Your Health   -  A to Z of Common Medical Conditions

Fingernail Problems

Description - Fingernails protect the ends of the fingers. They grow about 4 cms in a year, more in the dominant hand than the non-dominant hand and more in the young than the old. Some nail conditions are part of a general skin condition, notably psoriasis (see Psoriasis), though sometimes only the nails are affected in psoriasis making diagnosis most difficult. Single horizontal ridges may occur as a result of previous general illness, multiple ridges can result from inflammation around the nail. Longitudinal ridges are caused by various skin conditions including psoriasis and lichen planus. Thickening of the nail is usually caused by psoriasis or fungal infection. The doctor will usually be able to tell from nail clippings whether, or not, fungal infection is present. Splitting of the nails is commonly caused by outside factors such as having the hands immersed in water a lot of the time. Shedding of a nail often follows injury to the nail bed but can be the result of general illness or skin disease. Discoloration of the nails usually results from outside factors particularly the prolonged use of nail varnish. Flattening of the nails can be a sign of anaemia. White patches can be caused by local and general conditions. Paronychia (whitlows) are infections of the side of the nail and can be very uncomfortable. Chronic paronycychii can be caused by the yeast organism, Candida. All these problems can be seen with toenails though probably the most troublesome are chronic paronychia (in-growing toenail) and fungal nail infections. If the finger has been injured, bleeding under the fingernail (sub-ungual haematoma) can be very painful indeed.

Management - If the fingernail problems seem any more than minor and particularly if they are associated with skin problems or general illness, the doctor should be consulted. Simple conditions, such as splitting of the nails, may be helped by the wearing of protective gloves etc. Fungal nail infections are not easy to clear and may take several months of anti-fungal treatment to respond. Generally, nail conditions, such as psoriasis, do not respond to treatment and it is sometimes necessary for the individual concerned simply to come to terms with the problem to some degree. If there is thought to be any underlying medical condition, blood tests etc. will be carried out. If paronychia are particularly infected antibiotics may be necessary and the doctor may want to drain any accumulated pus. If a sub-ungual haematoma is very painful,  the doctor may make a hole in the nail to relieve the pressure.

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