Your fingernails and toenails do more than just complete your look. They’re also a window into your overall health.
Changes in your nails can be a sign of something going on inside your body, from a simple infection to a more serious systemic disease. They can even be a sign of malignancy.
Nail disorders are surprisingly common and can significantly impact your daily life. So, it’s important to pay attention to your nails and know what to look for.
Here’s a look at 14 nail disorders you should know about:
- Brittle nail syndrome
- Onychomycosis (nail fungus)
- Paronychia (nail infection)
- Nail psoriasis
- Longitudinal melanonychia (dark stripes on the nail)
- Beau’s lines (horizontal grooves)
- Onychomadesis (nail shedding)
- Retronychia (ingrown nail)
- Onychogryphosis (thickened, curved nails)
- Ingrown toenails
- Onycholysis (nail separation)
- Onychoschizia (nail splitting)
- Ram’s horn nails
- Onychocryptosis (another term for ingrown toenails)
Brittle Nail Syndrome
What it is
Brittle nail syndrome means your nails are fragile and break, crack, split, or peel easily. It’s a pretty common problem, affecting up to 20 percent of people. Women are twice as likely to have it as men.
What causes it
There are two kinds of brittle nail syndrome:
- Idiopathic brittle nails. That just means doctors can’t figure out what’s causing your nails to be brittle.
- Secondary brittle nails. In this case, the brittleness has an underlying cause, such as a health condition or something in your environment. For example, thyroid problems, iron deficiency, or exposure to harsh chemicals can make your nails brittle.
How to treat it
There are a few things you can do to help your brittle nails:
- Wear gloves when you’re washing dishes or using chemical solvents.
- Keep your nails short.
- Moisturize your nails regularly.
If an underlying condition is the culprit, treating that condition can help your nails. You might also consider taking biotin supplements.
Onychomycosis
Onychomycosis is the medical term for a fungal infection of the nail. It’s the most common nail disorder, affecting about 5.5% of people worldwide. It’s important to differentiate this from other conditions that may affect the nail, such as dry toenails. In fact, onychomycosis is responsible for about half of all nail disorders that doctors see.
As you might expect, onychomycosis is more common in older people. About 20% of people over 60 have this type of infection.
Symptoms of onychomycosis
There are several types of onychomycosis:
- Distal subungual onychomycosis (DSO)
- Proximal subungual onychomycosis (PSO)
- White superficial onychomycosis (WSO)
- Total dystrophic onychomycosis (TDO)
The symptoms of each type vary, but most people with onychomycosis have:
- Thickened nails
- Discolored nails
- Nails that break or crumble easily
- Separation of the nail from the nail bed (called onycholysis)
Diagnosing and treating onychomycosis
Doctors may use a dermoscope to examine the nail, which can help them make a diagnosis. They may also perform a KOH examination, fungal culture, or PCR testing to identify the specific type of fungus causing the infection.
Once the diagnosis is confirmed, treatment options include:
- Topical antifungal medications, applied directly to the nail
- Oral antifungal medications, taken by mouth
If you’re an older adult, your doctor will likely want to monitor your lab values before and during antifungal treatment to ensure your health and safety.
Paronychia
Paronychia is an infection of your nail folds, or the skin that surrounds your nail. It can be caused by bacteria, yeast, or fungus.
Types of paronychia
There are three main types of paronychia:
- Acute paronychia. This type comes on suddenly and is usually caused by a bacterial infection. If you have acute paronychia, you’ll probably notice swelling, pain, redness, and maybe even pus around your nail.
- Chronic paronychia. This type develops over time and is often caused by a yeast or fungal infection. It’s also linked to frequent exposure to irritating chemicals.
- Chemotherapy-associated paronychia. This is a subtype of paronychia that is related to cancer treatments.
Treatment for paronychia
The right treatment for paronychia will depend on the type of infection you have. Here’s what your doctor might recommend:
- Acute paronychia. Antibiotics are usually prescribed to fight the bacterial infection. If you have an abscess, your doctor may need to drain it.
- Chronic paronychia. Antifungal medications that you put directly on your skin can help clear up the infection. You should also try to avoid irritants and keep the area dry.
Nail Psoriasis
If you have psoriasis, you’re not alone: about 3.2 percent of adults in the U.S. have this skin condition.
Psoriasis can cause a variety of symptoms on the skin, but did you know it can also affect your nails?
Nail psoriasis is very common. It affects roughly 50 to 79 percent of people who also have psoriasis on their skin. In fact, 90 percent of people with psoriasis will experience nail symptoms at some point in their lives. Sometimes, nail psoriasis shows up about 10 years after skin psoriasis does.
Clinical Presentations
When psoriasis affects the nails, you may notice:
- Nail pitting (small dents in the nail)
- Onycholysis (when the nail plate separates from the nail bed)
- Discoloration of the nail
- Subungual hyperkeratosis (a buildup of material under the nail)
Treatment
If you think you have nail psoriasis, talk to your doctor or a dermatologist. They may recommend:
- Topical treatments like corticosteroids or vitamin D analogs
- Systemic treatments, such as biologics or DMARDs (disease-modifying antirheumatic drugs)
- Injections
Longitudinal melanonychia
Longitudinal melanonychia (LM) sounds like a mouthful, but it simply refers to a dark streak that runs up and down your nail, from the cuticle to the tip. For more in-depth information, see this article about black lines on nails.
Causes of LM
Sometimes, the cause is non-melanocytic. In other words, it isn’t related to the cells that create pigment. Non-melanocytic causes of LM include:
- trauma
- certain medications
- systemic diseases
Other times, the cause is melanocytic. This means it has to do with melanocytes, the pigment-producing cells in your body. Melanocytic causes can be:
- melanocytic activation (when melanocytes start producing more pigment)
- melanocytic hyperplasia (when there are more melanocytes than normal)
- subungual melanoma (a rare but serious form of skin cancer that occurs under the nail)
Diagnosis and management
Because longitudinal melanonychia can be a sign of subungual melanoma, it’s important to get it checked out by a dermatologist.
To diagnose the cause of LM, your doctor may use:
- dermoscopy (a special magnifying tool used to examine the skin and nails)
- biopsy (removing a small piece of tissue for examination under a microscope)
If you have LM, your doctor will likely refer you to a dermatologist for evaluation. They can determine the cause of the streak and recommend the appropriate treatment.
Beau’s lines, onychomadesis, and retronychia
Beau’s lines, onychomadesis, and retronychia have a few things in common: They’re all nail disorders, and they all stem from some insult to the nail matrix.
Beau’s Lines
Beau’s lines appear as horizontal grooves in the nail plate. They’re caused by a temporary interruption of nail growth. Something has interrupted the nail’s production process.
Onychomadesis
Onychomadesis is when the nail plate separates and sheds from the proximal nail fold. It’s often thought of as a more severe form of Beau’s lines.
Retronychia
Retronychia is an ingrown nail of the proximal nail fold. It’s often caused by some kind of trauma to the nail.
Diagnosis and treatment
Your doctor can typically diagnose these conditions with a clinical examination of your nails.
Treatment usually involves identifying and removing whatever insult has affected the nail matrix. You’ll also need to avoid any trauma to your nails and keep them free from irritants.
Onychogryphosis
Onychogryphosis is a nail disorder that causes the nails to thicken, curve, and grow excessively. The nails often end up looking like a ram’s horn.
What causes onychogryphosis?
Onychogryphosis is often caused by trauma, neglect, or age-related changes.
Symptoms of onychogryphosis
The primary symptom of onychogryphosis is a thickened, curved, and yellowed nail.
Additional symptoms can include pain and difficulty wearing shoes.
How to treat onychogryphosis
Conservative treatments, like regular nail trimming and filing, can help manage the condition.
Medical interventions, like mechanical or electric nail debridement, may also be necessary.
Ingrown toenails (onychocryptosis)
Ingrown toenails happen when the nail grows into the skin around it, rather than over it.
The most common causes of ingrown toenails include:
- Cutting your toenails too short or at an angle
- Wearing shoes that fit too tightly
- Having a genetic predisposition that makes ingrown toenails more likely
If you have an ingrown toenail, you may experience pain, redness, swelling, and infection.
Treatments for ingrown toenails range from home care to medical interventions. You can try:
- Soaking your foot in warm water
- Keeping your foot dry
If those treatments don’t help, a doctor can prescribe antibiotics to treat the infection or perform partial or complete removal of the affected nail.
Onycholysis
What it is and what causes it
Onycholysis is when the nail plate separates from the nail bed. For information on fixing the underlying damage, read more about how to fix a damaged toenail bed. It can be caused by:
- An injury to the nail
- A fungal infection
- Psoriasis
- Certain medications
Symptoms
The most common symptom is a white or yellowish tint to the part of the nail that’s separated from the nail bed.
Treatment
If you think you have onycholysis, it’s important to see a doctor or other health professional to figure out what’s causing it. For example, if the cause is a fungal infection or psoriasis, you’ll need treatment for that.
You can protect the nail by keeping it short and dry and avoiding repeated exposure to water.
In Summary
We’ve covered a lot of ground in this article, exploring conditions like onychomycosis (nail fungus), paronychia (nail infection), onycholysis (nail separation), subungual hematoma (blood under the nail), ingrown nails, nail psoriasis, clubbing, koilonychia (spoon nails), Beau’s lines, leukonychia (white spots), yellow nail syndrome, melanonychia (dark stripes), onychogryphosis (thickened nails), and habit-tic deformity.
The appearance of your nails can indicate underlying problems, so it’s important to pay attention to changes. Early diagnosis and treatment can improve your outcome and prevent complications. If you notice changes in your nails, don’t hesitate to seek medical attention.
Taking good care of your nails is an important part of your overall well-being. Proper nail care and regular self-exams can help you spot problems early and keep your nails healthy.