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Nail Disorders

Nails are essentially hardened skin cells. Made mostly of keratin, a protein found in the skin and hair, nails are made by living cells in the fingers and toes. These living cells begin in the matrix, the hidden area under the cuticle. As new skin cells grow in the matrix, the older cells are pushed forward, harden, and form a visible nail.

Common nail disorders: While uncommon in children, nail disorders affect a large number of older adults. As we age, nails thicken and become more susceptible to fungal nail infections. Circulatory problems and use of medications, which also tend to increase as we age, raise the risk of developing a nail condition. The following describes common nail conditions and the causes:

Paronychia: The nail disease paronychia commonly misidentified as a synonym for whitlow or felon, is an often-tender bacterial or fungal hand infection or foot infection where the nail and skin meet at the side or the base of a finger or toenail. The infection can start suddenly (acute paronychia)

Acute paronychia is usually caused by bacteria. This is often treated with antibiotics, sometimes as a cream, other times orally. Chronic paronychia is most often caused by a yeast infection of the soft tissues around the nail but can also be traced to a bacterial infection. If the infection goes on and on then a fungal infection is often the cause and this needs anti-fungal cream or paint to treat it.

Onychogryphosis: A hypertrophy that may produce nails resembling claws or a ram's horn, possibly caused by trauma or peripheral vascular disorders, but most often secondary to neglect and failure to cut the nails for extended periods of time. Onychogryphosis is most commonly seen in the elderly, and some recommend avulsion of the nail plate with surgical destruction of the matrix with phenol or the CO2 laser, if the blood supply is good.

Melanonychia: A black or brown pigmentation of the normal nail plate, and may be present as a normal finding on many digits in black patients, as a result of trauma, systemic disease, or medications, or as a postinflammatory event from such localized events as lichen planus or fixed drug eruption.

Onychorrhexis: Also known as Brittle nails, is a brittleness with breakage of finger or toenails that may result from excessive strong soap and water exposure, nail polish remover, hypothyroidism, anemia, anorexia nervosa or bulimia, or after oral retinoid therapy. Onychorrhexis affects up to 20% of the population.

Onychocryptosis: Also known as an ingrown nail, or "unguis incarnatus" is a common form of nail disease. It is an often painful condition in which the nail grows so that it cuts into one or both sides of the nail bed. While ingrown nails can occur in both the nails of the hand and feet, they occur most commonly with the toenails. An ingrown toenail often is not really "ingrown" at all. The appearance of being ingrown may actually be a result of inflammation of the flesh around the nail. The nail becomes embedded and soft under the flesh that has inflamed around it.

Pterygium: Describes the common condition of the forward growth of the cuticle on the nail. The cuticle sticks to the nail plate and, if not treated, will grow over the nail to the free edge.

The nail pictured is an extreme case and will take several manicures to get the cuticle back in place.

Nail disorders are caused by infections, skin diseases, benign or malignant tumors, or certain system wide diseases. Chronic renal failure, for example, is known to cause various nail pathologies. They also may be self induced.

To Prevent Nail Disorders

* Keep your toenails cut short.

* Make sure your shoes fit properly.

* Avoid walking barefoot at public showers and swimming facilities.

* Throw out old, worn footwear.