Sophia Delgado
Eczema is a common skin disease that affects around 5.5% of American adults. It is characterised by red, itchy skin and can occur anywhere on the body. When eczema affects the hands and feet, it is called pompholyx eczema, and it commonly involves the nail folds and skin around the nails (cuticles), resulting in swelling. This can cause a build-up of scale under the nails, known as onycholysis, as well as ridging, pitting, thickening, and discolouration of the nails. Treatment for nail eczema may involve avoiding triggers, using topical steroids, and seeking medical advice from a dermatologist for proper diagnosis and care.
| Characteristics | Values |
|---|---|
| Prevalence | Eczema affects around 5.5% of American adults |
| Location | Eczema can affect the fingers, hands, feet, and toenails |
| Symptoms | Red, itchy skin, swelling, inflammation, crumbling nails, nail pitting, thickening, discolouration, horizontal ridging, nail splitting, nail dystrophy |
| Diagnosis | Allergy testing, tests of nail clippings, physical examination by a dermatologist, eczema area and severity index (EASI) score |
| Treatment | Topical steroids, avoiding triggers, antibiotic therapy, antifungal treatment |
| Prevention | Trim nails straight, wear comfortable and well-fitting shoes, avoid excessive cleaning under nails |
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What You'll Learn
Eczema can cause nail pitting, crumbling, and thickening
Eczema can affect the nails in several ways, including nail pitting, crumbling, and thickening.
Nail pitting is a common symptom of eczema, characterised by small dents or pits on the surface of the nail, resembling holes made by a sharp object. These pits can vary in size and depth, ranging from pin-sized to crayon-sized, and can appear as a single pit or multiple pits on each nail. While nail pitting is often associated with nail psoriasis, it can also occur in individuals with eczema.
In addition to pitting, eczema can cause nail crumbling. This is usually a result of the nails becoming thin and brittle due to the condition. The nails may weaken and break easily, leading to crumbling. Crumbling nails can also be a sign of a fungal infection, so proper diagnosis by a dermatologist is important to differentiate between these conditions.
Furthermore, eczema can lead to nail thickening. This thickening can occur alongside pitting and discolouration, particularly in individuals with pompholyx eczema or eczema on the palms or feet. The nails may become thickened, pitted, and discoloured, causing cosmetic concerns and potential discomfort.
The presence of nail abnormalities, such as pitting, crumbling, and thickening, can significantly impact an individual's quality of life, affecting their ability to perform daily tasks and causing self-consciousness about the appearance of their nails. However, proper treatment and management of eczema can help alleviate these symptoms and improve nail health.
To manage and treat nail eczema, it is essential to consult a dermatologist or healthcare provider for a proper diagnosis and tailored treatment plan. Treatment may involve a combination of lifestyle changes, such as avoiding triggers and keeping the affected area dry, as well as medical interventions, including the use of topical steroids. Protecting the nails and hands by wearing gloves can also help prevent further irritation and potential infection.
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Eczema can cause inflammation of the nail fold tissues (paronychia)
Eczema can cause inflammation of the nail fold tissues, known as paronychia. This condition can be acute or chronic, with acute paronychia typically developing rapidly over a few hours and usually affecting a single nail fold. It is caused by polymicrobial infections after the protective nail barrier has been breached. Symptoms of acute paronychia include pain, redness, swelling, and sometimes the presence of yellow pus under the cuticle. Treatment for acute paronychia includes warm soaks with or without Burow solution or 1% acetic acid, as well as topical antibiotics and steroids if simple soaks do not relieve the inflammation.
Chronic paronychia, on the other hand, is a gradual process that may start in one nail fold but often spreads to several other fingers. It is characterised by symptoms lasting at least six weeks and is a result of irritant dermatitis rather than an infection. Common irritants include acids, alkalis, and other chemicals commonly encountered by housekeepers, dishwashers, and swimmers. Once the protective nail barrier is disrupted, repeated exposure to these irritants can lead to chronic inflammation. The main complication of chronic paronychia is nail dystrophy, with the nail plate often becoming distorted, ridged, and discoloured.
Paronychia is commonly seen in individuals with eczema and can be made worse by a secondary yeast infection. It is also prevalent among nurses, hospitality workers, mothers with small children, and anyone who frequently immerses their nails in water for extended periods. Treatment for chronic paronychia can be more challenging and may involve oral antibiotics for severe or prolonged bacterial infections.
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Pompholyx eczema can affect the nail folds and skin around the nails
Eczema is a common skin disease affecting around 5.5% of American adults. It is characterised by red, itchy skin and can affect any area of the body. When eczema impacts the hands and feet, it is called pompholyx eczema. This type of eczema involves the development of intensely itchy, watery blisters on the sides of the fingers, palms, and soles of the feet. Pompholyx eczema can also affect the nail folds and skin around the nails (cuticles), resulting in swelling (paronychia).
The exact causes of pompholyx eczema are unknown, but several factors are believed to aggravate the condition. These include stress, sensitivity to metal compounds such as nickel, cobalt, or chromate, heat, and sweating. It is also associated with hyperhidrosis, or excessive sweating. People with this type of eczema may experience skin that is red or darker than the surrounding skin, along with painful cracks (skin fissures) and peeling as it dries out.
In terms of treatment, it is recommended to apply petroleum jelly to the nails before handling potassium permanganate, as it can stain the nails and skin. Soaking the affected area in a solution of potassium permanganate for 3-7 days can help manage acute flare-ups of pompholyx eczema. After the soak, it is essential to continue moisturising the hands and feet with an emollient. Emollient soap substitutes are also preferable to regular soap, as soap can act as an irritant and degrease the skin.
Nail eczema can cause changes to the nails, such as pitting, which appears as dents in the nails. It can also lead to grooved, thin, or brittle nails. Proper diagnosis and treatment are crucial, and a dermatologist can help differentiate nail eczema from other skin diseases, such as nail psoriasis. Allergy testing or examination of nail clippings may be conducted to rule out a fungal infection. Treatment may involve avoiding triggers and using topical steroids.
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Eczema can cause horizontal ridging of the nail plate
Fingernails can reveal a lot about the state of your health. One common change is the appearance of vertical or horizontal ridges. While vertical ridges are often a sign of ageing, horizontal ridges can point to issues like malnutrition, serious nail injury, or Beau's lines.
Deep horizontal ridges, or Beau's lines, are often a symptom of serious conditions. For example, if you have developed Beau's lines due to diabetes, successfully managing your blood sugar may reduce these horizontal fingernail ridges.
Horizontal ridging of the nail plate can also occur due to eczema. When the fingertips and surrounding skin are affected by eczema, swelling and inflammation of the nail fold tissues (paronychia) may develop. This may be made worse if a secondary yeast infection develops. A build-up of skin cells (scaling) may occur under the free edge of the nail plate. If the eczema is ongoing for some months, horizontal ridging of the nail plate may occur.
Chronic eczema of the fingers can cause a build-up of scale under the free edge of the nails along with onycholysis. Onycholysis is when the nail plate becomes separated from the nail bed, and the white colour will extend down the nail. Ridging in nails can be either longitudinal (along the nail) or transverse (across the nail). While longitudinal ridging normally becomes more prominent with age, transverse ridging can be caused by eczema.
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Eczema can cause nail dystrophy
Eczema can affect the nails in several ways, causing nail dystrophy. It is a common skin disease affecting around 5.5% of American adults. It is also called atopic dermatitis and is characterised by red, itchy skin.
Nail dystrophy is a deformation of the nails, which can be caused by eczema. This is because nails often reflect the pathologic features of adjacent tissues. In the case of eczema, this can lead to nail abnormalities such as transverse groove (Beau's line), nail pitting, koilonychia (thin or concave nails), trachyonychia, leukonychia, brachyonychia, melanonychia, onychomadesis, onychoschizia, and onycholysis. These nail abnormalities are thought to be caused by pathologic changes in the nail matrix region.
Eczema around the nails can cause the skin alongside the nail to become infected with bacteria, typically Staphylococcus aureus. This infection is called paronychia and can cause pain, redness, and swelling around the cuticle, as well as a yellow-green discharge. In chronic cases, the nail may become distorted and discoloured, and the skin may lift at the site of infection.
Fingernail changes are more common than toenail changes in eczema. Pompholyx eczema can affect the nail folds and skin around the nails (cuticles), resulting in swelling. This type of eczema can cause pitting in the nails, which requires treatment to avoid worsening. More severe cases of nail eczema can cause nail deformity that requires medication and lifestyle changes.
Treatment for nail eczema involves seeing a dermatologist for a proper diagnosis and differentiating it from other skin diseases like nail psoriasis. Treatment may then involve avoiding triggers, such as certain products, and keeping hands dry, as well as using topical steroids.
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Frequently asked questions
Eczema is a common skin disease affecting around 5.5% of American adults. It is also called atopic dermatitis. It is characterised by red, itchy skin and can involve any area of the body.
When the fingertips and surrounding skin are affected by eczema, swelling and inflammation of the nail fold tissues (paronychia) may develop. This may be made worse if a secondary yeast infection develops. Nail eczema can cause pitting, grooving, and thinning of the nails.
Paronychia is a build-up of skin cells (scaling) that occurs under the free edge of the nail plate. If eczema is ongoing for several months, horizontal ridging of the nail plate may also occur.
Treatment for nail eczema starts with a dermatologist visit for a proper diagnosis. This involves differentiating nail eczema from other skin diseases like nail psoriasis. Treatment may involve avoiding triggers and/or using topical steroids.
It is important to be upfront about your eczema with the nail technician or hairstylist. You can also ask your dermatologist for a letter detailing your eczema-related issues and ways to avoid triggering reactions.
