Nail diseases and nail problems

structure of the nail

For us humans, nails have largely lost their function as claws. While we can still scratch ourselves with them, their primary function is to provide abutment for the fingertip. The pressure that can be built up against the nail enables fine tactile perception .

The average human nail is approximately 0.5mm thick and grows across the nail bed at a rate of approximately 0.1mm per day. Growth starts from the nail matrix , which is under your cuticles . The final piece of nail matrix can be seen as the nail moon (lunula), the bright crescent at the base of your nail. The nail is limited on both sides by the nail fold .

What does a normal nail look like?

A healthy human nail plate should be relatively smooth and transparent . There should be no white spots other than the nail moon. The skin around the nail should not be painful or reddened . These are signs of inflammation. The nail should not be excessively curved, nor should it be completely flat, although the curve can vary greatly between individuals. Aside from the pain, the most important factor to look out for is change. Are new spots or ridges appearing, are the curves of your fingers changing, or are your nails yellowing and crumbling lately? These are all signs of nail disease.

But which doctor deals with nail problems? In medicine, nails count as skin appendages, which is why it is mainly dermatologists who deal with diseases of the nails. In most cases, however, your family doctor should be the first point of contact. He can recognize and treat common nail diseases and, in special cases, issue a referral to a specialist.

The field of nail diseases is large. This article will therefore focus on the nail problems that you will encounter most often in everyday life.

Discoloration and deformation of the nail

yellowing

Heavy smoking can deposit nicotine in the nails and cause yellowing. The fingers holding the cigarette are most affected. Colored nail polishes can also turn the nails yellowish. To avoid this discoloration, you can use base coats, which form a protective layer under the pigments. Yellowing of the nails can also be caused by nail fungus.

Hazy white nails

Hazy white nails are also known as “frosted glass nails” . The nails are colored so white that the nail moon can no longer be seen. Such nails can be congenital, but if they appear again, they can also indicate a serious liver disease, chronic inflammatory bowel disease or problems with the sugar balance.

Gray discoloration

Gray discoloration of the nails is often associated with increased brittleness of the nails. In these cases, a lack of vitamins, zinc or iron can be the reason for the gray colouration. With laboratory tests at the doctor’s, you can have these deficiencies tested and replenish your stores with substitute preparations.

White dots/spots

The most common cause of white spots on your nails is mechanical trauma . The spots will then have no effect on the health of your nails other than cosmetic changes. However, horizontal white stripes can appear with iron deficiency or after a severe infection. White longitudinal stripes indicate a congenital cornification disorder, but can also be a sign of nail fungus.

Dark discoloration

In most cases, dark spots under the nails are caused by bleeding under the nails after injuries, heavy loads or splinters. If you can’t remember a triggering event, you should see a doctor. Dark spots under the nails can be caused by a malignant skin tumor ( malignant melanoma ), impress in the context of psoriasis as so-called “oil stain nails” or indicate diseases of the thyroid gland. A vitamin B12 deficiency can also cause brown discoloration of the nails.

Splitting, brittle nails

Splitting and brittle nails are most often caused by external influences. Soaps, detergents, nail polish, and nail polish remover dry out your nails , which encourages them to split. The mechanical stress caused by playing certain instruments can also lead to a splintering nail.
Soft, brittle nails can be a sign of severe iron deficiency or vitamin A overdose, or can be caused by thyroid/parathyroid disorders.

If you suffer from brittle nails, you can be careful not to let your nails dry out more. Applying lotion regularly after washing your hands, wearing gloves when cleaning and taking breaks between applying nail polish helps here.

grooves

Grooves can run across the nail or be vertical in the direction of growth. The causes of the misaligned grooves differ.

• Transverse grooves :
  Transverse grooves can be caused by hormonal fluctuations, neurodermatitis, zinc deficiency and infections. Taking medication for cancer therapy can also lead to this nail change. Severe bruising of the nail wall can damage the soft, freshly grown nail and thus also lead to the formation of transverse grooves.
• Longitudinal ridges :
  Longitudinal ridges are a normal sign of nail aging. The grooves can appear from the age of 35 and lead to chips and tears on the free edge of the nail.

Shiny nails

Very shiny nails are also called polishing nails . The uppermost layers of the nail are polished smooth by continuous mechanical stress, which leads to a strong shine. Severe itching, for example caused by neurodermatitis (atopic eczema), can lead to increased scratching and thus to very shiny nails.

thickening and curvature

• Watch crystal nails :
  The term watch glass nail describes a thickened nail that curves due to the enlargement of the last phalanx (“drumstick finger”). These changes usually occur in the context of diseases that cause a long-lasting reduction in oxygen in the blood. These include chronic lung disease and heart disease.
• Onychogryphosis :
  Onychogryphosis is the severe thickening of the nails with a claw-like appearance. Usually triggered by repeated trauma, it is often found on the big toe or 2nd toe in soccer players.

Indentation of the nail surface

Notched nails are also called “spoon nails”. They can be a sign of vitamin and/or iron deficiencies. Reduced blood flow to the fingers and toes due to vascular diseases can also cause spoon nails.

Small dimples in the nail

When small dimples are found on one or more nails, it is called “spotted nails”. They are typically found in psoriasis (psoriasis vulgaris), but can also be triggered by eczema or autoimmune-related hair loss (alopecia areata).

A detached nail

Many people know it: After a strong blow on the nail, it first turns black and then falls off. In this case, the nail coming off is not a cause for concern, and in the vast majority of cases the nail will grow back on its own. Other reasons for nail peeling can include:

• Medication : You can read on the package leaflet whether the medication you are taking is causing your nails to fall off.
• Prolonged exposure to water, soap, or detergent : Long soaking of nails can not only cause brittleness, but also detach the nail from the nail bed.
• Illnesses such as thyroid disease, diabetes mellitus (diabetes), various skin diseases and nail fungus
• Pregnancy : During pregnancy, the nail can detach from the nail bed due to the altered calcium metabolism.

infections of the nail

Nail infections occur worldwide and can be classified based on the causative agent.

nail fungus

Nail fungus is most commonly caused by skin fungi (dermatophytes), although yeast and mold infections are also possible. The triggering fungi in the bathroom at home are usually transmitted directly from family member to family member. Other places of infection are, for example, swimming pools, saunas or sports halls.

The fungus can reach the nail from two directions. In most cases, they enter from the nail tip and migrate from there under the nail, or, in far fewer cases, they can migrate across the cuticle towards the nail matrix and reach the nail tip with the growing nail. In both cases, the horny layer of the nail bed under the nail thickens – this is where the fungi are located. As a result of the infection, the nail loses transparency and becomes dull, brittle, yellowish and can detach from the nail bed. In rare cases, the nails can also turn white. The longer the infection lasts, the worse these symptoms become. If a nail fungus is not treated, the entire nail can be destroyed.

Toenails are much more likely to be affected by nail fungus than fingernails. Inappropriate footwear can lead to injuries, through which the fungi can easily penetrate. The vascular situation on the feet is often worse than on the hands. Factors that cause an increased susceptibility to fungal nail infection are:

• high age
• previous injury to the nail
• vascular diseases
• Diabetes mellitus (diabetes)
• a weakness of the immune system
• increased sweating of hands and feet

Unfortunately, a nail fungus infection does not go away on its own and should therefore always be treated. Depending on how deep the infection goes, you can buy creams or nail polishes at the pharmacy that you can apply topically to your nails. In severe cases, your doctor may prescribe oral medication.

Bacterial nail infection

Most bacterial nail infections start from purulent inflammation of the nail bed. The triggering bacteria are often moist germs, known in technical terms as pseudomonads. They penetrate through small injuries to the nail or through a lifted nail. Risk factors for bacterial nail infection are:

• Small injuries of the nail
• wet work
• Biting your fingernails
• Psoriasis vulgaris
• thumb sucking
• Diseases of the sugar balance
• Immune system disorders and immunosuppressive therapy
• Artificial fingernails (they are more colonized with bacteria and fungi than natural fingernails)

The greenish discoloration of the nail is typical of an infection with pseudomonas. The therapy of a bacterial nail infection depends on the triggering pathogen and must be individually adapted.

Here’s how Med-Healths can help

Spotted a change in your nails and not sure what’s causing it? Via Med-Healths you can send a photo of your nails to a doctor who can advise you individually on your problem.

Similar diseases:

• athlete’s foot
• hair loss
• skin rash
• neurodermatitis
• psoriasis