What's wrong with my nails?

It’s nice to have healthy nails. Over recent years they have almost become a fashion accessory, but they can also provide an early sign of some medical conditions for which you may have to seek further advice from your doctor.

Nails help with dexterity and provide vital protection to the very sensitive ends of the fingers and toes. Nails are formed from keratin which is a main component of the skin and are constantly renewed by the nail matrix. Healthy nails will grow at a rate of 0.5mm to 1.2mm per week. Even at this rate, a fingernail will take anywhere from six to nine months to renew itself completely, with a toenail taking up to a year.

Although it might seem that the nail is totally waterproof, this is not the case. The nail contains many small air spaces in between the keratin structures and the nail is therefore porous. This is why your nails will soften slightly when you have had a bath. These spaces may become invaded by fungal pathogens which can attack the keratin and de-stabilise the nail structure.

There are a multitude of reasons why your nails may develop imperfections and these fit broadly into three categories:

Physical Reasons, such as trauma to the nail causes by accidents or deliberate chewing of the nails as well as pressure from ill-fitting footwear
Chemicals, such as detergents can cause damage to the nails. Solvents or nail varnish removers can have a serious effect on the proteins of the nail structure
Microbiological reasons such as a fungal infection (called onychomycosis). A nail infection can develop when there has been another fungal infection affecting the local area such as athlete’s foot.

Once you develop any sort of nail imperfection, you have to wait for this to grow out completely and it can often be difficult to disguise a problem nail.

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The first thing that you might notice about your nail is that it has become coloured. If you have a yellow nail or perhaps a brown or white discolouration, you may have a nail infection. These are generally caused by various fungi which can get under your nail and rapidly reproduce within the nail plate. The presence of these pathogens results in the nail becoming de-stabilised and a nail can often become crumbly as the infection takes hold.

An infected nail may often occur when you have had a co-existing fungal infection such as Athlete’s Foot as the two conditions are caused by the same fungal pathogens. As these infections are very common, sports changing room floors or the floors around swimming baths often carry the fungal spores which can be picked up by a innocent passer by to infect the nail.

Anybody can pick up a fungal nail infection, although those who play team sports or those who work out or swim in health centres are more at risk.

Other risk factors include:

Wearing tight footwear that does not allow the feet to breathe
Some medical conditions such as diabetes. These infections should be treated by a physician as soon as they are noticed or they could spread rapidly.

Fungal nail infections are not the only the only conditions to affect the nails. Various splits and pitting of the nails may occur due to the nails being too dry, maybe as a result of damage caused by chemicals or trauma. Here are some pictures of nails which have been affected in this way:

This is the type of ‘pitting’ of the nail which may occur if you suffer with psoriasis. More than 50% of psoriasis patients will have their nails affected in this way
You don’t necessarily have to expose your nails to detergents or aggressive solvents to cause damage to your nails. Repeated washing and drying of the nails with just water can result in what is known as ‘lamellar’ splitting of the nails as per the picture below. The nails are up to 1000 times more permeable to water than the skin and the more that nails are exposed to water, the greater potential there is to damage them. This is a condition which commonly affects swimmers and those involved in the catering and medical professions due to the need for frequent hand washing. Indeed, this is a condition which affects between 27 and 35% of the adult female population.
Another effect of excessive washing of the nails or damage by chemicals may be the appearance of longitudinal ridges on the nails as pictured below.

Types of Nail Infection

The most common form of nail infection is the type that gets in under the free end of the nail or down the lateral seal by the side of the nail. This means that the nail is often attacked from underneath and an infection takes hold. This is known medically as ‘Distal Lateral Subungual Onychomycosis’ (phew!) We’ll just refer to it as DLSO then!

The more serious nail infections are those which affect the nail matrix, where the nails grow from. You will notice a whitening of the nail with the new nail growth and this will grow down towards the free end of the nail if left untreated. It is important to get treatment from a physician for this as nothing that you can purchase will be able to effectively treat an infection in the nail matrix. This is known as ‘Proximal Subungual Onychomycosis’ (PSO)
If the nail infection really takes hold, or is left for a long period of time, total nail destruction may occur. This is known as Total Dystrophic Onychomycosis (TDO). Again, brush on treatments will be ineffective against this severity of fungal nail and this will require treatment by a physician or podiatrist
There is also another slightly rarer type of fungal nail infection. This one demonstrates the slightly porous nature of the nail in that the offending fungus actually penetrates directly through the nail surface. This is know as Endonyx Onychomycosis (EO) and is its appearance is a milky white clouding of the nail, usually away from the nail edges. This infection is sometimes overlooked because it looks similar to the white mark on the nail sometimes left by a small trauma to the nail.

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