By Enyeribe Ejiogu
Women love their nails to bits. They invest good money, to ensure that their nails look great, appealing and “swaggalicious” at all times. And if the natural nails are not exactly of the shape and look that can be given excellent manicure attention, they often attach artificial nails on top of the natural nails – all in the bid to be fashionable.
Now, consider other women, whose nails look mottled, rough and unsightly. Such nails may be discoloured and darker in shade more than the other nails, either on the fingers or toes. However, it is not just women who may have these kinds of nails – men also have them, whether on the fingers or toes.
Most problems of the nails of the fingers or toes are the result of fungal infection, which is known in medicine as distal subungual onychomycosis (DSO). It is caused by the same fungi that cause most cases of athlete’s foot (dermatophytes). It begins as a white or yellow-brown spot under the tip of your fingernail or toenail. As the fungal infection goes deeper, the nail may discolour, thicken and crumble at the edge. Nail fungus can affect several nails.
Fungal infection of the nails sometimes makes the condition sound contagious or related to poor hygiene. In fact, up to 10 per cent of all adults in the world have fungal infection of the nails. This percentage increases to 20 per cent of adults who are age 60 or older. Toenail fungus is much more common than fingernail fungus.
Beyond fungal infection, some other conditions can cause people to have abnormal-looking nails. There are many other reasons why your nails may look different.
Types of nail problems
Onychomycosis is a fungal infection usually caused by a special type of fungus known as a dermatophyte. Since most of these infections are relatively superficial, it would seem that topical treatments ought to work well. This is not the case because the nail unit is relatively impenetrable.
Examples of conditions that are often mistaken for fungal nails include yellow nails (onycholysis), hematoma, green nails (caused by Pseudomonas bacteria), pitted nails (usually associated with psoriasis), nail infection (paronychia), and previous injury (trauma).
Other nail conditions
Here are some other conditions you may have instead of fungal nails:
Lines and ridges: These are common and may be considered normal. They may worsen during pregnancy. A large groove down the centre of the nail can be caused by nail biting. Some people may develop these changes following chemotherapy.
Senile nails: As you age, the nails become brittle and develop ridges and separation of the nail layers at the end of the nail. To avoid this, try to clean solutions and don›t soak the nails in water.
Whitish or yellowish nails can occur due to onycholysis. This means separation of the nail from the nail bed. The color you see is air beneath the nail. The treatment is to trim the nail short, don’t clean under it, polish if you want to hide the color, and wait two to three months. Persistent onycholysis can make the nails susceptible to fungal infection.
Red or black nails due to a hematoma, or blood under the nail, usually occur from trauma (like whacking yourself on the thumb with a hammer). The discoloured area will grow out with the nail and be trimmed off as you trim your nails. If you have a black spot under your nail that was not caused by trauma, you may want to see a dermatologist or a podiatrist if it involves a toenail to make sure it is not melanoma (a type of skin cancer associated with pigmented cells). A simple biopsy can rule out malignancy (cancer).
Green nails can be caused by Pseudomonas bacteria, which grow under a nail that has partially separated from the nail bed. This infection may cause a foul odour of the nails. The treatment is to trim the nail short every four weeks, don’t clean it, polish if you want to hide the colour, and wait two to three months. It is also advised to avoid soaking the nail in any sort of water (even if inside gloves) and to thoroughly dry the nail after bathing. If the problem continues, there are prescription treatments that your doctor may try.
Pitted nails may be associated with psoriasis or other skin problems that affect the nail matrix, the area under the skin just behind the nail. This is the area from which the nail grows. Nails affected by psoriasis can also be tan in colour.
Swelling and redness of the skin around the nail is called paronychia. This is an infection of the skin at the bottom of the nail (cuticle). If the infection is acute (has a rapid onset), it is usually caused by bacteria. It may respond to warm soaks but will often need to be drained by a doctor. A chronic paronychia occurs when a cuticle becomes inflamed or irritated over time. Sometimes, yeast will take advantage of the damaged skin and infect the area as well. Therapy begins with keeping the skin dry and out of water. If the problem continues, a physician should be consulted. Antibiotics are not often used but may be necessary in severe infection.
Chronic nail trauma, such as repeatedly starting and stopping, kicking, and other athletic endeavours, can cause damage to the nails that can look a lot like fungal nails. This sort of repetitive trauma can also occur with certain types of employment or wearing tight-fitting shoes. Some traumas may cause permanent changes that may mimic the appearance of fungal nails.
Treatment of nail fungal infection
Fungal nail infections typically don’t go away on their own, and the best treatment is usually prescription antifungal pills taken by mouth. In severe cases, a healthcare professional might remove the nail completely. It can take several months to a year for the infection to go away.