Nail-abnormalities

A pincer nail, also called a trumpet nail, is one of four types of an ingrown nail. It is often viewed as the most painful. A couple of factors separate the pincer nail from the classic, more familiar ingrown nail. First, the term “ingrown nails” is often associated with an ingrown toenail, and we may visualize only one side of the big toe being affected. A pincer nail, on the other hand, can form on any nail – fingernail or toenail. Second, by definition, a pincer nail rolls into the skin on both sides of the nail plate. Techs will notice an exaggerated arch when they examine the C- curve of the nail, and the ends of the nail will visibly push into the skin. Clients who have the beginning stages of a pincer nail may complain that they feel like something is caught under their nail. When techs investigate, they will notice the nail pinching into the skin and be able to relieve the pressure by “unrolling “the nail.

Onychorrhexis is a very long and technical name for brittle nails. Nails that peel and or break easily would likely be suffering from Onychorrhexis and understanding the nails and the body will help in coping with Onychorrhexis.

Both the fingernails and toenails are made up of protein layers and like the texture, strength and thickness of an individual’s hair; the thickness of the nail is largely hereditary. Some people are genetically inclined to thin brittle nails, though some health conditions, environmental factors and the aging process can also contribute to Onychorrhexis. Heath conditions that can result in brittle nails include Raynaud’s syndrome, psoriasis, hypothyroidism, and malnutrition. Environmental factors that can lead to brittle nails include frequent hand washing, prolonged exposure to dry and or cold air, and excessive exposure to chemicals such as nail polish remover; all which are extremely drying.

If you have experienced an inability to grow out your nails, find that your nails peel or break easily it is likely that you suffer from onychorrhexis. If other’s in your family also have brittle nails then you probably have a genetic disposition to the condition. If you have a job that requires your hands (or feet) to be in water or chemicals excessively or are often in dry and cold air this is likely the cause of your Onychorrhexis and treatment as well as prevention would depend on your ability to change your environment. If; however, neither the hereditary nor the environmental factors fit your situation you may want to seek the advice of a physician as it may be a symptom of a much more serious health condition.

To treat and prevent Onychorrhexis you will want to limit the amount and frequency of soap and water exposure to your hands or your feet. It is also beneficial to use a hand moisturizer such as a lotion; however, over exposure to petroleum based products may contribute to Koilonychia, another nail disorder. Therefore use a lotion or hand cream that contains natural plant oils. Wearing protective gloves while working with water or in dry and cold conditions can greatly improve the strength and condition of your nails and be sure to get proper nutrition and take a supplement if needed.
The treatment for onychorrhexis is largely in the prevention. Since nails continuously grow, as you change the conditions that create the problem the thin brittle part of the nail will eventually grow out leaving a stronger thicker nail in its place. The treatments and preventions that are used will need to be continued in order to avoid the Onychorrhexis from reappearing.

It is important to check with your physician for any underlying health conditions should none of the prevention and treatment methods work as the Onychorrhexis may be a symptom of poor health. The treatment of the underlying health condition will then in the majority of cased treat the condition of the Onychorrhexis. Brittle nails in it self poses no risks other than being unsightly and at times embarrassing. The use of acrylic nails will often cover the problem but will not solve the issue and can lead to other conditions including fungal infections.

Beau’s lines are deep grooved lines that run from side to side on the fingernail. They are usually bilateral and result from a temporary cessation in the growth of the nail plate during severe systemic illnesses. It is believed that there is a temporary cessation of cell division in the nail matrix. This may be caused by an infection or problem in the nail fold, where the nail begins to form or it may be caused by an injury to that area. Although transverse grooves can occur on the nails of one extremity, this has not been a commonly reported phenomenon. An unusual case of unilateral Beau’s line associated with a metaphysical fracture of the distal radius extending into the growth plate with wrist immobilization is presented. They may look like indentations or ridges in the nail plate. There are several reasons that humans get Beau’s lines. Beau’s lines may be also a sign of malnutrition, zinc or iron deficiency, anemia, any major metabolic condition or a not lasting condition when growth at the area under the cuticle is interrupted by an injury or after a stressful event that temporarily interrupted nail formation.

Beau’s lines may also be caused by an illness of the body, such as diabetes, certain drugs, such as those used in chemotherapy or even malnutrition. Beau’s lines are transverse depressions of all of the nails that appear at the base of the lunula weeks after a stressful event has temporarily interrupted nail formation. The lines progress distally with normal nail growth and eventually disappear at the free edge. They develop in response to many diseases, such as syphilis, uncontrolled diabetes mellitus, myocarditis, peripheral vascular disease, and zinc deficiency, and to illness accompanied by high fevers, such as scarlet fever, measles, mumps, and pneumonia. Beau’s lines in the fingernails of 6 divers following a deep saturation dive to a pressure equal to 335 meters of sea water, and in 2 of 6 divers following a similar dive to 305 meters. The lines progress distally with normal nail growth and eventually disappear at the free edge.

Treatment of Beau’s lines Tips:

Trim brittle nails after a bath or moisturized it.
2. Apply a moisturizer on nails each time you wash your hands.
3. Moisturize cuticles and nails at bedtime and cover them with cotton gloves.
4. Don’t use nail polish remover more than twice a month, touch up the polish.
5. Avoid removers with acetone, which dries nails
6. Chromonychia induced by antineoplastic drugs has a few distinct forms. The most frequent one is melanonychia, a dark pigmentation of nails seen in diffuse, transverse, or longitudinal band patterns.
7. Synergy or an additive effect of chemotherapy agents on cellular proliferation of nail compartments is accountable for the development of this complex pattern.

What is Onychogryphosis?
Onychogryphosis are claw-type nails that are characterized by a thickened nail plate and are often the result of trauma.

Causes of Onychogryphosis
The thickening of a nail, which is common in older people, may be caused by several factors, including injury (such as that caused by ill-fitting shoes), infection, poor blood supply, diabetes, or inadequate intake of nutrients.

Symptoms of Onychogryphosis
Discomfort can result when footwear or even bed sheets press on thickened nails, because the surface beneath the nails (the nail plate) is also thickened and tender. Therefore, whatever presses on the nail indirectly presses on the nail plate. Nails can become so long and deformed that they impair walking. Long curved nails can also penetrate adjacent toes, resulting in pain and infection of the skin.

Treatment of Onychogryphosis
The Treatment for the thickened toenail depends on the severity and whether it causes you any pain or difficulty with wearing shoes. Common treatment for Onychogryphosis are:
More commonly now the technique of using a saturated solution of Phenol after the nail is removed is used as it is a liquid the treatment reaches all parts of the germinal matrix and has a high success rate.
Apply a moisturizer on nails each time when you wash your hands or feet.

Several disease states that cause hypoalbuminemia may be associated with Muehrcke lines. The appearance of paired, white bands is most likely due to a chronic nutritional deficiency of albumin. Examples include nephrotic syndrome, glomerulonephritis, liver disease, and malnutrition. Even though the white bands are most often seen in patients with nephrotic syndrome (of which many causes exist), they are not specific for any one disease state. Additionally, a case of Muehrcke lines has been reported after trauma.

Treatment
Should be undertaken in a case-specific manner. In patients presenting with paired, white, transverse lines due to a serum albumin deficiency, albumin infusions to raise the serum level aid in the disappearance of Muehrcke lines. Treatment of the underlying disease additionally aids in correcting the abnormal serum albumin levels.
Muehrcke1 reported on the effects of intravenous albumin, cortisone, and corticotrophin therapy on the white bands. A 44-year-old engineer with amyloid disease presented with gross proteinuria, white bands on all the fingernails (except the thumb), and a serum albumin level of 1.9 g/100mL. Over the course of 3 weeks, he was given a total of 750g of albumin, resulting in a transitory increase in the serum albumin level. After 3 weeks of the albumin infusion, the white bands almost completely disappeared. However, 3 months later, the serum albumin level decreased again, and the bands reappeared.
In a similar fashion, a patient with nephrotic syndrome due to subacute membranous glomerulonephritis received an infusion of 750g of albumin, which increased his serum level from 2.2g/100mL to 3.4g/100mL. As a result, the white bands became progressively less visible. Once the serum albumin level returned to the reference range, the white bands fully disappeared.1
A third patient with nephrotic syndrome, with a serum albumin level of 1.6 g/100mL, and with prominent white bands was treated with cortisone therapy over 3 months. At the end of the 3-month period, her serum albumin level increased to 2.9 g/100mL, and the white bands disappeared.
A 14-year-old boy with anasarca, with a serum albumin level of 1.5 g/100mL, and with white fingernail bands received 10 days of corticotrophin therapy, followed by a cortisone maintenance treatment. Over the course of several months, his albumin level increased to 3.7g/100mL, and the white bands disappeared.1 Large amounts of multivitamin injections did not have any effect on the appearance of the white bands in the fingernails of patients.

Onychauxis is a thickening of the nails. It can be observed in both the toenails and the fingernails and may present in a number of different ways. Treatment of onychauxis requires addressing the underlying cause of the nail thickening and adopting a special nail care routine to encourage the overgrown nail to grow out so that it can be replaced with a healthy nail.

Sometimes, only one or two nails are involved, while in other cases, every nail exhibits onychauxis. The nails thicken upward but can also sprawl outward and may be yellowish to white, with crumbling edges in some patients. The thickness of the nails makes them difficult to trim safely and evenly. As a result, the nails are often allowed to grow out and they can start to curl as they get long.

Some congenital conditions lead to onychauxis, along with other problems. Improperly fitted shoes are another culprit, as are conditions like diabetes and circulatory problems in the feet or hands. Injuries to the nails can also cause onychauxis as a reactionary response. Skin conditions like psoriasis can sometimes be associated with problems with the nails, as can nutritional deficiencies where the body does not get the nutrients it needs to grow healthy nails.

The immediate treatment for onychauxis is trimming to bring the nails down to size. If the nails are ingrown or heavily curled, it may be advisable to ask a doctor for assistance. The nails will still be thickened, but they will be neater in appearance. Trimming can also reduce the pain associated with pressure to the nails and ingrown nails. Aggressive trimming will need to be continued to keep the nails in good condition.

If the cause is treatable or curable, treating the cause can resolve the thickened nails. Frequent trimming will remove the overgrown nail and make room for new nail growth at the base of the nail. When the cause cannot be addressed, making dietary changes can support healthy nails, and patients may also find that trimming and filing the nails regularly keeps their appearance neat. In the case of onychauxis involving the feet, fitting shoes with care can also help people feel more comfortable.

Onychomadesis is a periodic idiopathic shedding of the nail beginning at its proximal end, possibly caused by the temporary arrest of the function of the nail matrix.

Koilonychia can be defined as a nail disorder of fingernails in which they are flattened and have concavities with raised edges.
It is also called spoon nails. Koilonychia is a well-recognized clinical sign of iron deficiency occurring either with or without anemia. In Koilonychia disorders produced as a result of the inadequate intake, unbalanced diet, digestive problems, absorption problems, or inadequate digestion of nutrients or other medical conditions will prevent nail improvement.
Koilonychia may be inherited as an autosomal dominant trait or it may be associated with other syndromes. Since the Koilonychia is associated with iron deficiency it is important to take care of your nutrition to fight not only against spoon nails but also with the fatigue, mood changes and decreased cognitive proper function of this condition. With proper nail care, the Koilonychia can improve in appearance especially if you avoid abusing your nails using them as tools to pick, poke or pry things like for brittle nails, keep the nails short and avoid nail polish. Use an emollient (skin softening) cream after washing or bathing.

What are the causes of Koilonychia ?
Koilonychia is the main nail disease in which the nail plate is changed from convex contour to concave contour. Koilonychia condition is usually self limiting.
Causes for Koilonychia are decribed as Chronic exposure to moisture or to nail polish can produce brittle nails with peeling of the edge of the nail, Nail biting can be a sign of anxiety, chronictension or uncontrollable compulsion, Crush injury to base of the nail or the nail bed may produce a permanent deformity and Fungus or yeast produce changes in the color, texture, and shape of the nails are some causes of koilonychia.

Treatment of Koilonychia:
* One should keep in mind that this nail disorder should be treated as soon as one recognizes it associating.
* Take iron as prescribed by your doctor to avoid possible problems related to iron overload, and do not mix iron with beverages such as coffee or tea because these drinks inhibits iron absorption.
* Since Koilonychia is caused due to malnutrition, therefore it is very important to take care of your nutrition habits and diets. As it occurs mainly due to iron deficiency, so you must eat food containing more iron content in them.
* One should wear gloves when exposing the hands to harmful chemicals such as alkalies or washing dishes, it is effective to reduce koilonychias.
* When this nail disorder is developed because of malnutrition, so it is necessary to take care of the diets and nutrition habits. If it happens because of lack of iron, one should eat diet that includes iron content
* One should wear only comfortable shoes.

Nails with onycholysis usually are smooth, firm, and without inflammatory reaction

Medical Care
Treatment for onycholysis varies and depends on its cause. Eliminating the predisposing cause of the onycholysis is the best treatment. Onycholysis related to psoriasis or eczema may respond to a midstrength topical corticosteroid. Pulsed dye laser treatment was reported as effective for psoriasis-induced onycholysis in one small series,11 but caution is advised until more data are available regarding this intervention. Psoralen plus ultraviolet A (PUVA) treatment has also been reported as an effective therapy for psoriatic onycholysis.12
* Patients should avoid trauma to the affected nail, and keep the nail bed dry.
* Patients should avoid exposure to contact irritants and moisture (important).
* Patients should clip the affected portion of the nail, and keep the nails short.
* Patients should wear light cotton gloves under vinyl gloves for wet work.
Intralesional injection may be required for onycholysis associated with more severe psoriatic nail dystrophy.
* Triamcinolone 2.5-5 mg/mL diluted with normal saline is injected into the proximal nail fold every 4 weeks in a series of 4-6 sessions.
* The proximal nail fold overlying the nail matrix is the ideal site for treatment of diseases that begin at the matrix (eg, psoriasis).
* A 30-gauge needle is adequate for medication delivery; a topical anesthetic may be used to reduce pain.
* Improvement should start after the initial series; continued injections depend on disease recurrence.
* For other nail changes associated with onycholysis (eg, oil drop sign of psoriasis, distal onycholysis, subungual hyperkeratosis), the ideal location for intralesional injection is the nail bed. The pain of this procedure necessitates the use of anesthesia. This problem can be overcome by injecting the lateral nail folds in an attempt to get medication to the affected area.

Activity
Advise patients with onycholysis to avoid contact irritants, trauma, and moisture.

Medication
In onycholysis, apply a topical antifungal imidazole or allylamine twice daily to avoid superinfection of the nail. An oral broad-spectrum antifungal agent (ie, fluconazole, itraconazole, terbinafine) may be used for cases with concomitant onychomycosis.

Midstrength topical corticosteroids are suitable for isolated onycholysis. High-potency topical steroids (eg, clobetasol ointment) under occlusion have been used with less than ideal results for patients with severe nail dystrophy unwilling to undergo intralesional injection of corticosteroids. Patients follow this regimen for 2 weeks and then discontinue use of topical steroids for 2 weeks to avoid the other local adverse effects of topical steroids.

Massaging 5-fluorouracil 1% solution twice a day into the proximal nail fold for 4 months has been effective for patients with nail pitting and hyperkeratosis from psoriasis. Application to the free end of the nail should be avoided, as this will cause onycholysis. Localized PUVA, oral etretinate, hydroxyurea, and isotretinoin are other agents that have had some success in treating onycholysis resulting from psoriasis.

Treatment is not without adverse effects. They may include subungual hematoma secondary to intralesional steroid injections and photo hemolysis secondary to PUVA treatment. Explain risks to patients before initiating therapy.

Antifungals
Treat superinfection of the onycholytic nail by dermatophytic molds and/or candidal yeasts.

Some people go to great lengths to keep their nails attractive with regular manicures – so it can be a disappointment when fingernails aren’t strong, smooth, and unblemished. Some nail issues are more than just a superficial problem – they can a sign of undiagnosed health disorders. One such problem is pitted fingernails. What causes pitted nails and what can you do about them?

Nail Pitting Causes: Pitted Nails Can Be a Sign of a Medical Problem

Pitted fingernails shouldn’t be confused with peeling ones. Pitted fingernails have tiny punctuate depressions on their surface -without significant peeling. It almost looks like someone has taken a thin nail and hammered tiny depressions into the nail plate. Pitted nails are a sign that something is disrupting the normal growth of the nail- so that it’s laid down improperly. In contrast, peeling nails occur when the nails are exposed to harsh environmental factors that cause the hard keratin sheet that makes up the nail to separate and peel off.

What Causes Pitted Nails?
The most common cause of pitted fingernails is the skin disease psoriasis. This disease which causes red plaques and silver colored scales on the skin also affects the fingernails in about half the people diagnosed with it. Psoriasis causes the nails to develop “”pits”” and “”dents”” that destroy the smooth appearance of the nail. The nails can also develop a yellowish discoloration with white spots and, in severe cases; the entire nail can crumble off. Needless to say, this is a frustrating problem to deal with.

Other Nail Pitting Causes
Some connective tissue and autoimmune diseases cause pitted fingernails, particularly Reiter’s syndrome, a type of inflammatory arthritis seen mostly in men after an infection. Pitted fingernails can also occur with alopecia areata – an autoimmune diseases associated with hair loss.

If you have pitted nails and any other symptoms such as joint discomfort, swelling, fever, fatigue, or weight loss, it’s a good idea to see a doctor to make sure you don’t have an undiagnosed autoimmune problem.

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