Nail Conditions

Unusual, discoloured or distorted finger or toenails is a normal ailment affecting people of all ages.

Causes
Nail conditions are usually the result of underlying trauma. Nail issues can be a symptom of other conditions and will be investigated wholly to exclude underlying causes. Skin conditions such as psoriasis, eczema and alopecia areata are commonly associated with common nail problems. Pictured below are how common nail problems may present.

Lifting of the Nail Plate (Onycholysis)
Repeated minor injury to the nail underside is the common root cause of the nail plate's lifting—the nail oxides' risen section and changes from pink to white. Concerning skin conditions, this can also be symptomatic for psoriasis, fungal nail infections (onychomycosis) or water immersion.

​Pitting
Pitting is while small divots in the nail roughly the size of a pinhead. This is usually associated with other skin conditions such as psoriasis, eczema and alopecia areata (hair loss).

​Ridging
Ridging is the vertical or horizontal elevations or depressions in the nail. Vertical ridging is common in older people with repeated nail injury or another condition of lichen planus. Horizontal ridging is caused by interference with the nail bed through biting or picking. It can also appear as a result of episodic paronychia.

Thickening of Nail (Onychogryphosis)
Common in toenails Onychogryphosis is seen in older adults who used long term ill-fitting footwear and/or nail neglect. It is also associated with psoriasis and fungal infections.

Discolouration
Yellow colouring is a result of fungal nail infection (onychomycosis), psoriasis or smoking. In rare conditions, ‘yellow nail syndrome’ can be seen as an underlying disorder affecting the lungs and lymphatics.

Green nails are usually due to a bacterial nail infection (pseudomonas) or an infection due to a yeast called candida. Pseudomonas infection can often affect nails that a common fungal infection or trauma has damaged.

Brown colouring can be caused by medications, chemicals from hair dyes, nail varnish, nicotine, trauma, chemotherapy and antibiotics. In rare conditions, melanomas may present as brown or black pigmentation on or under the nail. It is of high importance to seek medical advice to rule out melanoma in the case of a single brown or black nail.

White (leuconychia) nail colour could be familial or be caused by any medical condition, resulting in low protein levels in the blood.

Inflammation of the Nail Fold (Paronychia)
The nail cuticle's acute infection can cause redness, swelling, tenderness, and pain, in some cases, pus formation. This is commonly a result of over-zealous manicuring or when nails are immersed in water for long periods of time. Occasionally, Paronychia can also be seen in infants who suck their thumbs.

Treatment

Due to the variety of possible conditions, there are many treatment options. Most treatment options are dependant on the underlying cause of the nail disease, as many common conditions symptomatic of other more complex issues. Fungal infections can be diagnosed from a clipping or in some cases a biopsy as determined by your dermatologist.

​While many treatment options will include the diagnosis and treatment of the underlying condition, stand-alone nail diseases can be treated by:
*Topical therapy: antifungal creams may be used to treat infections affecting small parts of the nails.
*Oral therapy: antifungal tablets (e.g. terbinafine, itraconazole, fluconazole) can be used alone or in combination with topical treatments.

Please note treatment options many include many months of topical or oral therapy and may require further testing to determine suitability, please consult with your dermatologist.

To read more about Nail Conditions, its causes and treatment options, DermNetNZ.