STUBBORN NAIL PROBLEMS CAN IMPROVE FROM PROPER DIAGNOSIS,
TREATMENT BY DERMATOLOGISTS
Brittle nails, nail fungus and problems from nail cosmetics
are among the most common complaints
CHICAGO (July 30, 2008) – For many of us, the health of our nails is something
we often take for granted. That is until something goes wrong and changes the
appearance or texture of the nails. Dermatologists, who are the physician
experts in the care of skin, hair and nails, find that brittle nails, nail fungus and
problems from nail cosmetics are among the most common sources of nail
disorders. Help can be found by seeking proper diagnosis and starting a proven
treatment regimen, which can include medications and behavioral changes.
At the American Academy of Dermatology’s Summer Academy Meeting
2008 in Chicago, dermatologist C. Ralph Daniel, MD, FAAD, clinical professor of
dermatology at the University of Mississippi in Jackson, Miss., and clinical
associate professor of dermatology at the University of Alabama in Birmingham,
Ala., discussed these common nail complaints and how to recognize when a
problem requires medical intervention.
Brittle nails are a common nail problem frequently seen by dermatologists
in their practices. While it is rare for an internal illness or a drug to cause brittle
nails, the primary cause is typically environmental. Dr. Daniel explained that
there are two types of brittle nails – hard and brittle nails, and soft and brittle
Hard and brittle nails are caused by too little moisture, with older people
more prone to this condition. This type of brittle nails can make nails feel dry,
and chipping or flaking commonly occurs anywhere on the nail plate. Dry skin
also is common in people with brittle nails, and the condition occurs more
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frequently in the winter from dry heat used to warm the indoors and in very dry
climates with little humidity, such as Arizona.
At the other end of the spectrum, soft and brittle nails are thought to be
caused by too much moisture and can affect people of any age. However, soft
and brittle nails are more common in young people, particularly those who wash
their hands frequently – including medical professionals and chefs. While soft
and brittle nails don’t feel dry, they tend to layer more at the end of the nail plate
when they chip.
“When we treat brittle nails, we always ask patients if their toenails are
affected as well – and most will say no,” said Dr. Daniel. “This indicates that if
the condition was caused by a lack of something in the body, such as a vitamin
or mineral, it also would cause brittleness in the toenails. For that reason,
dermatologists believe brittle nails are the result of contact with the environment,
particularly work environments due to contact with water, or low or high
Typically, hard and brittle nails are treated by adding moisture to the nails;
whereas patients with soft and brittle nails need to reduce the amount of moisture
that comes in contact with their hands. For example, Dr. Daniel recommends
that people with soft and brittle nails who engage in wet work should wear light
cotton gloves under vinyl gloves to keep moisture away from the nails. Latex
gloves are not preferred, because latex is more irritating and causes the hands to
sweat. In general, he said it is a good idea for patients with either type of brittle
nails to wear gloves and avoid irritants.
Fungal infections, known as onychomycosis, comprise approximately half
of all visits to the dermatologist for nail-related problems. Since the infection
occurs under the nail plate or in the nail bed, it can be difficult to treat. Fungal
infections – which can be white, green, yellow or black in color – often cause the
end of the nail to separate from the nail bed, and they may build up under the nail
plate and discolor the nail bed. Because the feet are usually confined in a warm,
moist environment, toenails are more susceptible to fungal infections.
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“We know that the foot acts as a reservoir for fungus that can spread
elsewhere on body, so it is important for dermatologists to treat the source of an
infection and check the toenails and bottom of the foot when a fungus is present,”
said Dr. Daniel. “Patients who have had trauma to a nail also are more
susceptible to nail fungus, as the trauma can serve as a pre-disposing event.”
Dr. Daniel added that psoriasis patients are prone to developing nail
fungus. In fact, one study found that the occurrence of nail fungus was 56
percent greater in patients with psoriasis than in non-psoriatic patients. Men with
psoriasis also were two-and-a-half times more likely to have nail fungus than
women with psoriasis. Dermatologists find that while medications traditionally
used to treat nail fungus work for psoriatic patients affected by this infection,
these medications will not improve the underlying psoriasis.
Nail fungus can be difficult to treat, but most cases improve with the use of
available prescription topical medications. Experimental treatments for nail
fungus include photodynamic therapy (PDT) and new topical treatments, and
studies are currently being done with nanoparticles.
Side Effects of Nail Cosmetics
Nail cosmetics, used to enhance the appearance of nails, also can be a
source of potential problems. Though not common, allergic reactions and
infections from nail cosmetics used at home or at nail salons pose serious health
For example, Dr. Daniel reported that most of the problems associated
with nail salons are from the use of acrylic glues to hold artificial nails in place,
which can cause pain, redness, itching or scaling. Although the U.S. Food and
Drug Administration (FDA) banned the use of methyl acrylics, there are still
instances of these types of nails being used at some salons despite their known
In addition, some of the ingredients in nail polishes and polish removers
can cause allergic reactions. Free formaldehyde, which means it is not bound to
another substance, also is banned by the FDA as a nail hardener because it can
cause itching, redness or even blisters. Dr. Daniel also advised that consumers
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use nail polish remover with acetates rather than acetones, which are more
drying and irritating.
To decrease the chance of contracting an infection at nail salons, Dr.
Daniel recommended these tips:
• Don’t use the instruments at nail salons – bring your own instruments
• If you don’t own your own instruments, buy a pack of disposable
instruments at the nail salon that are only intended for one-time use.
• If you must use the reusable instruments at a nail salon, make sure
they are sterilized properly in an autoclave. If not, find another salon.
“To ensure that your nails are strong and healthy, it is important to take
care of them properly and not subject them to harsh environmental conditions or
unnecessary hazards in an attempt to improve their appearance,” said Dr.
Daniel. “Oftentimes, changes in our nails can signal a serious underlying health
problem. In a sense, dermatologists act as detectives who can diagnose a
variety of health problems from clues they observe in the nails. So, see your
dermatologist if you notice any abnormalities or have any concerns about the
health of your nails.”
Headquartered in Schaumburg, Ill., the American Academy of
Dermatology (Academy), founded in 1938, is the largest, most influential, and
most representative of all dermatologic associations. With a membership of
more than 15,000 physicians worldwide, the Academy is committed to:
advancing the diagnosis and medical, surgical and cosmetic treatment of the
skin, hair and nails; advocating high standards in clinical practice, education, and
research in dermatology; and supporting and enhancing patient care for a lifetime
of healthier skin, hair and nails. For more information, contact the Academy at
1-888-462-DERM (3376) or www.aad.org.
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