Nails are the horny tissue on the outside of the fingertips, made up of keratin protein. Nails contribute physically to the functioning of the hands and feet and are also a part of the aesthetic appearance of the hands and feet. Just like other organs and tissues, some disorders and diseases can sometimes be encountered in nails. A healthy nail has the appearance of a light-colored, almost transparent, smooth plate with a regular placement on the pinkish nail bed at the fingertip. Changes observed in the appearance, shape, color and thickness of the nail indicate that there is a disorder in the nail.

What Causes Nail Disorders?

The main factors that cause nail disorders and diseases are fungal infections, psoriasis, hygienic care errors, heavy pressure and strain, side effects of medications and mineral deficiencies. White, yellow and brown color changes in the nail are often a symptom of fungal infection. Fungal infections in nails can be transmitted from person to person through the shared use of items such as slippers and shoes, and through non-sterile manicure and pedicure tools. Fungal infections can settle in the nail more easily with a blow to the nail area and an open wound.

The red and black color of the nail can be a sign of bleeding inside the nail. Inflammation (inflammation) around the nail is also bacterial, causing redness, swelling and pain around the nail and when it progresses, it forms an abscess. In the case of ingrown nails, the nail's inability to grow outwards and moving inwards can cause pain and inflammation. Ingrown nails are encountered especially in the big toes due to incorrect and very short cutting of the nails and incorrect shoe selection. Dullness, dryness and weakness in the nails can occur in cases such as deficiency of minerals such as magnesium, calcium, iron and zinc in the body.

The main factors that cause nail disorders and diseases are fungal infections, psoriasis, hygienic care errors, heavy pressure and strain, side effects of medications and mineral deficiencies.

How Are Nail Disorders Treated?

The first step in the treatment of nail disorders is to correctly determine the cause of the nail deterioration by examining the appearance, shape, color and thickness of the nail deterioration. Nail disorders can usually be detected during the examination, and if necessary, a culture taken from the nail can be examined in a laboratory environment. Laboratory examinations provide clearer results regarding whether there is a fungal infection in the nail and, if present, provide information about the type of fungal infection. Depending on the characteristics of the nail disorders detected, a dermatologist can offer different treatment alternatives to the patient. After the diagnosis is made regarding the nail deterioration, oral medications, polishes applied to the nail and medications can be used depending on the cause of the disease. Treatment of diseases related to nail deterioration can be long-term since the nail tissue needs to renew itself. Fractional laser systems, which have been frequently used in the field of aesthetic dermatology in recent years, are another method observed to be beneficial in the treatment of nail disorders. With fractional laser systems operating with CO2 rays, the upper part of the areas where the nail disorders are located is peeled off with heat and a healing effect can be provided for unhealthy tissues by creating renewal in the tissue.

Nail Findings in Systemic Diseases

Clubbed finger (Drumstick finger)

It occurs with an increase in the curvature of the nail and thickening and expansion of the soft tissue around it. The nail resembles a watch glass. It is most often associated with chronic lung diseases. It can also be seen in heart, liver or thyroid diseases. If it is seen together in the hands and feet, congenital heart diseases should be considered. Unilateral clubbing is observed in neurological or vascular diseases.

Spoon nails (koilonychia)

It is the spoon-shaped formation of the nail plate. It is derived from the Greek word koilos, meaning "sink-pit". It is normal to see it especially in the big toe nail in children, it returns to normal within a few years. The thumbs are most commonly affected, and in adults it is most commonly seen in iron deficiency anemia. In addition, it can also be seen in fungal infections, diabetes, lupus, and thyroid diseases. Occupational contact with mineral oils and perm solutions in hairdressers can be listed among the causes.

Beau Lines

They are transverse depressions that occur in the nail. They occur in more than one nail or in all nails due to a disease that is severe enough to affect the nail's growth. They are less common in toenails due to their slow growth. They can be caused by various infections, medications, and autoimmune diseases.

White Strips on Nails

It can be seen in liver cirrhosis, chronic congestive heart failure, and adult-onset diabetes. A 1-2 mm band of whiteness on the free edge of the nail can be a common symptom of cirrhosis, while whiteness at the base of the nail can be a symptom of chronic kidney disease. Spot whiteness can also be seen due to minor trauma (such as manicures).

Muehrcke Tapes

It is seen as thin, white horizontal lines on the fingernails. It is an important finding of hypoalbuminemia, nails improve when albumin levels return to normal. Although it is most commonly seen in nephrotic syndrome, it can also be seen in other diseases that cause hypoalbuminemia. It can also be encountered as a side effect of antineoplastic drugs.

Yellow Nail Syndrome

Fingernails and toenails may appear hard, curved, and yellow-green. It has been described with lymphedema and pleural effusion. 20 nails may be involved, and nail growth is slowed.

Melanonisi

It is characterized by longitudinal dark lines. It can be seen in drugs, Addison's disease, AIDS, hyperthyroidism, folic acid deficiency, vitamin B12 deficiency, and Cushing's syndrome.

Nail Infections

Nail fungus (onychomycosis: onycho: nail and mycosis: fungus). Nail fungus can be caused by several fungal elements.

Nail Fungus

1-It is formed by fungal elements called dermatophytes. It is negatively affected by humidity.

2- It can be caused by yeast (Candida albicans) fungi.

3- It can be caused by mold fungi, it is rare

Diabetes and weakened immune systems can lead to fungal infections. Fungal spores live for a long time in items such as towels, swimsuits, slippers, and sun loungers used during bathing and swimming. It can be transmitted from places such as swimming pools, showers, saunas, fitness centers, and changing rooms.

If one member of the family contracts nail fungus, the other family members are more likely to get the infection. Therefore, it is necessary to be careful.

Nails become thicker, appear yellow and dull, and become more brittle due to fungus.

Peripheral Nail Disorders

Nail edge inflammation (inflammation): It is the inflammation of the soft tissue around the nail. Inflammation is usually seen around fingernails, but it can also be seen in toenails. The most common factors are usually splinters or thorns, nail biting, finger sucking, nail picking, unhygienic and/or incorrect manicure practices and frequent contact with water.

In addition to bacteria, viruses and fungi can also cause whitlow. The reproduction of these bacteria is easier in diabetics and those with vascular diseases that cause circulatory disorders. Dishwashers, cleaners, those who frequently come into contact with chemicals, cooks, fishermen, those who wash their hands frequently, and swimmers are more prone to it due to the nature of their jobs.

Around the nail swelling, redness occurs. Sometimes purulent discharge is added to the picture and can spread to other fingers.

Since the nail is left unprotected and damaged due to inflammation of the edge, thinning and breaking of the nail may be observed. Nail edge inflammation can also be seen in psoriasis and allergic skin diseases. In such cases, the dermatologist makes differential diagnoses of the diseases and, if necessary, performs examinations and arranges treatment.

Ingrown toenail: It is a condition that occurs as a result of a hard nail getting stuck in the soft tissue and is usually chronic. It is frequently seen on the first toe of the foot. Tight, unsuitable shoes-slippers, incorrect nail cutting, weight, pregnancy, chronic irritation caused by impacts, genetic predisposition are important reasons.

In mild, newly developing cases, no surgical procedure is required. After the necessary applications are made around the nail, attaching wire may be sufficient. In advanced cases, treatment methods such as removing the abnormal tissue developing at the edge of the nail, destroying the nail root to prevent ingrowing at the same place, or cutting and removing a part of the nail are applied. There will be no permanent solution unless the edematous tissue at the edge of the nail is treated.

Nails in Dermatological Diseases

Nail psoriasis: Nail psoriasis is a common nail disorder among skin diseases.

There may be pits, white spots/dots, yellow oil drop-like spots on the nail surface, thickening under the nail, and brittleness.

Nail psoriasis can easily be confused with fungal infections of the nail.

Lichen planus: Thinning of the nail, loss of volume, splitting, ridges, longitudinal lines, nail loss, tissue extension from the base of the nail to the top of the nail in the form of a wing may be observed. Nail thickening is less common.

Twenty nail dystrophy: (sandpaper nails) It appears as nail coarsening due to excessive vertical ridges. Nails are dull, thin, and dull. It has a sandpaper-sanded appearance. Many nails are affected, more common in children. It can be seen with regional hair loss.

Drug-Induced Nail Anomalies

Most or all of the nails may be affected. It is characterized by striations, separation of the nail from the nail bed, blue-black bands, and redness in the soft tissue around the nail. Cancer drugs, tetracyclines, and blood thinners may be the cause.

Suspicion of Melanoma in the Nail

It is usually seen after the age of 50, and is characterized by brown-black vertical bands wider than 3 mm. It is most commonly seen on the thumb. These colored bands extend to the soft tissue at the base and sides of the nail. The presence of atypical moles in the family should be questioned.