Noah Sinclair
Humans have nails on both their hands and feet, and while they may not be essential for survival, they do serve several important functions. Nails are made of keratin, a type of tissue that is also found in hair and horse hooves. They are thought to have evolved from claws, which were useful for climbing, digging, and grasping small branches. As primates, humans have broader fingertips than other mammals, which may have been supported by the development of nails. Nails also provide protection for the delicate tissues, nerves, blood vessels, and muscles underneath, and they can provide clues about a person's health.
| Characteristics | Values |
|---|---|
| Condition | Retronychia (ingrown double nails) |
| Cause | Trauma to the toe and nail plate, ill-fitting shoes, repetitive activities like dancing and jogging, arthritis, thrombophlebitis |
| Symptoms | Pain, inflammation, yellow or white discoloration of the nail plate (xanthonychia), growth of new connective tissue on inflamed areas (granulation tissue), swollen, red, and tender tissue around the nail, missing cuticle |
| Treatment | Surgical removal of the nail, corticosteroids applied to or injected into the nail |
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What You'll Learn
- Retronychia, a rare condition, causes nails to grow backward, resulting in stacked plates
- Onychoschizia, or nail peeling/splitting, is caused by repeated wetting and drying of nails
- Brittle nails can be caused by cosmetics, procedures, chemicals, and underlying medical issues
- Minor nail matrix damage can cause temporary changes in nail appearance and texture
- Severe eczema and psoriasis can affect the nail matrix, leading to nail growth issues
Retronychia, a rare condition, causes nails to grow backward, resulting in stacked plates
Retronychia is a rare nail condition that causes nails to grow backward, resulting in stacked plates. It occurs when there is a disruption in the normal longitudinal growth of the nail, often due to an injury or trauma to the nail or nail bed. This disruption leads to the separation of the old nail plate from the nail matrix and nail bed, resulting in vertical growth into the proximal nail fold. This abnormal growth causes the new nail to grow beneath the existing nail, pushing it upward and leading to the stacking of multiple nail plates.
Retronychia is characterised by flares of infection (paronychia) and inflammation at the cuticle, resulting in pain, redness, and swelling. It typically affects the great toenails and is often caused by repetitive microtrauma, such as wearing tight shoes or performing activities that cause toenail trauma, like running or walking downhill for extended periods. The condition can also be precipitated by systemic illnesses or conditions that slow down nail growth, such as poor circulation, chronic illness, or chemotherapy.
The diagnosis of retronychia is typically made by an experienced podiatrist based on clinical grounds. It is important to differentiate retronychia from paronychia, a more common infection of the periungual tissues. Clinical features that help distinguish retronychia include the presence of xanthonychia (yellow or white discolouration of the nail plate) and swelling of the proximal nail folds rather than the lateral nail folds, which are more commonly affected in paronychia.
Treatment for retronychia aims to resolve the condition and prevent long-term complications. It varies depending on the stage of the condition and may include topical or intralesional corticosteroids to manage inflammation and pain. In some cases, minor surgery may be required to remove the nail plate, especially if the condition does not respond to conservative treatments. With proper medical intervention, retronychia can typically be resolved, and normal nail growth can be restored.
It is important to consult with a qualified podiatrist for a proper diagnosis and treatment plan for retronychia. Early intervention can help prevent potential complications and promote the regrowth of healthy nails.
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Onychoschizia, or nail peeling/splitting, is caused by repeated wetting and drying of nails
Onychoschizia, or nail peeling/splitting, is characterised by horizontal splits across the width of the nail plate. The nail plate peels off in layers, and the condition may occur alongside onychorrhexis, which involves longitudinal splits or ridges in the nail plate. These conditions, alone or together, are sometimes referred to as "brittle nails".
Onychoschizia is most frequently caused by repeated wetting and drying of the nails. Frequent wetting and drying of the hands is the most common cause of brittle nails. Occupations that require regular hand washing or exposure to chemicals can increase the risk of brittle nails.
Nail cosmetics, such as nail hardeners, polish, and polish removers, can also contribute to nail splitting. While nail-hardening agents containing formaldehyde can increase nail strength, they can also cause nail brittleness and other problems if not used cautiously. Acrylate-containing hardeners are effective too but may cause allergic reactions in the skin.
Underlying medical problems, such as gland diseases, tuberculosis, Sjögren syndrome, and malnutrition, can also cause brittle nails. Skin diseases, including lichen planus and psoriasis, are also associated with nail splitting. Oral medications containing vitamin A (retinoids) may further increase the risk of nail splitting.
In newborns and young children, horizontal nail splitting is relatively common, affecting about one in three newborns and children up to two years old. This is often attributed to the thinness of their nails, and thumb-sucking can be a contributing factor.
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Brittle nails can be caused by cosmetics, procedures, chemicals, and underlying medical issues
Brittle nails are common, affecting nearly 20% of the population, especially women and older adults. Nails become fragile due to various factors, some of which are controllable, while others are not.
Cosmetics
The use of cosmetics such as nail hardeners, nail polish, and nail polish removers or solvents can cause nails to become brittle. Nail-hardening agents containing formaldehyde may increase nail strength but can also cause brittleness and other nail issues. Applying a clear coat of nail polish may help increase nail strength, but it is important to avoid nail conditioners that contain alcohol, as they can further dry out the nail.
Procedures
Procedures such as nail trephination, which involves draining trapped blood under the nail, can cause nail brittleness. Additionally, the application of artificial nails and the materials and procedures used can contribute to nail fragility.
Chemicals
Occupational exposure to various chemicals, including alkalis, acids, cement, solvents, thioglycolates, salt, and sugar solutions, can lead to brittle nails. Frequent hand washing and sanitizing can also cause nails to dry out and become brittle. This is because nails lose water faster than the skin, leading to increased exposure to dry air, water, and sanitizers over time.
Underlying Medical Issues
Brittle nails can be a symptom of several underlying medical conditions, including:
- Fungal infections, which may cause nails to thicken or turn yellow in addition to cracking.
- Nutritional deficiencies, such as a lack of protein, iron, vitamin B, or vitamins and amino acids in general.
- Thyroid disorders, including hyperthyroidism, hypothyroidism, and Graves' disease, can affect the body's absorption of minerals, leading to nail splitting.
- Raynaud's syndrome, which results in diminished blood flow to the fingers, causing brittle nails.
- Psoriasis, an immune system disorder that causes dry, scaly patches under the nail beds and can alter nail colour and texture.
- Sjögren syndrome.
- Malnutrition.
- Anemia, caused by an iron deficiency, can lead to extreme fatigue and brittle nails.
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Minor nail matrix damage can cause temporary changes in nail appearance and texture
The nail matrix is where your fingernails and toenails form. It has two parts: the germinal matrix and the sterile matrix. The germinal matrix contributes to about 90% of nail growth, while the sterile matrix makes up the remaining 10% and is important for keeping your nail attached to the underlying skin. Minor nail matrix damage can cause temporary changes in nail appearance and texture.
Injuries and certain health conditions can damage your nail matrix and interfere with nail growth. For example, severe eczema can affect your nail matrix and cause temporary changes, such as Beau's lines, pitting, and texture or colour changes. Nail psoriasis can also cause white lines, pitting, and crumbling. In addition, subungual melanoma, a type of skin cancer that affects the nail matrix, can lead to brown or black discolouration. Any change in the appearance or texture of your nails could indicate a nail matrix problem.
Minor nail matrix damage can result in temporary changes such as dents, horizontal ridges, or lines. These changes are often accompanied by a difference in how the nail feels to the touch. In some cases, minor damage can lead to nail trephination, a procedure that drains trapped blood under the nail, providing pain relief and helping the new nail grow correctly.
Additionally, brittle, peeling, or splitting nails can be caused by nail cosmetics, procedures, or exposure to various chemicals. Repeated wetting and drying of the nails can also lead to onychoschizia, a condition characterised by horizontal splits in the nail plate. Certain medical conditions, such as lichen planus, psoriasis, and vitamin A medications, have also been linked to nail splitting.
In the case of ingrown double nails, or retronychia, trauma or repetitive injury to the nail can cause a new nail plate to grow beneath the existing one, resulting in multiple nail plates stacked on top of each other. This condition usually affects the big toenails and can be treated with antibiotics and, in more severe cases, surgical removal of the affected nail plates.
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Severe eczema and psoriasis can affect the nail matrix, leading to nail growth issues
The nail matrix is where your fingernails and toenails form. It comprises two parts: the germinal matrix and the sterile matrix. The germinal matrix contributes to about 90% of nail growth, while the sterile matrix accounts for the remaining 10% and plays a crucial role in keeping your nail attached to the underlying skin.
Injuries and specific health conditions, such as severe eczema and psoriasis, can damage the nail matrix and interfere with nail growth. Severe eczema can cause nail matrix issues, leading to temporary disruptions in nail growth. Eczema on the nails can result in discoloration, grooving, pitting, and other abnormalities. It typically affects individuals who have eczema elsewhere on the body. Nail eczema often requires a combination of lifestyle modifications, such as avoiding triggering products and keeping hands dry, along with medications like topical steroids.
Similarly, psoriasis can impact the nail matrix and cause nail growth problems. Up to 80% of people with psoriasis develop nail psoriasis, which can lead to white lines, pitting, crumbling, and other changes. Nail psoriasis is an autoimmune disease where the immune system overreacts, causing new skin cells to grow too rapidly. It can result in discoloration, known as salmon patches or oil drop spots, which may appear yellow, red, pink, or brown. Additionally, your nails may develop pits or dents, ranging in size and depth. Horizontal ridges or grooves, known as Beau's lines, can also form across your nails. In some cases, nail psoriasis may cause your nails to become thin and crumble, leading to onycholysis, where the nail separates from the nail bed.
Both eczema and psoriasis can lead to nail growth issues by affecting the nail matrix. Proper diagnosis and treatment are crucial to managing these conditions effectively. For eczema, this may involve lifestyle changes and medications, while psoriasis treatment could include corticosteroids, medicine injections, oral medicines, phototherapy, or laser therapy.
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