike wart.
- Psoriasis of nail plate causes brittle dry nail, which may crack and partially fall off from bed.
- Nail is dry, pitting and fracture or broken.
- Reddish brown discoloration.
Orychogyropsis - Cause by Trauma
- Claw type nail.
- Result of trauma.
- Curve inward and may need surgical treatment.
Onychorrhexix - Cause By Chemicals
- Brittle nail.
- Cause by household cleaning substances.
Treatment for Nail Diseases
Antifungal Medications to Treat Nail Diseases
Onychomycosis - Fungal Infection
- Topical: ciclopirox, amorolfine and butenafine.
- Systemic: terbinafine, itraconazole, griseofulvin.
Antibiotics for Nail Diseases
Paronychia - Bacterial infection
- Topical: Iodine or antibiotic ointment.
- Oral antibiotics advised by physician depending on antibiotic sensitivity and resistant studies.
Antiparasitic Medications for Nail Diseases
- Tinea Unguis- Ringworm infection.
- Topical- amorolfine, tioconazole solution.
- Systemic- terbibafine.
Laser Treatment for Nail Diseases
Nd Yag- laser treatment is often used for wart and psoriatic nail disease.
Alternative Medicines for Nail Diseases
Australian tea tree oil, Grapefruit seed extract, snakerrot leaf extract, Thymol.
Hydration for Nail Diseases
Maintains regular hydration of hand and feet.
Vitamin E for Nail Diseases
One pills a day.
Prevention Of Nail Diseases
- Avoid biting nail and hand.
- Keep nail dry and clean.
- Avoid trauma.
- Wear gloves when necessary.
- Trim and file nail regularly.
- Shoes must not be too tight or loose.
- Moisturize nail frequently in dry weather.
- Take vitamin as advised by physician.