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Nail Disorders

Nail disorders include a wide variety of conditions that affect the nail plate, nail bed, and surrounding skin folds. While often dismissed as "cosmetic" nuisances, nails are frequently a window into overall health. Changes in colour, shape, texture, or thickness can signal fungal infections, autoimmune diseases (like psoriasis), or even systemic medical conditions. At Smooth Skin Clinic, we treat nail problems medically to restore both the appearance and the health of the nail unit.

Key Points

  • Nail changes are often the first sign of underlying skin or systemic disease.
  • The most common conditions are fungal infections (Onychomycosis) and nail psoriasis.
  • A dark stripe on a nail (Melanonychia) requires urgent assessment to rule out melanoma.
  • Over-the-counter antifungal paints often fail because they cannot penetrate the nail plate effectively.
  • Diagnosis often requires nail clippings or scrapings to ensure the correct treatment is prescribed.

What are nail disorders?

A nail disorder is any abnormality affecting the nail unit. This can range from brittle, splitting nails to severe infections that cause the nail to lift off the bed (onycholysis). The two most frequent conditions we see are fungal infections (where the nail becomes yellow and crumbly) and inflammatory conditions like psoriasis (where the nail becomes pitted or thickened).

 

Who gets nail disorders?

Nail problems affect people of all ages. Fungal infections are more common in older adults, athletes, or those with diabetes. Nail psoriasis is seen in up to 50% of people who have skin psoriasis. Women are often affected by chemical damage from gels, acrylics, and frequent manicures.

 

Contact Smooth Skin Clinic for a professional diagnosis of your nail concerns.

Clinical features

Symptoms vary depending on the specific condition, but common signs include discoloration, where nails may turn yellow, white, green, or black. Patients often notice texture changes such as pitting (tiny dents), ridging, or crumbling of the nail plate. Significant thickening can also occur, making the nails hard to cut and causing debris to accumulate underneath. In some cases, the nail may lift and separate from the pink nail bed (onycholysis), or there may be pain and redness due to swelling of the skin fold around the cuticle (paronychia).

Diagnosis and differential diagnosis

It is impossible to diagnose a nail condition just by looking at it. Fungal infections and psoriasis can look identical. We use:

 

- Dermoscopy: To look for specific patterns like "salmon patches" (psoriasis) or "spikes" (fungus).

- Mycology Clipping: We take a small piece of the nail to send to a pathology lab for culture. This confirms if a fungus is present and exactly which fungus it is.

- Biopsy: In rare cases, especially if a tumour or lichen planus is suspected, a small biopsy of the nail matrix may be required.

Impact and complications

Nail disorders can cause significant pain, making it difficult to walk or perform fine motor tasks (like buttoning a shirt). Complications: untreated fungal infections can spread to other nails or the skin (tinea pedis). In diabetics, nail infections can lead to serious secondary bacterial infections (cellulitis).

Causes and triggers

    • Infection: Dermatophytes (fungi), Candida (yeast), or bacteria (Staph/Pseudomonas).

    • Trauma: Repetitive injury (jogging in tight shoes) or acute injury (slamming a finger in a door).

    • Autoimmune: Psoriasis, Alopecia Areata, and Lichen Planus.

    • Chemicals: Prolonged exposure to water, harsh detergents, or nail cosmetics.

       

    • Medications: Certain antibiotics and chemotherapy drugs can damage nails.

Treatment Options

  • Topical Lacquers Prescription-strength antifungal nail paints (e.g., Amorolfine) for superficial infections.
  • Oral Medications Antifungals: Terbinafine or Itraconazole tablets are the gold standard for clearing established fungal nail infections.
    Retinoids/Methotrexate: For severe nail psoriasis.
  • Intralesional Injections Steroid injections into the nail matrix can effectively treat nail psoriasis or lichen planus.
  • General Care trimming thickened nails and advice on footwear/gloves to reduce trauma.

Expectations and Outcomes: Nails grow slowly. Fingernails take 6 months to replace themselves; toenails take 12–18 months. You must be patient to see the clear nail grow out from the base.

Frequently Asked Questions

Have questions about scheduling or what to expect? Here are answers to common inquiries to help you feel fully prepared.

Nails are hard and designed to be impenetrable. Most over-the-counter paints cannot penetrate through a thick fungal nail to reach the infection bed. Oral medication or prescription lacquers used after filing the nail down are usually required for a cure.

We generally advise against this during treatment. Fungus thrives in dark, moist environments. Covering the nail with polish traps moisture and prevents medicated lacquers from working.

While some clinics offer laser treatment for fungus, the medical evidence is mixed. At Smooth Skin Clinic, we focus on treatments with the highest proven cure rates, which are typically oral antifungal tablets combined with topical hygiene.