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Doctor, what’s wrong with my nails I Dr. Elsade Kruger l Beloved Health

Nail abnormalities on fingers or toes can have many different causes. Normal nails are smooth and have consistent colouring, but there may be changes, particularly as we age. Some changes may be due to injury, or to toxic products coming into regular contact with your hands.  Other changes may be the result of medical conditions that require diagnosis and treatment.

What are the commonest causes of nail abnormalities?

1. Vitamin and mineral deficiency:  

  1. A lack of calcium can cause nails to become thin and brittle. This may also be an indication of bone density problems.  
  • Iron deficiency (anaemia) is one of the things that causes nails to have ridges and be curved inwards. This condition is known as Koilonychia.
  • A lack of zinc, most common in school-age children, causes white spots to appear on the nails. This can be easily fixed with short-term zinc supplements.

d) Malnourishment and lack of zinc in particular can also be the cause of Beau’s Lines, a depression running across the nail. There may be other causes as well, such as an illness that causes a high fever, diabetes, pneumonia or vascular disease.

2. Autoimmune diseases:

  1. Psoriasis causes the “pitting” of nails, sometimes thickening and discoloration.
  • Dusky red half-moons are associated with a number of possible conditions: lupus, heart disease, alopecia areata, arthritis, dermatomyositis.
  • Vasculitis (Inflammation of the blood vessels) affects blood flow to the nailbed and causes blood splinters in the nail.

3. Abnormal growth:

  1. Onychogryphosis (Ram’s Horn nail) – is where trauma to the nailbed causes the nail to grow out unevenly, and to become very hard and thick.

b)  Ingrowing toenails- can lead to infection if left untreated.

4. Onygomicosis (fungal infection):a common condition caused by an overgrowth of fungi that live on the skin. Fungal infections can be spread by skin to skin contact and unsterilised manicure and pedicure equipment.

5. Chronic illnesses like kidney failure can also affect nail growth.

6. Melanoma (skin cancer) can cause dark pigmented spots under nails.

How are nail abnormalities treated?

Depending on the diagnosis, treatment includes:

  • Topical applications such as antifungal creams and nail paints.
  • Oral medication- itraconazole (anti-fungal medicine); immune suppressants for autoimmune diseases.
  • Physical interventions- podiatrists can file and clip toenails; surgeons can partially or totally remove nails.
  • In the case of suspected melanoma, the patient should seek urgent referral to a plastic or general surgeon.

What to look out for

You should seek medical attention if you experience any of the following symptoms:

  • changes in nail shape (curling or clubbing);
  • nails that become brittle;
  • redness or inflammation around nails;
  • thickening or thinning of nails;
  • nails that are pitted;
  • bleeding around nails;
  • discoloration (dark streaks, white streaks, or changes in nail colour);
  • a nail separating from the skin;
  • pain in and around the nail.

Most conditions require fairly straightforward treatment, but the longer the condition exists, the longer it may take to cure or the more complex the treatment may be. Nail abnormalities by themselves do not allow a doctor to diagnose a specific disease, so it is important to get other tests as early as possible if you suspect something is wrong.

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