Medical dermatology · Nails
Nail disorders: fungal infection, ingrown nails, discoloration and brittle nails
Nails can be affected by infections, such as fungal infection (onychomycosis), by skin diseases, such as psoriasis, by trauma, by ingrown nails and, more rarely, by tumors, including melanoma. Changes in color, shape, thickness or growth should be evaluated by a dermatologist, who uses onychoscopy (dermoscopy of the nails) and other exams to reach a diagnosis. At Yamagata Dermatologia, in Ipanema, Rio de Janeiro, diagnosis and treatment are carried out by dermatologists.
Symptoms and how to recognize it
- Yellowish, thick or detaching nails (onychomycosis)
- Small pits, discoloration or detachment (nail psoriasis)
- Pain, inflammation and swelling at the side of the nail (ingrown nail)
- Nails that peel or break easily (brittle nails)
- A dark band on the nail that is new or widening (melanonychia)
Causes and risk factors
Nail changes have varied causes: fungal infections, skin diseases (psoriasis, lichen planus), repeated trauma, tight shoes, improper trimming, frequent contact with water and chemicals, nutritional deficiencies, thyroid disease and, more rarely, benign and malignant tumors.
Diagnosis
The dermatologist examines the nails and uses onychoscopy, dermoscopy applied to the nails, to tell the causes apart. A mycological exam confirms fungal infection, and dermatologic ultrasound assesses changes under the nail. For suspicious lesions, such as atypical dark bands, a biopsy may be recommended.
Treatments
Treatment depends on the cause and requires patience, because nails grow slowly.
- Onychomycosis treatmentTopical and oral antifungals, according to the extent of the infection.
- Ingrown nail treatmentCare, treatment of inflammation and partial nail matrix removal in recurrent cases.
- Dermatologic surgeryBiopsy and removal of nail lesions, when indicated.
- Treatment of brittle nails and nail psoriasisInvestigation of causes, topical medications and, in psoriasis, systemic treatment when needed.
Living with it and prevention
- Trim toenails straight across, without cutting deep into the corners.
- Wear comfortable shoes and cotton socks.
- Wear gloves when handling water and cleaning products.
- Do not share nail clippers and files.
When to see a dermatologist
See a dermatologist if you notice changes in the color, thickness or shape of your nails, persistent pain and inflammation, nails that detach or a new dark band.
All procedures are recommended and performed after an individual medical evaluation. Results vary from person to person.
Questions
Frequently asked questions
Is every yellowish nail a fungal infection?
No. Psoriasis, trauma, nail polish and other diseases can also make the nail yellowish or thick. A correct diagnosis avoids long, unnecessary treatments.
Does a dark band on the nail need to be evaluated?
Most of the time it is benign, but a dark band that is new, widening, has irregular colors or stains the surrounding skin should be evaluated by a dermatologist, who examines the nail with dermoscopy to rule out melanoma.
Why does nail treatment take so long?
Nails grow slowly: complete renewal takes about six months for fingernails and 12 to 18 months for toenails. Results only show as the new nail grows.
Can weak nails be caused by a vitamin deficiency?
Sometimes, but the most common causes are frequent contact with water and chemicals, nail polish and removers. Deficiencies and thyroid disease can also contribute.
Team
Medical team
See also