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Skin care: nail disorders SKIN CARE: NAIL DISORDERS
There are a number of relatively minor disorders of the nails and the surrounding skin. These are fairly common in the community, and for this reason will be mentioned. Most of the more major disorders are fortunately less common, so only some of these will be discussed.
Fungal infections of the nail are also a reasonably common problem. Several fungi may be involved, including the common tinea fungus responsible for 'athletes foot'. Initially the infected nail is merely discoloured at the end, but as the infection spreads, it may become softened, fragile, and later thickened.
Eventually the nails will separate and lift off, or become grossly distorted. Most commonly, the toenails are the ones affected.
Unfortunately surface applications are rarely sufficient to remedy the situation, nor is removing the affected nail. The most effective treatment is regular clipping of the nail, plus the taking of specific anti-fungal tablets. Because of a toenail's slow rate of growth, and the necessity to take the medication for the entire growth period of the nail, this treatment may be required for anything between 6-18 months.
An ingrown toenail forms when the edge of the nail penetrates the adjoining soft tissue. The first symptoms are redness and pain, followed by swelling and a discharge. Secondary infection then frequently occurs. The most common causes of this problem are ill-fitting shoes, nails that have been cut too short, excessive curvature of the nail, and flat feet. The first three of these problems may be avoided by wearing adequately wide and long shoes, as well as by cutting the nails straight across and not too short. Mild cases may be treated with wet dressings and packing sterile cotton wool under the affected edge of the nail. Antibiotics may also be necessary. Severe cases may require an operation.
A corn is a cone-shaped overgrowth of hard skin with a central core. Corns usually occur over bony prominences, such as toe joints, or between the toes. They are a result of chronic pressure or rubbing for long periods. Poorly fitting shoes are the most common cause, but arthritis, improperly positioned toes or bony spurs may also be involved. Prevention requires shoes to fit properly and, occasionally, mechanical devices to position the toes correctly. Otherwise the corn may be padded over or gradually pared down. The latter may be done with either a salicylic acid paste or the help of a podiatrist. If there is an underlying bony spur, then an orthopaedic surgeon may have to deal with it.
Psoriasis frequently affects the nails, resulting in deformities which may precede all other manifestations of the disease. Although the nails may occasionally be the only part of the body affected, in most cases of psoriasis, the symptoms are much more widespread. Almost all patients with psoriasis find their nails are affected at some time during the course of their disease. This, however, may be quite transient. The character istic changes are fine thimble-like pitting, lifting, discolouration, and gross thickening of the nails. Treatment of nail psoriasis is most unsatisfactory. Some cases clear spontaneously, whereas others respond to rather painful cortisone injections into the nail-fold.
Eczema or dermatitis affecting the hands will often affect the nail as well. The usual symptoms are transverse ridging, coarse pitting, discolouration, and eventually marked deformity of the nail. This will all correct itself once the eczema or dermatitis is controlled.
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