Nailing it down

In my last article, I 
discussed the common conditions affecting nails. Now I will discuss certain uncommon causes of discoloured and disfigured nails. In most cases, the nail changes are not specific to any condition. Hence I should include a standard disclaimer that this is for informational purposes only and is not a substitute for professional medical advice.

The technical term for brittle, thin nails with excessive longitudinal ridging is ‘trachyonychia’. The nail plate becomes rough and opaque. The common associations are a type of patchy hair loss called alopecia areata and an itchy skin condition called lichen planus. The nail changes can precede or follow these conditions by several years. Treatment is mainly cosmetic as it is not permanent in most cases.

The discolouration of the nails can be due to abnormalities of the nail plate, nail attachment or nail bed. Many of us are familiar with the brownish nail discolouration caused by tobacco and henna. As a rule, a nail bed discolouration can be blanched with pressure while a nail plate discolouration remains unchanged. Though white spots can normally be seen on the nails, uniform white nails could be a sign of liver, kidney or heart problems. But, needless to say, involvement of these major internal organs will be associated with various other symptoms as well. Transverse white bands may be seen in heavy metal poisoning like arsenic. Arsenic may be seen in certain alternative medicine preparations though whether the concentration is significant enough to cause these changes is doubtful. It is also present in significant quantities in the ground water of certain regions of India and Bangladesh. If you are anaemic, your nails may appear white.

Yellow nails are normal in the elderly. It can also be seen in jaundice and with the administration of certain medications. Nails may become yellow in fungal infections and in psoriasis. Psoriasis is a condition with thick, scaly skin that I described in detail in a previous article. Drugs can also cause bluish discolouration of nails along with certain silver salts. Silver salts are commonly found in photographic films. However, occupational exposure to silver salts for photographers have reduced with the popularity of digital photography.

Carbon monoxide poisoning kills around 200 people per year in the US. Though the statistics for our region is not known, it is likely to be high because of the extensive use of air conditioners. Carbon monoxide is a colourless and odourless gas and the initial symptoms of poisoning resembles common flu. It can cause a reddish discolouration of the nails.

Though strictly not a nail disease, I will explain here a condition called interdigital intertrigo, more commonly known as athlete’s foot when caused by fungus. Athlete’s foot can occur in non-athletes too, leading to scaling, flaking, and itching of the web spaces. Blisters, pain and swelling can occur in severe cases. It can later spread to other areas of the body. These fungi can live on shower floors, wet towels, and footwear. It can spread from person to person from shared contact with showers and towels. Using occlusive footwear for long periods in hot and humid climate and the contamination during ablutions make it one of the commonest skin infections in our region. Yeast infection of the web spaces is more common in diabetics and is usually white and macerated.

Though you may need your doctor’s help to deal with many of these conditions, there are certain basic nail care steps you can follow to reduce nail problems. The nail matrix (situated below the root of the nail) is the most sensitive region of the nail. Since the matrix generates the visible nail plate, any injury to the matrix will be reflected on the nail. Hence, always moisturise and protect the root of the nail and the cuticle. The cuticle seals the space between the nail plate and the skin.

Wearing gloves while doing household work will also help to reduce trauma to this region. Do not forget this area when you apply sunscreen. Keep your nail implements clean to prevent infections. Do not soak your nails in water for too long and avoid excessive use of nail polish removers. Keep your foot clean and dry to avoid athlete’s foot. Avoid occlusive shoe materials like vinyl. Always use absorbent socks. Diabetics should do a foot infection check periodically.

Everyone wants their nails to look clean, clear and strong. But this cannot always be achieved in a beauty parlour. Treatment of many conditions of nails takes a long time to complete as there is no blood supply to your nail plates. So you need to be patient with your doctor. Though clichéd, let me also say that a little prevention goes a long way to preserving beautiful nails.

(Dr Bell R Eapen is a Dubai-based specialist dermatologist 
with Kaya Skin Clinic. Write to him at wknd@khaleejtimes.com)