The Nuts and Bolts of Nail Care

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    NEWSLETTERS

    Not everyone gets a manicure regularly, but experts say nail care is more than an exercise in vanity. Without the proper attention, irritating and sometimes painful problems can develop, including ingrown nails and persistent fungal infections. And nails can sometimes reveal that someone is suffering from an underlying illness.

    Below, Dr. Darryl Haycock, a spokesperson for the American College of Foot and Ankle Surgeons, explains what you need to do to keep your nails healthy.

    What are the different parts of the nail?
    There is the cuticle at the base of the nail and then a whitish area that's called the lunula. Then you have the nail plate itself, which grows out on a nail bed.

    Why do people have nails?
    It's felt that it's an evolutionary leftover. A lot of animals have claws, and nails were a means of allowing people to use their fingers and toes to grab things and hold onto things. Basically it helps stabilize the end of the finger or toe.

    What should a healthy nail look like?
    A healthy nail should look smooth. It should look pink in coloration and the white portion near the cuticle should be nice and clear. It shouldn't be excessively thickened. In the drier weather, however, you'll get more cracking and hangnails.

    Are nail problems ever a sign of a medical illness?
    There are a lot of medical illnesses that are diagnosed through the fingernails or toenails. These include nutritional problems, such as calcium and protein deficiencies, and diseases like psoriasis, which can cause a pitted look and white discoloration.

    Another problem may be lichen planus, which is basically a thickening of the skin. White spots under the nail are usually due to some kind of trauma, or injury. Sometimes you can even see a malignant melanoma, a type of skin cancer, as a black discoloration underneath a nail. However, that doesn't mean that every black discoloration is a cancer; sometimes those are just normal changes in the nail color.

    What causes ingrown nails?
    Ingrown nails have a number of different causes. Some people have a lot of thick skin around the nail itself, and it's hard for the nail to grow out through it. Some people have nails, particularly toenails, that become curved, almost like an old covered wagon that buckles around and pinches in. Trauma such as having the nail stepped on can also cause ingrown nails by putting pressure on the nail and forcing it to grow into the skin. This causes a cut between the side of the nail and the skin, which can become infected and irritated.

    Trimming the nails poorly can cause ingrown nails. Teenagers are particularly prone to ingrown nails. It seems that teenagers who are going through a rapid growth spurt also have faster-growing nails, so they need to cut them more often.

    How can you prevent and treat ingrown nails?
    Always cut your nails properly. It's recommended that you go straight across. If you prefer to cut in a curved fashion on the corners, you can do that, but you have to be aware that you have to frequently trim them. Be careful not to pull any thickened skin that may grow in the corner of the nails but to clip it. If you get a cut in the side of your nail as you're doing that, it's important to disinfect that area. Put an antibiotic ointment on there to keep it nice and moist, and to give it a chance to heal up. If it does become infected, then it's probably going to be best to see your podiatrist or dermatologist.

    What about blood under the nail?
    Blood underneath the nail is usually from a trauma, such as if someone drops something or crushes or pinches their finger or toe.

    People can have shoes that are too short or too small for them, so when they walk or run, the toenail is continually driven into the end of the shoe. This is what doctors call microtrauma; the toenail can either come off completely or it can cause a build up of blood underneath that toenail. "We see it a lot in soccer players and distance runners," says Haycock. "It is also common in ballet dancers who wear pointe shoes. Likewise, typists who have long nails may have problems with their fingernails from constantly hitting the keys."

    If the area with the blood clot is painful, doctors will try to relieve the pressure by drilling a hole in the nail and allowing the blood underneath the nail to come out.

    How do you identify and treat nail fungus?
    It can start in several different ways, but typically it appears as a yellow, brownish discoloration of the nail. It usually starts at the end of the nail, then works its way back. It makes the nail thick, yellow, crumbly. Sometimes you'll see yellow streaks on the nail as the fungus progresses.

    Nail fungus tends to be resistant to cure with most topical ointments and creams. The only one that's been approved by the Food and Drug Administration is ciclopirox, a nail polish-like material that is brushed on. There are also oral medications, or, if the nail has been completely deformed or thickened or is painful, it will sometimes be removed.

    Is it possible to get a fungal infection from a manicure or pedicure?
    If someone has a manicure or pedicure from an establishment that does not properly clean instruments a fungus could spread from person to person.

    What should proper nail care involve?
    Examine your nails and frequently trim them. If they get too long, they can cause a number of other problems from being torn to being completely lifted off because the nail catches on something.

    Don't push the cuticle back all the time. The cuticle is actually a nice barrier that keeps infection from coming into the nail. You might need to slide it back a little bit, but you have to be careful about pushing it too hard.

    As far as putting anything onto the nails, it's tough to say whether that has a real benefit. "I know some people have a natural split in their nails," says Haycock, "and they'll put superglue in that split and that seems to help keep that from splitting farther and causing more problems."

    Nail polish does strengthen the nails a bit and doesn't seem to create problems. But if you put on too much, it will stain your nails. And nail polish covers up your ability to see your nails and see if they're healthy. Nail polish remover may dry the nails.

    When should someone go to the doctor?
    If they have any concerns about their toenails or their fingernails. If they see something that just doesn't look right such as a dark discoloration. If they've had a trauma to their nail. If they have an ingrown nail; sometimes doctors see people come in with some serious infections because they waited too long to come in. It's best to get on the road to recovery as soon as possible, so that you can have a healthy nail and not have to worry about it.