Signs and Symptoms

Signs and symptoms of a nail disorder include:

• Discoloration or spotting
• Painful, red swelling
• Pits, ridges, scars
• Lesions
• Brown black band

What Causes It?

Several nail disorders are present at birth or develop during infancy. Nail disorders are caused by:

• Infections
• Skin diseases
• Benign or malignant tumors
• Certain systemic diseases

Chronic renal failure, for example, is known to cause various nail pathologies. They also may be self induced.

Who is Most At Risk?

People with the following conditions or characteristics are at risk for developing a nail disorder:

• Genetic predisposition
• Excessive exposure to water, heat, and humidity
• Tight fitting shoes
• Chemical damage
• Diabetes
• Skin diseases
• Tumors
• Over manicuring
• Habits involving picking at the skin surrounding a nail
• Soil contamination
• Human immunodeficiency virus (HIV), the virus that causes AIDS

What to Expect at Your Provider's Office

If you have symptoms of a nail disorder, you should see your health care provider. Your provider will make a diagnosis based on a:

• Physical exam
• Lab tests, such as fungal or bacterial cultures
• Imaging procedures if a tumor is suspected

Treatment Options

Prevention

To prevent a nail disroder, you should:

• Keep your toenails cut short.
• Make sure your shoes fit properly.
• Avoid walking barefoot at public showers and swimming facilities.
• Throw out old, worn footwear.

Treatment Plan

Your health care provider may remove the infected nail and prescribe oral medication, as well as medication to apply to the nail.

Drug Therapies

Your provider may prescribe the following antifungal or antibacterial medications.

• Terbinafine
• Itraconazole
• Fluconazole
• Steroids
• Antibiotics
• Efalizumab (for nail involvement in psoriasis)

Surgical and Other Procedures

Your provider can:

• Remove or drain lesions
• Drain blood clots
• Sometimes surgically remove the nail

Complementary and Alternative Therapies

A comprehensive treatment plan for nail disorders may include a range of complementary and alternative therapies.

Virtually every nutritional deficiency can affect nail growth. These nutritional tips may help reduce symptoms:

• Eliminate potential food allergens, including dairy, wheat (gluten), corn, preservatives, and food additives. Your provider may want to test for food sensitivities.
• Eat calcium-rich foods, including beans, almonds, and dark green leafy vegetables (spinach and kale).
• Eat antioxidant-rich foods, including fruits (blueberries, cherries, and tomatoes), and vegetables (squash and bell peppers).
• Avoid refined foods, such as white breads, pasta, and sugar.
• Use healthy oils in foods, such as olive oil or vegetable oil.
• Reduce or eliminate trans fatty acids, found in commercially-baked goods, such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
• Avoid coffee and other stimulants, alcohol, and tobacco.
• Drink 6 to 8 glasses of filtered water daily.
• Exercise at least 30 minutes daily, 5 days a week.

You may address nutritional deficiencies with the following supplements:

• A multivitamin daily: containing the antioxidant vitamins A, C, E, the B-complex vitamins, and trace minerals, such as magnesium, calcium, zinc, and selenium.
• Probiotic supplement (containing Lactobacillus acidophilus):5 to 10 billion CFUs (colony forming units) a day, for maintenance of gastrointestinal and immune health. if you have a suppressed immune system, speak to your doctor before taking probiotics. Some probiotic supplements need refrigeration. Check the label carefully.
• Omega-3 fatty acids: such as fish oil, 1 to 2 capsules or 1 tbsp of oil, 1 to 2 times daily, to help reduce inflammation. Fish oils may increase bleeding in sensitive individuals, such as those taking blood-thinning mediations (including aspirin).
• Grapefruit seed extract (Citrus paradisi): 100 mg capsule or 5 to 10 drops (in favorite beverage) 3 times daily, for antibacterial/antifungal activity and immunity. Grapefruit products can interact with a variety of medications. Speak with your physician.
• L-glutamine: 500 to 1,000 mg, 3 times daily, for support of gastrointestinal health and immunity. DO NOT take glutamine if you have a history of mania or seizures, unless you are being closely monitored by a physician.

Herbs are one way to strengthen and tone the body's systems. As with any therapy, you should work with your provider to diagnose your problem before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. of herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups per day. You may use tinctures alone or in combination as noted.

• Green tea (Camellia sinensis) standardized extract: 250 to 500 mg daily, for inflammation and antibacterial or antifungal effects. You may also prepare teas from the leaf of this herb.
• Cat's claw (Uncaria tomentosa) standardized extract: 20 mg, 3 times a day, for antibacterial or antifungal effects. Cat's claw can interact with many medications, including blood pressure medications and immunosuppressant drugs. Speak with your doctor if you are taking any medications. People with leukemia should not use cat's claw.
• Reishi mushroom (Ganoderma lucidum) standardized extract: 150 to 300 mg, 2 to 3 times daily, for immunity. You may also take a tincture of this mushroom extract, 30 to 60 drops, 2 to 3 times a day. Reishi can increase the effects of blood pressure medications and blood-thinning medications, such as warfarin (Coumadin) and aspirin. Speak with your doctor.
• Milk thistle (Silybum marianum) seed standardized extract: 80 to 160 mg, 2 to 3 times daily, for detoxification support. Milk thistle can interact with a variety of medications. Speak with your doctor.
• Topical: Tea tree oil (Melaleuca alternifolia):apply undiluted to affected nail (using a cotton swab) 3 to 4 times daily, for antibacterial/antifungal activity.

Few studies have examined the effectiveness of specific homeopathic remedies. A professional homeopath, however, may recommend one or more of the following treatments for nail disorders based on his or her knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type, includes your physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.

• Calendula: for reddish, scaly rashes
• Graphites: for cracking skin and nails with oozing fluid caused by fungal infections; symptoms improve with open air
• Sulphur: for fungal disorders that itch, particularly if warmth worsens symptoms

Acupuncture may help:

• Enhance immune function
• Normalize digestion
• Address disease conditions

Massage can help stimulate circulation, which aids the transport of nutrients to the nail bed.

Alternating hot and cold foot baths can help shuttle blood and immune cells to infected nails. Fill one bucket with hot water (be sure the water temperature is not so hot as to burn, but similar to a Jacuzzi, about 100° F - 37.7° C) and one with cold water. Place feet in hot water for 3 minutes, then immediately into cold water for 1 minute. Repeat this series 3 times, then vigorously rub feet with a dry towel. You can add 7 drops of essential oil of lavender to the hot water to increase its stimulating effects. People with a vascular disease or any other type of compromised circulation or peripheral neuropathy should NOT do hydrotherapy without their doctor's supervision.

Prognosis/Possible Complications

The consequences of most nail disorders are purely cosmetic. Regenerating a toenail usually takes 8 to 12 months, while regrowing a fingernail takes half as long. Infection relapses or permanent damage sometimes occur. Complications may include cellulitis (tissue inflammation) and the embarrassment caused by unsightly nail appearance. Nail abnormalities are also associated with hair, teeth, or gland abnormalities.

Following Up

Follow up with your health care provider if you have any drug side effects or interactions.

Supporting Research

Bagg J, Jackson MS, Petrina Sweeney M, Ramage G, Davies AN. Susceptibility to Melaleuca alternifolia (tea tree) oil of yeasts isolated from the mouths of patients with advanced cancer. Oral Oncol. 2006;42(5):487-92.

Baran R, Thomas L. Combination of fluconazole and alpha tocopherol in the treatment of yellow nail syndrome. J Drugs Dermatol. 2009;8(3):276-8.

Bolognia: Dermatology. 3rd ed. Philadelphia, PA: Elsevier Mosby. 2012.

Cabrera C, Artacho R, Gimenez R. Beneficial effects of green tea--a review. J Am Coll Nutr. 2006;25(2):79-99.

Cashman MW. Nutrition and nail disease. Clin Dematol. 2010; 28(4):420-5.

Chu D, Rubin A. Diagnosis and Management of Nail Disorders in Children. Pediatric Clinics of North America. Philadelphia, PA: W.B. Saunders Company. 2014; 61(2).

Cvetnic Z, Vladimir-Knezevic S. Antimicrobial activity of grapefruit seed and pulp ethanolic extract. Acta Pharm. 2004;54(3):243-50.

Das M, Sur P, Gomes A, Vedasiromoni JR, Ganguly DK. Inhibition of tumor growth and inflammation by consumption of tea. Phytother Res. 2002;16 Suppl 1:S40-4.

Dehesa L, Tosti A. Treatment of inflammatory nail disorders. Dermatol Ther. 2012; 25(6):525-34.

Gonclaves C, Dinis T, Batista MT. Antioxidant properties of proanthocyanidins of Uncaria tomentosa bark decoction: a mechanism for anti-inflammatory activity. Phytochemistry. 2005;66(1):89-98.

Hartford O, Zug KA. Tea tree oil. Cutis. 2005;76(3):178-80.

Heggers JP, Cottingham J, Gussman J, et al. The effectiveness of processed grapefruit-seed extract as an antibacterial agent: II. Mechanism of action and in vitro toxicity. J Altern Complement Med. 2002;8(3):333-40.

Lamerson C, Stevens G, Sax K. Treatment of nail psoriasis with efalizumab: a preliminary study. Cutis. 2008;82(3):217-20.

Rainone F. Milk thistle. Am Fam Physician. 2005;72(7):1285-8.

Richert B. Nail disorders in children: diagnosis and management. Am J Clin Dermatol. 2011; 12(2):101-12.

Rotsein OD. Oxidants and antioxidant therapy. Crit Care Clin. 2001;17(1):239-47.

Salem A, Al Mokadem S, Attwa E, Abd El Raoof S, Ebrahim HM, Faheem KT. Nail changes in chronic renal failure patients under haemodialysis. J Eur Acad Dermatol Venereol. 2008;22(11):1326-31.

Schelz Z, Molnar J, Hohmann J. Antimicrobial and antiplasmid activities of essential oils. Fitoterapia. 2006;77(4):279-85.

Simopoulos AP. Omega-3 fatty acids in inflammation and autoimmune diseases. J Am Coll Nutr. 2002;21(6):495-505.

Yoon JH, Baek SJ. Molecular targets of dietary polyphenols with anti-inflammatory properties. Yonsei Med J. 2005;46(5):585-96.

Wischmeyer PE. Clinical applications of L-glutamine: past, present, and future. Nutr Clin Pract. 2003;18(5):377-85.

Zaiac MN, Walker A. Nail abnormalities associated with systemic pathologies. Clin Dermatol. 2013; 31(5):627-49.