Nails, composed primarily of keratin, serve as protective coverings for the distal phalanges and often reflect systemic health. Nail problems can arise from local trauma, infections, dermatological conditions, nutritional deficiencies, or systemic diseases. They may affect fingernails, toenails, or both, presenting with changes in color, texture, thickness, growth, or shape.
Common Causes of Nail Problems
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Infections
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Fungal infections (onychomycosis) – Nails become thickened, brittle, yellow or brown, and crumbly.
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Bacterial infections (paronychia, pseudomonas) – Surrounding skin becomes red, swollen, tender; nail may develop greenish discoloration.
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Viral warts (periungual warts) – Rough, raised lesions around nail folds.
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Trauma and External Factors
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Repeated injury (tight shoes, nail biting, or manicures) can cause ridges, splits, or bruising.
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Chemical exposure (detergents, nail polish removers, occupational solvents).
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Dermatological Conditions
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Psoriasis – Pitting, nail separation (onycholysis), yellow-brown “oil spots.”
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Eczema/dermatitis – Rough, brittle nails.
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Lichen planus – Nail thinning, ridging, and possible permanent nail loss.
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Nutritional Deficiencies
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Iron deficiency (anemia) – Spoon-shaped nails (koilonychia).
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Zinc or protein deficiency – White spots, delayed nail growth.
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Vitamin B12 deficiency – Dark pigmentation or bluish nails.
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Systemic Diseases
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Thyroid disorders – Brittle, thin nails (hyperthyroidism) or slow-growing nails (hypothyroidism).
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Lung disease – Clubbing of nails.
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Liver disease – White nails (Terry’s nails).
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Kidney disease – Half-and-half nails (Lindsay’s nails).
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Aging
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Nails naturally thicken, become brittle, and grow more slowly with age.
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Symptoms Suggesting Nail Problems
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Discoloration (yellow, brown, white, green, or black).
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Abnormal shapes (spoon-shaped, clubbing, ridges).
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Brittle, splitting, or crumbling nails.
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Pain, swelling, or tenderness around nails.
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Detachment of the nail from the nail bed (onycholysis).
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Slow or absent nail growth.
Diagnosis
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Clinical examination of nail and surrounding skin.
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Nail clipping or scraping for fungal culture/microscopy.
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Blood tests to assess for systemic conditions (e.g., thyroid, liver, kidney, anemia).
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Biopsy if malignancy or rare dermatosis is suspected.
Treatment Options
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General Care
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Keep nails trimmed, clean, and dry.
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Avoid harsh chemicals and frequent nail polish use.
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Wear well-fitting shoes and protective gloves when necessary.
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Medications
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Antifungals
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Topical: Ciclopirox, Amorolfine
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Oral: Terbinafine, Itraconazole, Fluconazole (used for severe fungal infections; doses vary by drug and duration 6–12 weeks or longer for toenails).
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Antibacterials
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Topical mupirocin or fusidic acid for paronychia.
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Oral antibiotics (e.g., flucloxacillin, cephalexin) for severe bacterial infections.
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Anti-inflammatory/Immunosuppressants
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Topical corticosteroids for inflammatory dermatoses.
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Systemic agents (methotrexate, cyclosporine, biologics) for psoriasis/lichen planus if severe.
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Vitamin/Mineral supplementation
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Iron, zinc, biotin, vitamin B12 if deficiencies are confirmed.
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Procedures
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Nail debridement (removing diseased nail tissue).
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Chemical or surgical nail avulsion in severe cases.
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Laser therapy for fungal infections (adjunctive).
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Precautions
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Avoid nail-biting and aggressive manicures.
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Keep feet dry and change socks daily to prevent fungal infections.
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Disinfect nail tools before use.
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Seek medical advice for persistent nail changes, pain, or swelling.
Drug Interactions
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Oral antifungals (terbinafine, itraconazole, fluconazole) interact with:
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Warfarin (increased bleeding risk).
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Statins (risk of muscle toxicity).
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Certain antidepressants and antiarrhythmics (QT prolongation with azoles).
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Corticosteroids (topical/systemic) may interact with immunosuppressants, increasing infection risk.
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Methotrexate + NSAIDs may increase toxicity risk if used for nail psoriasis.
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