Nail Health
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Does the texture of nails reflect health?
It is common for patients to worry that the texture of their nails can reflect a vitamin deficiency or some other aspect of their health. There are some nail issues that are tied to some sort of health issue and others that reflect natural aging of the nails or external causes. Pitted nails
Little pits scattered across the nail plate are seen with psoriasis and alopecia areata (hair loss in circles- autoimmune condition). This can be treated by your dermatologist. Brittle nails/ split easily
There are many causes of brittle nails. In general, brittle nails reflect less moisture or water content in the nail plate. Normally almost 20% of the composition of our nails is thought to be composed of water. When this concentration of water drops, the nails can become brittle and break easily. There are a number of internal and external causes for this. Internally, thyroid conditions and dehydration can contribute to brittle nails. Externally, detergents, nail polish removers, and overwashing of the hands are common triggers. Vertical ridges
Vertical ridges are considered normal as we get older but can be associated with iron deficiency anemia. See your doctor and have your blood work checked. Concave or spoon shaped nails
Think iron deficiency anemia! See your doctor and have your blood work checked. Horizontal ridges
These are associated with any illness that stops or slows nail growth suddenly. Examples would be kidney conditions, chemotherapy, diabetes. One deep vertical divet from cuticle to the free edge of the nail
I often see these with an underlying cyst below the cuticle.
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Does the color of your nails reflect nail health?
Have you ever looked at the color or hue of your nail and felt like something was just a little different? The normal hue of our nails is a pink or mauve color. This color reflects the translucent quality of the nail plate as a window to the vascular nail bed. When the color is not pink or mauve, there can be a sign of disease. Normal
Pink/ mauve Not normal
Green
Green nail syndrome is caused by a bacteria called Pseudomonas. This bacteria releases a green pigment when trapped under the nail. It is most common in people that have their hands in the water quite a bit as this is where the bacteria tend to be found. Although this is not a harmful condition, it can be unsightly! It can be treated with vinegar soaks. Yellow/ orange
Nails tend to turn yellow with no thickening when stained by darker shades of nail polish. Some of the darker dyes in these colors can stain the nails directly.
If there is a thickening of the nail plate along with the yellowish color and some lifting of the nail plate with debris underneath, the early signs of a fungal infection are likely to be present.
One more cause of yellow thickening of the nails with excess curvature is excessive swelling in the extremities. Black streaks and lines
These need to be checked by your dermatologist as Melanoma under the nail plate can present in this manner. White nails
Think about liver disorders such as hepatitis. See your doctor to have blood work checked Blue nails
Think lack of oxygen: lung problems such as emphysema or heart problems. See your doctor to check your oxygen levels with a pulse oximeter.
Red Another color to remember is red! Red lunulae (the half moon at the base of the nail) are associated with many internal diseases such as autoimmune conditions, COPD, heart failure, carbon monoxide poisoning, and cirrhosis. See your doctor and have your blood work checked.
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What about biting your nails, what happens to your nails after?
Nail biting medically referred to as onychophagia is a habit that can start early in life and be tough to break! Most have tried some method of stopping- dipping their nails in salt, hot peppers, or some other foul-tasting product; Snapping a rubber band on the wrist, getting a manicure, etc., etc. There are so many attempts to try something that will stick!
Onychophagia has been shown to start as early as the age of 5.
There are some interesting interventions I have come across and used in practice that are worth noting.
The first is a program that was performed by nurses in an elementary school. The results of their study were published last year in the Journal of Specialty Pediatric Nurses. * The program was called the “Do Not Bite Your Nails, Cut Your Nails” program. 299 students were observed by nurses over 6 weeks to see if this health promotion at a young age reduced nail biting. In this study, there were some impressive results of a drop from 83.9% of nail biters down to 6% after 6 weeks! There was no long-term follow-up noted but as with many habits - the goal is a stretch of time without the habit to break the cycle. Intervening at an early age may be important to stop this habit from persisting through adulthood.
One of the most important things I assess amongst patients that come in with recurrent inflammation around the nails from nail biting and skin pulling or biting is to determine if part of the issue is the fact that excess skin or split nails hang or stick out from beside the nail. Many times this dry peeling skin is just too tempting to pull or bite! This peeling skin is usually the sign of a condition called chronic paronychia or swelling around the nail folds. The swelling leads to peeling of the skin which can become chronic. This is more common in people that pull or push their cuticles or outright remove their cuticles.
Our cuticles are important to protect our nails. One of my favorite treatments that work so consistently that I find its been life-changing for many of my patients is relatively simple. I prescribe a combination cream that has a mild steroid and anti-yeast agent in it.
Chronic paronychia has been shown to have an element of excess yeast that builds up in the nail fold. I ask that my patients apply it twice daily around their nail folds for 2 weeks on then one week off for 6 weeks. In addition to this, once weekly I ask that they create an “artificial cuticle” using Krazy glue or nail glue around the crease where the nail meets the skin. This creates a sealant that prevents further moisture from building up under the nail over the treatment time.
After about 6 weeks of this intervention, the peeling skin stops as the chronic paronychia resolves and there just is no more dead skin to pick or peel. This leaves a lot more time for you to do more important things!
