Diseases Of The Nail

Fig. 1 Drawing of a normal nail.

Nail Disorders can occur in a number of diseases. Nail disorders may occur alone or associated with rashes.

Common diseases of the nails include :

1. Nail infection by bacteria, fungi, yeast and virus.
2. Paronychia - an infection of the nail fold
3. Nail disorder due to skin disease e.g psoriasis
4. Nail injury

Fig.2 Fungal infection of the nail.

Fig.3 Viral wart infection of the distal nail fold.

The commonest nail infection is fungal nail infection. Fungal nail infection can affect the finger and toe nails.

The infection reaches the nail plate from the free margin and sides of the nails. The nail plate may become brittle, thickened or completely destroyed.

Fungal nail infection can be confirmed by laboratory microscopic examination of clippings of the nail.

Oral antifungal tablets, or antifungal lotion may be prescribed by your doctor for treatment. Treatment may last from 2 to 12 months depending on the type of infection and the oral antifungal tablets prescribed. However, the nail may take as long as a few months to return to near normal appearance even after the treatment has been stopped.

Another common nail disorder is caused by viral wart infection of the nail fold and nail bed. The condition is called periungual viral warts. This condition is best treated by laser surgery.

Fig.4 Paronychia made worse by constant wet work

Paronychia is an inflammation of the nail folds. Nail fold damage usually results from injury to the proximal nail fold. Causes of injury include habit biting and constant wet work. People whose hands are exposed to water most of the time, e.g. housewives, canteen operators, cooks are more prone to develop paronychia.

Secondary infection by bacteria of fungus will cause painful swelling of the nail fold. If the infection had been there for a long time, the nail plate becomes deformed.

Treatment of paronychia include draining pus in the infected nail fold and oral antibiotics. Topical antifungal and antiseptic lotions may be used to treat paronychia. Patients with paronychia must avoid prolonged wet-work and injury to the hands. Wearing of impervious gloves during wet work helps to prevent paronychia.

Fig.5 Psoriasis of nails showing pits and onycholysis.

Nail changes in psoriasis are very varied. They may appear as pits on the nail plate. The nail plate may be separated from the nail bed (onycholysis). The nail may lose its normal luster and appear discoloured. Gross thickening of the nail is another feature of psoriasis. Typical psoriasis rash would often be present on the fingers, toes and elsewhere on the body.

Fig.6 Nail injury.

The nail can be damaged by nail-biting, habit-tic e.g. scratching the nail folds, bad manicuring or industrial accident. Damaged nails may appear ridged or cracked or broken.