Recognizing Nail Disorders – Causes, Symptoms, and Treatment of Nail Changes (Fungal Infections, Ingrown Nails, and the Most Common Nail Disorders)

Diseases or disorders affecting the fingernails or toenails can occur at any age. Common symptoms of nail diseases include, for example,

• spots,
• cracks,
• discoloration,
• brittle nails,
• deformities on the nail surface, and
• changes in color or abnormalities in the nail structure.

Not only the nail plate itself, but also the nail bed or the skin around the nail may be affected.

A healthy nail is smooth, has a white-looking half-moon, and is otherwise free of spots. An unhealthy nail often has a different color, is curved, or crumbles.

For the layperson, it is usually impossible to identify the underlying issue with the naked eye. A dermatologist is the specialist to consult for nail disorders.

Nail fungus (medical term: onychomycosis) is a fungal infection and one of the most common nail disorders. It commonly affects not only the fingernails and toenails but also the skin (skin fungus).

At the onset of a nail fungus infection, the nail develops small, yellowish spots. If left untreated, the nail becomes brittle and lifts away from the nail bed. Thickening of the nail plate may also occur as the infection progresses.

In nail psoriasis, the nails have spots that resemble oil stains. The nail is yellowish in color, the nail structure is crumbly, and without treatment, the nail detaches. It is generally heavily keratinized, and its appearance is very similar to that of a fungal nail infection. In advanced stages, significant pain may occur.

Nail discoloration appears yellow, gray, or brown. In addition, longitudinal and transverse ridges are typical symptoms of nail disorders. Severe thickening is referred to as “watchglass nails.” Dented nail surfaces are caused by what is known as a “spoon nail.” Other typical changes in the nails include longitudinal and transverse ridges. The symptoms mentioned are often indicative of a deficiency or a specific medical condition.

About 50 percent of all nail disorders are caused by an infection. Fungal infections, in particular, are often associated with a general weakening of the immune system.

People at increased risk for nail diseases include

• people with the metabolic disorder diabetes mellitus,
• people with circulatory disorders (arterial or venous)
• smokers.

Environmental factors can also contribute to an infection. For fungal infections in particular, this typically involves a warm, humid environment, which provides ideal growing conditions for fungi. This includes swimming pools, as well as saunas and gyms. You should therefore avoid walking barefoot in these places and always wear (swim) shoes.

Injuries are also a cause of nail diseases. They often result in bruising and other damage to the nail bed and nail plate.

If you sustain an injury, consult a dermatologist if necessary. Without medical intervention, a secondary condition could otherwise develop. One possible outcome is nail deformation, which may require the removal of the nail.

The examination by a specialist in nail diseases depends on the type and extent of the nail damage. If the cause is unknown, there are various diagnostic options.

The most important form of examination is dermatoscopy. During this painless microscopic examination, the doctor uses a reflected-light microscope to look into the deeper layers of the nail. This allows the doctor to identify damage that would not be visible to the naked eye.

If necessary, a mycological examination (mycology = the science of fungi) is performed. To do this, the doctor takes a tissue sample from the nail and prepares a fungal culture. This provides information about the type of nail fungus.

Additionally, laboratory diagnostic tests may be performed. These can also determine whether the nail symptoms are related to medication use. For example, some cancer treatments can cause nail disorders as a side effect.

The treatment of nail diseases on the hands or feet depends largely on the cause of the condition. If the symptoms are part of another medical condition, the patient may be referred to the appropriate specialists as needed.

Various treatment options are available for fungal infections. The doctor uses antifungal medications for this purpose. These can inhibit the growth of the fungus, so that after some time it is shed along with dead skin cells. Other active ingredients kill the fungus directly. In most cases, you can apply the medication to the affected areas yourself, just like nail polish.

In many cases, supplemental laser therapy is an option, though it may only be performed by a specialist. Medicated creams and ointments, applied regularly, are also part of nail treatment.

In very severe cases, local treatment is not sufficient. Systemic therapy is then necessary. You will usually be prescribed tablets for this purpose. The active ingredients they contain combat the fungus throughout the entire body, not just on the surface of the nail. Detailed counseling is required, as side effects are possible.

Nail diseases are usually very persistent. It can take many months before visible improvement is noticed. This is especially true for nail fungus and psoriasis. You will therefore need patience and discipline when taking the medication. For example, you must not stop treatment prematurely under any circumstances. Otherwise, there is a risk that the pathogen will cause the condition to recur.

The course of the disease depends on the exact cause.

Nail disorders stem from various causes, many of which are harmless. Some abnormalities, however, require treatment. The sooner you begin treatment with your dermatologist, the better your chances of recovery.