Six common nail problems: from fungus to hangnails

Whether or not you believe that the eyes are the “windows to the soul,” it’s impossible to argue that the nails are windows into the body and its health. Fingernails and toenails can alert you to health problems such as liver and kidney diseases, anemia, diabetes… even immediate emergencies such as circulation blockages. This is why surgeons may request you remove nail polish and/or artificial nail products from at least one fingernail prior to a surgical procedure.

While those serious issues can show themselves through our nails, the common problems and changes we see in our fingernails and toenails are minor- and usually preventable or treatable. Here are a few of the most commonly seen nail problems, along with what they mean and what can be done.

Fungus

Fungal infections are one of the most common nail problems seen by dermatologists, and the fungus may also bring on other, new problems. Nail fungus may appear on any nail, but it is more common on the toenails because toes are more often kept in the warm, moist space inside shoes. Fungal infection may cause the nail to be discolored or form a discolored spot (usually yellowish and/or greenish, but over time may turn darker.) The nail may also be thick, misshapen, and appear ‘crumbly’ or as if the nail is about to fall apart. It may be painful, and there may be inflammation (redness, swelling) of the finger or toe underneath or around the nail. In severe cases, the nail plate may start to lift away from the skin altogether. The infection may be on one nail, or several.

The fungi that cause most nail infections are microscopic organisms that don’t need sunlight to survive. In fact, as mentioned above, they thrive in environments that are warm, moist, dark and not always sanitized. There are also molds and yeasts that cause infections that are grouped together with ‘fungal infections.’ The fungus may get into your skin via a cut or opening in the skin, but may also work its way in to the toe or finger at the point where the nail plate meets the skin. Fungal infections may be spread on a larger scale at nail salons where proper sanitation procedures are not performed.

As for treatment, you should see your dermatologist or physician. They may be able to help you trim the nail, if needed (this can be difficult and painful on your own.) There are creams, solutions and oral medications that may be prescribed for you. In severe or recurring cases, they may recommend that the nail be removed. While a fungal infection is being treated, take precautions so as not to spread the infection to other nails, or to other people. Your doctor may advise you on that as well.

Don’t forget that fungal infections are extremely common. Don’t be embarrassed, and don’t hesitate to get the treatment you need. Once treated, nails will generally return to their original look and shape.

White Spots (Leuconychia)

I can’t even count the number of times I’ve had clients ask if the tiny white spot on their fingernail means they’ve got a vitamin deficiency. This is a common misconception- that white spots appear on nails when the body is lacking calcium or is experiencing some other vitamin or mineral problem. The truth is much, much simpler.

The skin at the base of your nail- your cuticle skin and the skin between the bottom of your nail and your outermost knuckle- is very tender and sensitive to trauma. If you bump your finger, for example, on a table… you may not even realize you’ve done it, and it may not hurt or show any sign of injury. But the new, developing nail cells underneath that skin could have been ever-so-slightly damaged by that bump, and as it grows out, it will have a small white spot where that ‘trauma’ occurred. It’s part of the nail plate, so it will grow out with the nail, from the cuticle out to the edge, until finally it will grow completely out and be gone. Another example: You smash your whole hand- all four long fingers- in a door. It hurts, it’s painful and may bruise or even bleed. Several weeks later, you may notice that all four fingernails have white spots at about the same place. They were caused by that injury, and will simply grow out.

There’s no treatment for these spots, as they don’t cause problems and simply grow out with the nail. They’re very common and mean nothing other than the finger was bumped or injured at some point. These spots will stay white- if you see any other discoloration, see a doctor as that’s not leuconychia.

Hang Nails

Hang nails are another very common issue nearly everyone experiences at various times. Hang nails are not usually part of the nail plate. In most cases, a hang nail occurs when the skin around the nail- which may be at the bottom near the cuticle, or at the sides- becomes dry and then tears or splits. In more severe cases, though, you may have some splitting of the nail plate itself, usually on one side. Because the skin is splitting apart, hang nails can be very painful- even though they’re small.

Hang nails may be caused by dryness, accidentally cutting the cuticle or skin, injury, or even nail biting. It will occur more often in people who wash their hands often through the day, especially if they’re not applying lotion afterwards.

Once you’ve got a hang nail, the best thing to do is apply anti-biotic ointment or cream and bandage it. (If it’s painful, get a cream that contains pain relief ingredients.) It’s important to remember that hang nails are open wounds, so they can easily become infected. If this occurs, the hang nail will become very red, swollen and more painful. Keeping cream and a bandage on it will help prevent this kind of infection.

To prevent hang nails, keep the skin around your nails moisturized with lotion or hand/nail cream. If you wash your hands often, reapply lotion. Also, drink your 8-10 glasses of water each day, as keeping your skin hydrated from the inside will help it be stronger on the outside.

Ingrown Nails

Ahhh, ingrown nails. Probably the most painful common nail problem out there. Ingrown nails are usually toenails, and most often happen on the big toe. An ingrown nail is a nail whose side curls around into the skin (see photo above) rather than staying straight and growing out on track. It grows inward toward the main flesh of the toe rather than outward toward the edge. There are minor cases that people may not even notice, but there are very severe cases that may be extremely painful, with inflammation around the nail and toe, cutting and bleeding, and even bacterial infections.

There’s a bit of controversy regarding whether ingrown nails are hereditary. Most doctors say they are not, but I’ve yet to meet a client with ingrown nails who doesn’t have relatives with them, too. Either way, ingrown nails may be caused- or made worse- by cutting toenails too short (particularly the big toes, and particularly the corners), wearing shoes that are too tight at the toe area, or even certain digestive problems.

In more minor cases, there are some things you can do at home to treat ingrown nails. One tip is to soak the feet in warm salt water, dry with a towel, apply antiseptic cream and cover with a bandage. This will help stave off infection and- keep it protected.

Another home treatment that may sound a bit strange is after soaking and cleaning the toe with sanitizer or antiseptic, ball up a tiny amount of sanitary cotton and use an orangewood stick or cuticle pusher tool to push the tiny ball of cotton into place in between the curling toenail and the skin it’s attempting to curl into. The cotton forms a physical barrier, stopping the nail from being able to curl into the skin. Change the cotton out at least once per day, and continue until the nail is no longer painful (it may be several days.)

There are, of course, medical treatments for ingrown nails. Doctors are able to fairly quickly cut out the portion of your nail that’s ingrown, assuming there’s no infection. Antibiotics may be necessary if infection is present. There are also procedures available in which the sides of the big toe’s nail are cut and removed, and a botox-like paralyzing agent is injected into the cuticle at the bottom corners of the nail. This prevents the very sides of the nails from growing back, thus preventing any possibility of ingrown nails later. Talk to your podiatrist, dermatologist or physician about these possible treatments.

To prevent ingrown nails as much as possible- and while healing during treatment- be sure to wear shoes that are comfortable and provide plenty of space for your toes. Make sure your socks, tights or pantyhose aren’t too tight around the toes, either. When trimming the toenails, keep the nail of the big toe a bit longer- especially the corners. The longer the nail is, the more difficult it is for it to cut back into the toe.

Ridges, Splitting, Peeling

These ones I’ve grouped together because they have similar causes and treatments, and are some of the most minor- but most common- nail issues that occur. Vertical ridges, or ‘furrows,’ go up and down, vertically, on the nail plate. Horizontal ridges, or ‘corrugations,’ go side to side. They may be congenital (which means some people just have them,) and they may be brought on by age. They may also be caused by certain medications, poor circulation or psoriasis, as well as other things, so if you’re concerned about them, check with your doctor. In most cases, furrows are minor and cause no other problems. If the appearance bothers you, you may use a buffer to smooth out the nail plate. Apply nail oil or cream afterward to keep the nail plate in good condition.

Splitting, peeling or ‘layering’ of the nail happens to nearly everyone at some point. It’s caused- or made worse- by hands always being wet, nails being exposed to harsh detergents or chemicals, artificial nails, or regular application and removal of nail polish. Even habits like continually tapping your fingertips on the desk may weaken the nail’s edge enough to cause splitting.

If, inside the nail plate, the protein is weakened, then the nail may start to peel apart or split. It’s simply a sign that the nail’s edge is no longer as strong as it should be. To prevent this, keep your nails away from chemicals, including nail products, and water as much as possible. (You may want to wear gloves if your hands work with such things.) Don’t over-file or over-buff your nail plate, as this physically breaks down the nail plate.

Once you have nail peeling or splitting, it cannot be reversed. Just keep your nails and cuticles moisturized and the weak areas will grow out on their own.

‘Black and Blue Nails’ or Bleeding under the nail

These are exactly what they sound like- bruised and/or bleeding nail beds. The nail bed is the area of skin underneath the nail plate. It’s very tender and fragile, because it’s usually protected well by the nail plate. If your nails, fingers or toes are injured in some way, you may have bruising or bleeding underneath the nail plate. In most cases, you’ll see blue, purple or blue-black coloration and/or the redness of bleeding. The finger or toe will probably swell and become inflamed, and it may be warm to the touch. Obviously, if there’s a worry that the limb may be broken or sprained, or if there’s a concern about infection, you should see a doctor immediately.

As far as the nails go, the pain should subside over time, but this can take several days. The inflammation (redness and swelling) should also gradually decrease. Applying ointments or creams won’t typically do any good, as these can’t penetrate through the nail plate. If you have bleeding, however, or if the nail plate is cracked or cut open, you should apply an antibiotic cream and a bandage. In the case of bleeding under the nail, generally after some time, the nail plate and the nail bed will return to normal coloration and shape. In some cases, depending on the injury, your nail may grow out with a ridge or furrow, or have a strange shape. This may last several weeks, but the nail will usually return to normal.

In the case of bruised nails, sometimes more treatment is necessary. The best scenario is that the bruising subsides and the nail plate and bed return to normal coloration. One of the more painful scenarios is that the blood and fluid continues to pool underneath the nail plate and hurts more and more over time, with nowhere for the fluids to drain. In these cases, your doctor may need to drill a tiny hole in your nail plate, allowing the blood and fluids to drain. This brings on immediate relief and allows the nail plate and bed to begin healing. Even another scenario is that the bruising subsides, but the nail plate may grow out misshapen or it could even fall completely off the finger. Typically when this occurs, the nail plate will eventually grow back and appear completely normal- but that can take many weeks or even months.

Overall, make efforts to keep your hands and feet sanitized, moisturized and well-groomed… not only for looks, but also for your health.