Lifestyle Choices

Finger nails take three to six months to grow and toe nails twelve to twenty-four months. Nail is made of keratin in much the same way as skin and hair. The visible part is quite inert and not much happens to it at that stage. The growing section lies mainly under the skin and the only part that can be seen is the half moon. Any disease which affects the matrix, as the growing area is called, may produce a variety of changes.

Nails may alter as a result of an internal disease. Iron deficiency, for example, leads to flat nails and liver disease may produce white nails. Some medications produce discoloration. Pits, like those on a thimble, sometimes occur in psoriasis and ridges and depressions may be a feature of eczema.

Brittle Nails

There are many minor variations in nails which cannot be classified as diseases. In some people there is a tendency to splitting. The split may be wafer-like at the free edge of the nail or run longitudinally. Undoubtedly there is an inherited factor in some cases of fragile or brittle nails but it is usually an isolated problem. Whatever the cause it becomes worse after repeated wetting of the nails, so housewives are particularly prone to the problem. Some varnishes can damage the top layers of nail as can varnish removers. The best remedy is to wear rubber gloves over light cotton glove liners when in contact with water. Treatment with calcium, iron and vitamin E is often recommended but we do not see consistently good results.

Thick, Hard Toenails

Huge, thick, yellowy toenails may slowly appear in some elderly people. Occasionally a curly horn-like shape may be seen. These nails become impossible to cut and even chiropodists may have difficulty dealing with them. Older people may find they cannot reach their toes to cut them or poor eyesight makes it hazardous to try. Repeated damage to the nail over a lifetime and poor circulation are two factors that contribute to this condition.

Ingrowing Toenails

This is usually only a problem of the big toenails but it may cause misery over a long period of time and seriously interfere with training in athletes. It is unusual before ten and after twenty-five years of age and is never seen in races who walk barefoot. Ill-fitting shoes play a part and `winkle pickers’ were great offenders.

There are various ways of dealing more permanently with the problem. After numbing the toe with local anesthetic a strip of nail can be removed from each side, thus taking the pressure off the inflamed area. A further small operation to remove the matrix at each side will make sure that the nail never regrows.

Infection

Considering the amount of wear and tear which our fingers are exposed to, it is little wonder that the system fails at times. When people put their hands in and out of water many times a day the cuticle can be softened. In addition some people pick at their cuticles and damage them in that way. When an infection develops under the cuticle there is pain, swelling and pus seeps out: this is called paronychia. Antibiotics are the best solution in this acute stage. In people who do wet work the problem may become chronic and the skin surrounding the nail becomes permanently red, swollen and tender. Very often yeast organisms start to grow in the damaged skin and make the problem even more difficult to treat. The hands should be kept warm and dry; wearing cotton gloves under rubber gloves for work is helpful. Suitable creams to kill the yeasts may also be necessary.

Herpes virus, which normally affects the face giving cold sores, may also infect a finger around the nail: it is then called a herpatic whitlow. Swelling and pain, with little blisters, may last for a week or so.

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