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Nails are made of keratin, which is a hardened protein also found in hair and skin. They protect the delicate tissues at the ends of fingers and toes. Healthy nails (smooth and free of spots and unusual shapes and colour) can be a sign of good overall health, whereas nail troubles could be a sign of a systemic disease or infection, such as diabetes, anemia, or thyroid disease.

Maintaining Healthy Nails and Cuticles

  • Keep nails clean and dry – washing your hands and feet and properly drying them can discourage bacteria, viruses, and fungi from invading.
  • Do not use nails as tools, as you can damage fingernails when you use them to pry and poke things.
  • Keep nails trimmed, but not too short.
  • Do not bite your nails – this can damage the nail bed, and infection can occur if bacteria or fungi to enter through a minor cut. For the same reasons, avoid picking at cuticles or hangnails.
  • To prevent hangnails, keep your hands and nails well moisturized, and avoid biting or picking at the skin around nails in general.

Nail Discolouration

Nail discolouration can be a visible clue that something is wrong. Healthy nails have a pinkish hue and are evenly coloured. Here are some examples of what can lead to nail discolouration.

  • Yellow – Nails can become yellowed due to lymphedema (build-up of lymphatic fluid in tissues), lung disease, or psoriasis
  • Green – “Green nail syndrome” can be caused by a fungal infection called Pseudomonas
  • Brown – Nails can become stained brown from nicotine use, nail polish, or chemotherapy
  • Purple – A nail can turn purple due to bruising, or red/purple streaks can result from a splinter hemorrhage (little bit of bleeding that occurs under the nail)
  • Blue – Taking minocycline (antibiotic) or certain other oral medications can turn nails blue
  • Black – Black nails are usually caused by a pseudomonas infection, but can also be due to severe bruising. However, a subungual melanoma (see below) must always be considered with black discolouration of the nails.
  • White – Can be hereditary, a sign of low albumin, may develop from trauma to the nail, or can be due to vitiligo (a loss of pigmentation)

Subungual Melanoma

Melanoma (a type of skin cancer) may develop under a nail (subungual), appearing as a black or brown streak. It is important to see a doctor as soon as possible if you suspect a subungual melanoma, as the cancer can spread to other parts of the body. Some warning signs for a subungual melanoma are:

  • a brown or black streak
  • streaks that increase in size
  • no known injury to the nail
  • a bruise that does not heal or grow out with the nail
  • nail separating from nail bed
  • ulcer, nodule or bleeding developing
  • darkening skin next to nail (advanced stage)
  • deformed and damaged nail (advanced stage)

Treatment involves surgically removing the melanoma, which often involves removing the whole nail. In severe cases, the end of the affected finger or toe may need to be amputated, but doctors try to avoid this if at all possible.

Nail Fungus/Infection

Fungal infections of the nail can be caused by the same fungi that cause athlete’s foot, jock itch, and ringworm. Public places where bare feet are common, such as swimming pools, locker rooms, and gym showers, are often the source of these fungal infections. Some signs to look for in nails are brittleness, changed nail shape, crumbling nail edges, debris trapped under the nail, if the nail is loose or lifting, if the nail is thicker than before, white or yellow streaks, and if the nails are dull and lacking shine. The only way to know for sure if you have a fungal infection is for your doctor to take a sample and send it to a lab. Treating fungal infections usually requires prescription strength topical and/or oral medication. It is important to treat, as infections can permanently damage affected nails, and potentially lead to paronychia (a type of skin infection that occurs around nails). You can prevent fungal infections by observing the following practices:

  • Keep skin clean and dry
  • Do not share tools such as nail files
  • Trim your nails straight across
  • Use antifungal spray or powder daily
  • Give feet a break from shoes to let skin breathe
  • Do not go barefoot in public places

Brittle and Peeling Nails

Onychoschizia (brittle, splitting, soft, or thin nails) is a common problem that is more prevalent in women and usually occurs with aging. Brittle nails can also reflect health conditions, such as thyroid problems, but often arise from purely cosmetic causes, such as long-term nail polish use, too much hand washing, or exposure to harsh soap or detergent. Some ways to prevent brittle nails are to wear rubber gloves when washing dishes and for general housecleaning, give nails a break from nail polish and nail polish remover, and moisturize them regularly.

For more information on nails and nail care from the Canadian Dermatology Association, click here!

Information has been referenced from the following sources: 1 2 3 4 5 6


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