Nails

Nails are important anatomic structures, which can be viewed either as cosmetic or medically important. These particular structures can be altered by internal disturbances and by skin diseases, as well. Nails are subject to the effects of numerous environmental constraints, including cosmetic manipulations, humidity and trauma. The following will describe nails and the various structures that comprise them.

NAIL CARE TIPS

• Keep nails clean and dry, to prevent bacteria accumulation or other infectious organisms from collecting under the nail bed.

• Give your nails periodic rest from any cosmetic related treatments, for one to three months per year.

• Eat plenty of protein and use biotin supplements (biotin can be found in health food stores, and dosed at one to two milligrams per day. Such proteins and biotin compounds are  found in high concentrations in meat, fish, milk, soy (tofu) and eggs. (at least  80 milligrams a day is recommended)

• Moisturize the nails on a daily basis. You can give nails an intense moisturizer therapy by soaking them in warm olive oil for 10 minutes a day

• Protect the nails from harsh detergents and solvents.

• Cut your fingernails and toenails straight across, and round them slightly at the tip, for maximum strength, and to prevent any unwanted, ingrown formation.

• Use a fine textured file to keep the nails shaped and free of snags.

• Avoid biting or picking at the nail or the nail skin, to prevent infection or ingrown nails.

• Develop good nail habits early.

• If you have an unusual or persistent wart, or any spot on your nail that does not heal, such as a pigmented band that localizes itself on the nail, seel your dermatologist immediately.

MANICURES

If you enjoy salons, take the necessary precautions. Inspect the salon, making sure it is up to you standards of hygiene. You should, probably, purchase your own instruments, if you are not sure that your salon is sterilizing appropriately. Although many salons take the time to soak their nail instruments in disinfectants, that does not get rid of some types of warts or bacteria or even fungus organisms. It is important to be aware of this.

What, actually, does the nail itself consist of?

The nail consists of the nail plate and the anatomic structures around it. The various structures which comprise the nail include the cuticle, the hyponychium, the lunula, the nail bed, and the nail plate. We will now describe these briefly.

Nail Anatomy

CUTICLE - The cuticle has been applied to describe the wet, thick rim of the nail, that borders the superficial rim of the where the nail plate meets the finger. The material is made up of a protein, sugar substance referred to a keratin. Keratin tends to be a transparent material, which protects the nail from moisture and unwanted bacteria.

HYPONYCHIUM - Includes the space and skin bordered by the line between the nail plate and the nail bed. The white appearance of the skin is the portion of the skin that is thick and protects the under surface of the nail edge, to prevent moisture and unwanted bacteria from entering the nail bed. The hyponychium is the area that can sometimes be traumatized with nail clipping.

LUNULA-refers to the visible portion of the nail matrix underneath the nail plate.

NAIL BED - The nail bed is noted to be the area of the nail that is very pink and under the hard nail plate. The nail bed is also referred to as the pulp of the nail, which can change in color, based on medical problems.

NAIL PLATE - This is the final product of the nail unit. It is a hard, relatively inflexible, multilayered sheet of skin cells that covers from one-seventh to one-half of every finger or toe. The product which makes up the nail plate is called onychokeratin and is responsible for the protective growth, which overlies the nail bed

How are nails influenced by systemic diseases?

Nail abnormalities are important to dermatologists when they relate to internal disorders. It is important to look at all twenty nails when assessing the medical condition. Nails can change in color, band size, have pitted depressions, or become thickened with trauma and/or medical problems. One of the more common nail changes, that one sees, is pitting of the nails, which can be seen in such conditions as psoriasis, hair loss and a medical rash condition called lichen planus. Nails can also separate from the nail plate, nail plates can separate from the nail bed, a term called onycholysis, in conditions such as psoriasis, fungal disease, thyroid disease, trauma, drug reactions, local allergy or some forms of irritant reactions. The nail can also change in color or size, depending on the medical condition, for example, blue nails can be a sign of copper poisoning, red nails can be associated with such things as carbon monoxide poisoning or rheumatoid arthritis or even liver problems. Nails, finally, can change in their shape, for example, clubbing of the nails, which is where the nail actually becomes thickened and over grown, can occur with such things as respiratory disorders. Other conditions like spooning of the nail, where the nail tends to curve inward, can be associated with iron deficiency.

What are some of the medications that can commonly affect nails?

Antibiotics, such as tetracycline, penicillamine or sulfa drugs, can cause nail changes. Tetracycline can cause pigment of the nails and nail bed photosensitivity. Sulfa drugs can cause partial white color of the nails. Also, multiple chemotherapy, such as with drugs like bleomycin, cyclophosphamide or hydroxyurea can cause nail colors and sensitivity.

Tetracycline induced nail disease

Fig 4

What are some of the important aspects to consider in nail cosmetics?

Patients frequently complain to Dr. Harvey and Dr. Hardy about their nails, noting that their nails grow slowly and become fragile with time. Women and men are disturbed by nails that split, chip or break easily. Considering the exposures to such things as cuticle removal, cutting and filing, it is not surprising that nails easily become traumatized. There have been studies to show that Biotin, which is a vitamin (vitamin H) can strengthen nails at a dose of 2000 micrograms per day. Other creams, such as cuticle creams, nail enamels, can also help to thicken the nails. Finally, nail conditioning with formaldehyde or conditioners can treat brittle nails by preventing water loss. These products often contain lanolin, petrolatum, mineral oil, fatty alcohols and fatty acid esters, which are useful in the treatment of brittle nails. It is important, when having nail care done, such as a pedicure or manicure, that one bring their own instruments to the beautician’s office, in order to minimize the risk of fungal transmission. Also, testing to such medical agents such as topical acrylates or hardeners, such as formaldehyde, may be important for people who have allergy tendencies, from the use of these products with nail manipulation.

Allergy to nail polish

Fig 5

How does one treat an ingrown toenail or nail?

Depending on the nature of the nail disorder, sometimes it is important to do a partial nail removal, called a partial matricectomy, or remove the entire nail plate in order for the nail to regrow. Kenalog™ injections can also be helpful, in these instances. In patients with severe bony arthritis, it may be important to see an rheumatologist and to have an orthopedic evaluation, to make sure there is no underlying bony structure, which could be causing an avulsion or problem. It is a good idea to consult both a podiatrist, dermatologist and rheumatologist when dealing with many of these nail conditions.

Ingrown Toenail

Fig 6

If you have any questions, or wish to schedule a consultation, please call  Ponte Vedra Dermatology & Aesthetic Surgery at (904) 285-7546 or email consultation@pvderm.com.