A nail disease or onychosis is a disease or deformity of the
nail
Nail or Nails may refer to:
In biology
* Nail (anatomy), toughened protective protein-keratin (known as alpha-keratin, also found in hair) at the end of an animal digit, such as fingernail
* Nail (beak), a plate of hard horny tissue at the tip ...
. Although the nail is a structure produced by the skin and is a
skin appendage, nail diseases have a distinct classification as they have their own signs and symptoms which may relate to other medical conditions. Some nail conditions that show signs of
infection
An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable dis ...
or
inflammation
Inflammation (from la, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants, and is a protective response involving immune cells, blood vessels, and molec ...
may require medical assistance.
Diseases
*''Onychia'' is an
inflammation
Inflammation (from la, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants, and is a protective response involving immune cells, blood vessels, and molec ...
of the nail folds (surrounding tissue of the nail plate) of the nail with formation of
pus
Pus is an exudate, typically white-yellow, yellow, or yellow-brown, formed at the site of inflammation during bacterial or fungal infection. An accumulation of pus in an enclosed tissue space is known as an abscess, whereas a visible collection ...
and shedding of the nail. Onychia results from the introduction of microscopic
pathogen
In biology, a pathogen ( el, πάθος, "suffering", "passion" and , "producer of") in the oldest and broadest sense, is any organism or agent that can produce disease. A pathogen may also be referred to as an infectious agent, or simply a germ ...
s through small wounds.
*''
Onychocryptosis'', commonly known as "ingrown nails" (''unguis incarnatus''), can affect either the fingers or the toes. In this condition, the nail cuts into one or both sides of the
nail bed, resulting in
inflammation
Inflammation (from la, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants, and is a protective response involving immune cells, blood vessels, and molec ...
and possibly
infection
An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable dis ...
. The relative rarity of this condition in the fingers suggests that
pressure
Pressure (symbol: ''p'' or ''P'') is the force applied perpendicular to the surface of an object per unit area over which that force is distributed. Gauge pressure (also spelled ''gage'' pressure)The preferred spelling varies by country and e ...
from the ground or shoe against the toe is a prime factor. The movements involved in
walking
Walking (also known as ambulation) is one of the main gaits of terrestrial locomotion among legged animals. Walking is typically slower than running and other gaits. Walking is defined by an ' inverted pendulum' gait in which the body vaults ...
or other physical disturbances can contribute to the problem. Mild
onychocryptosis, particularly in the absence of infection, can be treated by trimming and rounding the nail. More advanced cases, which usually include
infection
An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable dis ...
, are treated by
surgically
Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pa ...
excising the ingrowing portion of the nail down to its bony origin and thermally or chemically
cauterizing
Cauterization (or cauterisation, or cautery) is a medical practice or technique of burn (injury), burning a part of a body to remove or close off a part of it. It destroys some tissue in an attempt to mitigate bleeding and damage, remove an undes ...
the matrix, or 'root', to prevent recurrence. This surgery is called
matrixectomy. The best results are achieved by cauterizing the matrix with
phenol
Phenol (also called carbolic acid) is an aromatic organic compound with the molecular formula . It is a white crystalline solid that is volatile. The molecule consists of a phenyl group () bonded to a hydroxy group (). Mildly acidic, it ...
. The
Vandenbos Procedure is a highly effective method that focuses on excision of excessive nail fold tissue without affecting the healthy nail and nail matrix. The Vandenbos Procedure is showing high success rates in eliminating onychocryptosis without altering the normal nail. Another, much less effective, treatment is
excision of the matrix, sometimes called a 'cold steel procedure'.
*''
Onychodystrophy
A nail is a claw-like plate found at the tip of the fingers and toes on most primates. Nails correspond to the claws found in other animals. Fingernails and toenails are made of a tough protective protein called alpha-keratin, which is a polymer. ...
'' is a
deformation
Deformation can refer to:
* Deformation (engineering), changes in an object's shape or form due to the application of a force or forces.
** Deformation (physics), such changes considered and analyzed as displacements of continuum bodies.
* Defor ...
of the nails that can result from cancer
chemotherapy
Chemotherapy (often abbreviated to chemo and sometimes CTX or CTx) is a type of cancer treatment that uses one or more anti-cancer drugs ( chemotherapeutic agents or alkylating agents) as part of a standardized chemotherapy regimen. Chemothe ...
which includes
bleomycin
-13- (1''H''-imidazol-5-yl)methyl9-hydroxy-5- 1''R'')-1-hydroxyethyl8,10-dimethyl-4,7,12,15-tetraoxo-3,6,11,14-tetraazapentadec-1-yl}-2,4'-bi-1,3-thiazol-4-yl)carbonyl]amino}propyl)(dimethyl)sulfonium
, chemical_formula =
, C=55 , H=84 , N=1 ...
,
hydroxyurea
Hydroxycarbamide, also known as hydroxyurea, is a medication used in sickle-cell disease, essential thrombocythemia, chronic myelogenous leukemia, polycythemia vera, and cervical cancer. In sickle-cell disease it increases fetal hemoglobin and d ...
, or
5-fluorouracil
Fluorouracil (5-FU), sold under the brand name Adrucil among others, is a cytotoxic chemotherapy medication used to treat cancer. By intravenous injection it is used for treatment of colorectal cancer, oesophageal cancer, stomach cancer, pan ...
. It can include
discoloration of the nail, or
dyschromia
Dyschromia refers to an alteration of the color of the skin or nails.
"Hyperchromia" can refer to hyperpigmentation, and "hypochromia" can refer to hypopigmentation.
"Dyschromatoses" involve both hyperpigmented and hypopigmented macules.
__TOC__ ...
.
*''
Onychogryposis
Onychogryphosis is a hypertrophy that may produce nails resembling claws or a ram's horn.
Causes
Onychogryphosis may be caused by trauma or peripheral vascular disease, but most often secondary to self-neglect and failure to cut the nails for ...
'', also called "ram's-horn nail", is a thickening and increase in
curvature of the nail. It is usually the result of injury to the matrix. It may be partially
hereditary and can also occur as a result of long-term neglect. It is most commonly seen in the great
toe
Toes are the digits (fingers) of the foot of a tetrapod. Animal species such as cats that walk on their toes are described as being ''digitigrade''. Humans, and other animals that walk on the soles of their feet, are described as being ''plan ...
but may be seen in other toes as well as the fingernails. An affected nail has many grooves and ridges, is brownish in color, and grows more quickly on one side than on the other. The thick curved nail is difficult to cut, and often remains untrimmed, exacerbating the problem.
*''
Onycholysis
Onycholysis is a common medical condition characterized by the painless detachment of the nail from the nail bed, usually starting at the tip and/or sides. On the hands, it occurs particularly on the ring finger but can occur on any of the fingern ...
'' is a loosening of the exposed portion of the nail from the nail bed, usually beginning at the free edge and continuing to the
lunula. It is frequently associated with an
internal disorder,
trauma
Trauma most often refers to:
* Major trauma, in physical medicine, severe physical injury caused by an external source
* Psychological trauma, a type of damage to the psyche that occurs as a result of a severely distressing event
*Traumatic i ...
,
infection
An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable dis ...
,
nail fungi,
allergy
Allergies, also known as allergic diseases, refer a number of conditions caused by the hypersensitivity of the immune system to typically harmless substances in the environment. These diseases include hay fever, food allergies, atopic derm ...
to
nail enhancement products, or side effects of
drugs.
*''
Onychomadesis'' is the separation and falling off of a nail from the
nail bed. Common causes include localized
infection
An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable dis ...
, minor injury to the
matrix bed, or severe
systemic illness
A systemic disease is one that affects a number of organs and tissues, or affects the body as a whole.
Examples
* Mastocytosis, including mast cell activation syndrome and eosinophilic esophagitis
* Chronic fatigue syndrome
* Systemic va ...
. It is sometimes a side effect of
chemotherapy
Chemotherapy (often abbreviated to chemo and sometimes CTX or CTx) is a type of cancer treatment that uses one or more anti-cancer drugs ( chemotherapeutic agents or alkylating agents) as part of a standardized chemotherapy regimen. Chemothe ...
or
x-ray
An X-ray, or, much less commonly, X-radiation, is a penetrating form of high-energy electromagnetic radiation. Most X-rays have a wavelength ranging from 10 picometers to 10 nanometers, corresponding to frequencies in the range 30&nb ...
treatments for
cancer
Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast with benign tumors, which do not spread. Possible signs and symptoms include a lump, abnormal b ...
. A new nail plate will form once the cause of the disease is removed.
*''
Onychomycosis
Onychomycosis, also known as tinea unguium, is a fungal infection of the nail. Symptoms may include white or yellow nail discoloration, thickening of the nail, and separation of the nail from the nail bed. Toenails or fingernails may be affected, ...
'', also known as
''tinea unguium'', is a contagious
infection
An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable dis ...
of the nail caused by the same
fungal organisms which cause
ringworm
Dermatophytosis, also known as ringworm, is a fungal infection of the skin. Typically it results in a red, itchy, scaly, circular rash. Hair loss may occur in the area affected. Symptoms begin four to fourteen days after exposure. Multiple ar ...
of the
skin
Skin is the layer of usually soft, flexible outer tissue covering the body of a vertebrate animal, with three main functions: protection, regulation, and sensation.
Other animal coverings, such as the arthropod exoskeleton, have different de ...
(''Trichophyton rubrum'' or ''T. mentagrophytes'', rarely other
trichophyton
''Trichophyton'' is a genus of fungi, which includes the parasitic varieties that cause tinea, including athlete's foot, ringworm, jock itch, and similar infections of the nail, beard, skin and scalp. Trichophyton fungi are molds characterize ...
species or ''Epidermophyton floccosum''
). It can result in
discoloration,
thickening
A thickening agent or thickener is a substance which can increase the viscosity of a liquid without substantially changing its other properties. Edible thickeners are commonly used to thicken sauces, soups, and puddings without altering thei ...
,
chalkiness, or crumbling of the nails and is often treated by powerful oral medications which, rarely, can cause severe side effects including
liver failure. Mild
onychomycosis
Onychomycosis, also known as tinea unguium, is a fungal infection of the nail. Symptoms may include white or yellow nail discoloration, thickening of the nail, and separation of the nail from the nail bed. Toenails or fingernails may be affected, ...
sometimes responds to a combination of
topical
A topical medication is a medication that is applied to a particular place on or in the body. Most often topical medication means application to body surfaces such as the skin or mucous membranes to treat ailments via a large range of classes ...
antifungal medication
An antifungal medication, also known as an antimycotic medication, is a pharmaceutical fungicide or fungistatic used to treat and prevent mycosis such as athlete's foot, ringworm, candidiasis (thrush), serious systemic infections such as cryp ...
, sometimes applied as special
medicinal
Medicine is the science and practice of caring for a patient, managing the diagnosis, prognosis, prevention, treatment, palliation of their injury or disease, and promoting their health. Medicine encompasses a variety of health care practic ...
nail
lacquer, and
periodic filing of the nail surface. For advanced onychomycosis, especially if more than one nail is
infected, systemic medication (pills) is preferred. Home remedies are often used, although their effectiveness is disputed.
*''
Onychophosis'' is a growth of
horny epithelium in the nail.
*''
Onychoptosis'' is the periodic shedding of one or more nails, in whole or part. This condition may follow certain diseases such as
syphilis, or can result from
fever
Fever, also referred to as pyrexia, is defined as having a temperature above the normal range due to an increase in the body's temperature set point. There is not a single agreed-upon upper limit for normal temperature with sources using val ...
, trauma,
systemic upsets or
adverse reaction to drugs.
*''
Onychorrhexis
Onychorrhexis (from the Greek words ὄνυχο- ''ónycho-'', "nail" and ῥῆξις ''rhexis'', "bursting"), is a brittleness with breakage of finger or toenails that may result from hypothyroidism, anemia, anorexia nervosa or bulimia, or aft ...
'' also known as brittle nails, is brittleness with breakage of fingernails or toenails.
*''
Paronychia
Paronychia is an inflammation of the skin around the nail, which can occur suddenly, when it is usually due to the bacterium ''Staphylococcus aureus'', or gradually when it is commonly caused by the fungus ''Candida albicans''. The term is fro ...
'' is a
bacterial
Bacteria (; singular: bacterium) are ubiquitous, mostly free-living organisms often consisting of one biological cell. They constitute a large domain of prokaryotic microorganisms. Typically a few micrometres in length, bacteria were amon ...
or
fungal
A fungus ( : fungi or funguses) is any member of the group of eukaryotic organisms that includes microorganisms such as yeasts and molds, as well as the more familiar mushrooms. These organisms are classified as a kingdom, separately from th ...
infection
An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable dis ...
where the nail and
skin
Skin is the layer of usually soft, flexible outer tissue covering the body of a vertebrate animal, with three main functions: protection, regulation, and sensation.
Other animal coverings, such as the arthropod exoskeleton, have different de ...
meet.
*''
Koilonychia
Koilonychia, also known as spoon nails,James, William; Berger, Timothy; Elston, Dirk (2005). ''Andrews' Diseases of the Skin: Clinical Dermatology''. (10th ed.). Saunders. . is a nail disease that can be a sign of hypochromic anemia, especially ...
'' is when the nail curves upwards (becomes spoon-shaped) due to an
iron deficiency
Iron deficiency, or sideropenia, is the state in which a body lacks enough iron to supply its needs. Iron is present in all cells in the human body and has several vital functions, such as carrying oxygen to the tissues from the lungs as a key ...
. The normal process of change is: brittle nails, straight nails, spoon-shaped nails.
*''
Subungual hematoma
A subungual hematoma is a collection of blood (hematoma) underneath a toenail or fingernail. It can be extremely painful for an injury of its size, although otherwise it is not a serious medical condition.
Nature
A laceration of the nail bed c ...
'' occurs when trauma to the nail results in a collection of
blood
Blood is a body fluid in the circulatory system of humans and other vertebrates that delivers necessary substances such as nutrients and oxygen to the cells, and transports metabolic waste products away from those same cells. Blood in the cir ...
, or
hematoma, under the nail. It may result from an acute injury or from repeated minor
trauma
Trauma most often refers to:
* Major trauma, in physical medicine, severe physical injury caused by an external source
* Psychological trauma, a type of damage to the psyche that occurs as a result of a severely distressing event
*Traumatic i ...
such as running in undersized shoes. Acute
subungual hematoma
A subungual hematoma is a collection of blood (hematoma) underneath a toenail or fingernail. It can be extremely painful for an injury of its size, although otherwise it is not a serious medical condition.
Nature
A laceration of the nail bed c ...
s are quite painful, and are usually treated by releasing the
blood
Blood is a body fluid in the circulatory system of humans and other vertebrates that delivers necessary substances such as nutrients and oxygen to the cells, and transports metabolic waste products away from those same cells. Blood in the cir ...
by creating a small hole in the nail.
Drilling and
thermal cautery are common methods for creating the hole. Thermal cautery is not used on
acrylic nails because they are
flammable.
*''
Onychomatricoma'', a tumor of the nail matrix.
*''Nail
pemphigus
Pemphigus ( or ) is a rare group of blistering autoimmune diseases that affect the skin and mucous membranes.
The name is derived from the Greek root ''pemphix'', meaning "pustule".
In pemphigus, autoantibodies form against desmoglein, whi ...
'', an auto-immune disease.
*''
Erythronychia'', red bands in the nail from some inflammatory conditions.
*''
Melanonychia Melanonychia is a black or brown pigmentation of the normal nail plate, and may be present as a normal finding on many digits in Afro-Caribbeans, as a result of trauma, systemic disease, or medications, or as a postinflammatory event from such local ...
'', a black, brown or grey discoloration of the nail, with numerous causes.
Nail changes and conditions associated with them
Nail inspection can give hints to the internal condition of the body as well.
Nail disease can be very subtle and should be evaluated by a dermatologist with a focus in this particular area of medicine. A nail technician may be the first to note a subtle change in nail health.
Pliability
*Brittleness is associated with iron deficiency, thyroid problems,
and impaired kidney function.
*Splitting and fraying are associated with
psoriasis
Psoriasis is a long-lasting, noncontagious autoimmune disease characterized by raised areas of abnormal skin. These areas are red, pink, or purple, dry, itchy, and scaly. Psoriasis varies in severity from small, localized patches to complete ...
and deficiencies of
folic acid
Folate, also known as vitamin B9 and folacin, is one of the B vitamins. Manufactured folic acid, which is converted into folate by the body, is used as a dietary supplement and in food fortification as it is more stable during processing and ...
, protein, and
Vitamin C.
*Unusual thickness is associated with circulation problems.
Shape and texture
*
Nail clubbing
Nail clubbing, also known as digital clubbing or clubbing, is a deformity of the finger or toe nails associated with a number of diseases, mostly of the heart and lungs.Freedberg, et al. (2003). ''Fitzpatrick's Dermatology in General Medicine''. ...
- nails that curve down around the fingertips with nailbeds that bulge is associated with oxygen deprivation and lung, heart, or liver disease.
*
Koilonychia
Koilonychia, also known as spoon nails,James, William; Berger, Timothy; Elston, Dirk (2005). ''Andrews' Diseases of the Skin: Clinical Dermatology''. (10th ed.). Saunders. . is a nail disease that can be a sign of hypochromic anemia, especially ...
- spooning, or nails that grow upwards. Associated with
iron-deficiency anaemia or
vitamin B12 deficiency.
*Pitting of the nails is associated with
psoriasis
Psoriasis is a long-lasting, noncontagious autoimmune disease characterized by raised areas of abnormal skin. These areas are red, pink, or purple, dry, itchy, and scaly. Psoriasis varies in severity from small, localized patches to complete ...
.
*
Beau's lines are horizontal ridges in the nail.
*
Habit-tic deformity is a condition similar to Beau's Lines caused by long-term skin picking.
Discoloration of entire nail bed
*Yellowing of the nail bed is associated with chronic bronchitis, lymphatic problems, diabetes, and liver disorders.
*Brown or copper nail beds are associated with
arsenic
Arsenic is a chemical element with the symbol As and atomic number 33. Arsenic occurs in many minerals, usually in combination with sulfur and metals, but also as a pure elemental crystal. Arsenic is a metalloid. It has various allotropes, ...
or
copper poisoning
Copper toxicity (or Copperiedus) is a type of metal poisoning caused by an excess of copper in the body. Copperiedus could occur from consuming excess copper salts, but most commonly it is the result of the genetic condition Wilson's disease and ...
, and
local fungal infection.
*Redness is associated with heart conditions.
Other color changes and markings
*
Melanonychia Melanonychia is a black or brown pigmentation of the normal nail plate, and may be present as a normal finding on many digits in Afro-Caribbeans, as a result of trauma, systemic disease, or medications, or as a postinflammatory event from such local ...
(longitudinal streaking that darkens or does not grow out), especially on the thumb or big toe, may indicate subungual melanoma.
*White lines across the nail (
leukonychia
Leukonychia (or leuconychia) is a medical term for white discoloration appearing on nails.Freedberg, et al. (2003). ''Fitzpatrick's Dermatology in General Medicine''. (6th ed.). McGraw-Hill. pp. 658–59. . It is derived from the Greek words ''l ...
striata, or transverse leukonychia) may be
Mees' lines or
Muehrcke's lines.
*Small white patches are known as
leukonychia
Leukonychia (or leuconychia) is a medical term for white discoloration appearing on nails.Freedberg, et al. (2003). ''Fitzpatrick's Dermatology in General Medicine''. (6th ed.). McGraw-Hill. pp. 658–59. . It is derived from the Greek words ''l ...
punctata.
*Dark nails are associated with B
12 deficiency.
*Stains of the nail plate (not the nail bed) are associated with smoking, and henna use.
*
Splinter hemorrhages (or haemorrhages) are tiny blood clots that tend to run vertically under the nails.
*Drug-induced nail changes are caused by drug usage which may result in various abnormalities.
[Freedberg, et al. (2003). ''Fitzpatrick's Dermatology in General Medicine''. (6th ed.). McGraw-Hill. .]
Treatment
In approximately half of suspected nail fungus cases there is actually no fungal infection, but only some nail dystrophy.
[, which cites
*
*] Before beginning oral antifungal therapy the health care provider should confirm a fungal infection.
Administration of treatment to persons without an infection is
unnecessary health care
Unnecessary health care (overutilization, overuse, or overtreatment) is health care provided with a higher volume or cost than is appropriate.
In the United States, where health care costs are the highest as a percentage of GDP, overuse was the ...
and causes needless exposure to side effects.
See also
*
Hangnail
A hangnail is a tiny, torn piece of skin next to a fingernail or toenail, related to ingrown nails. The hangnail's other scientific names are: eponychium or paronychium. Hangnails are typically caused by having dry skin, or by trauma to the fin ...
*
List of cutaneous conditions
*
Occupational hazards associated with exposure to human nail dust
*
Yellow nail syndrome
References
External links
Fungal Nail Infections- explanation covering causes, treatment, and prevention
Links to pictures of Toenail Diseases (Wiggins MD)
{{DEFAULTSORT:Nail Disease
Nails (anatomy)
Conditions of the skin appendages