A nail disease or onychosis is a disease or deformity of the
nail. 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 or
inflammation may require medical assistance.
Diseases
Onychia is an
inflammation of the nail folds (surrounding tissue of the nail plate) of the nail with formation of
pus and shedding of the nail. Onychia results from the introduction of microscopic
pathogens 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 and possibly
infection. The relative rarity of this condition in the fingers suggests that
pressure from the ground or shoe against the toe is a prime factor. The movements involved in
walking 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, are treated by
surgically excising the ingrowing portion of the nail down to its bony origin and thermally or chemically
cauterizing the matrix, or 'root', to prevent recurrence. This surgery is called
matrixectomy. The best results are achieved by cauterizing the matrix with
phenol. 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'.
Onychogryposis, 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 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.
Onychomadesis is the separation and falling off of a nail from the
nail bed. Common causes include localized
infection, minor injury to the
matrix bed, or severe
systemic illness. It is sometimes a side effect of
chemotherapy or
x-ray treatments for
cancer. A new nail plate will form once the cause of the disease is removed.
Onychomycosis, also known as
tinea unguium, is a contagious
infection of the nail caused by the same
fungal organisms which cause
ringworm of the
skin (Trichophyton rubrum or T. mentagrophytes, rarely other
trichophyton species or Epidermophyton floccosum[1]). It can result in
discoloration,
thickening,
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 sometimes responds to a combination of
topicalantifungal medication, sometimes applied as special
medicinal 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.
Koilonychia is when the nail curves upwards (becomes spoon-shaped) due to an
iron deficiency. The normal process of change is: brittle nails, straight nails, spoon-shaped nails.
Subungual hematoma occurs when trauma to the nail results in a collection of
blood, or
hematoma, under the nail. It may result from an acute injury or from repeated minor
trauma such as running in undersized shoes. Acute
subungual hematomas are quite painful, and are usually treated by releasing the
blood 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.
Erythronychia, red bands in the nail from some inflammatory conditions.
Melanonychia, 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.[2][3][4]
Pliability
Brittleness is associated with iron deficiency, thyroid problems,[5] and impaired kidney function.
Unusual thickness is associated with circulation problems.
Shape and texture
Nail clubbing - nails that curve down around the fingertips with nailbeds that bulge is associated with oxygen deprivation and lung, heart, or liver disease.
Small white patches are known as
leukonychia punctata.
Dark nails are associated with B12 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.[6]: 665–6
Treatment
In approximately half of suspected nail fungus cases there is actually no fungal infection, but only some nail dystrophy.[7] Before beginning oral antifungal therapy the health care provider should confirm a fungal infection.[7] Administration of treatment to persons without an infection is
unnecessary health care and causes needless exposure to side effects.[7]
Roberts, D. T.; Taylor, W. D.; Boyle, J.; British Association of Dermatologists (2003). "Guidelines for treatment of onychomycosis". The British Journal of Dermatology. 148 (3): 402–410.
doi:
10.1046/j.1365-2133.2003.05242.x.
PMID12653730.
S2CID33750748.
Mehregan, D. R.; Gee, S. L. (1999). "The cost effectiveness of testing for onychomycosis versus empiric treatment of onychodystrophies with oral antifungal agents". Cutis. 64 (6): 407–410.
PMID10626104.
A nail disease or onychosis is a disease or deformity of the
nail. 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 or
inflammation may require medical assistance.
Diseases
Onychia is an
inflammation of the nail folds (surrounding tissue of the nail plate) of the nail with formation of
pus and shedding of the nail. Onychia results from the introduction of microscopic
pathogens 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 and possibly
infection. The relative rarity of this condition in the fingers suggests that
pressure from the ground or shoe against the toe is a prime factor. The movements involved in
walking 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, are treated by
surgically excising the ingrowing portion of the nail down to its bony origin and thermally or chemically
cauterizing the matrix, or 'root', to prevent recurrence. This surgery is called
matrixectomy. The best results are achieved by cauterizing the matrix with
phenol. 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'.
Onychogryposis, 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 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.
Onychomadesis is the separation and falling off of a nail from the
nail bed. Common causes include localized
infection, minor injury to the
matrix bed, or severe
systemic illness. It is sometimes a side effect of
chemotherapy or
x-ray treatments for
cancer. A new nail plate will form once the cause of the disease is removed.
Onychomycosis, also known as
tinea unguium, is a contagious
infection of the nail caused by the same
fungal organisms which cause
ringworm of the
skin (Trichophyton rubrum or T. mentagrophytes, rarely other
trichophyton species or Epidermophyton floccosum[1]). It can result in
discoloration,
thickening,
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 sometimes responds to a combination of
topicalantifungal medication, sometimes applied as special
medicinal 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.
Koilonychia is when the nail curves upwards (becomes spoon-shaped) due to an
iron deficiency. The normal process of change is: brittle nails, straight nails, spoon-shaped nails.
Subungual hematoma occurs when trauma to the nail results in a collection of
blood, or
hematoma, under the nail. It may result from an acute injury or from repeated minor
trauma such as running in undersized shoes. Acute
subungual hematomas are quite painful, and are usually treated by releasing the
blood 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.
Erythronychia, red bands in the nail from some inflammatory conditions.
Melanonychia, 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.[2][3][4]
Pliability
Brittleness is associated with iron deficiency, thyroid problems,[5] and impaired kidney function.
Unusual thickness is associated with circulation problems.
Shape and texture
Nail clubbing - nails that curve down around the fingertips with nailbeds that bulge is associated with oxygen deprivation and lung, heart, or liver disease.
Small white patches are known as
leukonychia punctata.
Dark nails are associated with B12 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.[6]: 665–6
Treatment
In approximately half of suspected nail fungus cases there is actually no fungal infection, but only some nail dystrophy.[7] Before beginning oral antifungal therapy the health care provider should confirm a fungal infection.[7] Administration of treatment to persons without an infection is
unnecessary health care and causes needless exposure to side effects.[7]
Roberts, D. T.; Taylor, W. D.; Boyle, J.; British Association of Dermatologists (2003). "Guidelines for treatment of onychomycosis". The British Journal of Dermatology. 148 (3): 402–410.
doi:
10.1046/j.1365-2133.2003.05242.x.
PMID12653730.
S2CID33750748.
Mehregan, D. R.; Gee, S. L. (1999). "The cost effectiveness of testing for onychomycosis versus empiric treatment of onychodystrophies with oral antifungal agents". Cutis. 64 (6): 407–410.
PMID10626104.