Apart from consulting in our wonderful clinic in South Melbourne, I also am a staff specialist at The Alfred Hospital in the general dermatology clinic and have held that position for about 6 years. But another position I also hold is at the Nail Clinic in the Skin and Cancer Foundation Inc in Carlton. Here at this monthly clinic, our team consisting of dermatology specialists, podiatrist, nurses and clinical photography assess all manner of nail conditions and concerns. Dr Anne Howard leads our team and she has contributed to a recent article in Prevention Magazine about Nail Conditions in Salons. A lot of patients may not even know that nail conditions are managed by dermatologists! Nail conditions are a sub-specialty interest of mine and I see a lot of patients with nail issues in my private clinic in South Melbourne too. Recently I have seen a whole load of nail cases and below are some of my recommendations about nail issues arising from common cases or questions that my patients ask me.
- Be careful to only use LED light and not UV light in the curing phase for these types of nail treatments. There have been studies to suggest that using UV lamps to harden gel nail polish may be harmful and lead to skin cancers. One observational study from Ireland has recently published about this risk in the Australasian Journal of Dermatology and has suggested the use of a high SPF, broad spectrum sunscreen before lamp exposure or the use of fingerless gloves to minimise risk.
- Try to avoid pushing back or cutting the nail cuticles with your nail treatment as the cuticle is important for healthy nail growth.
- Some chemicals used in the nail manicure process can cause allergic contact dermatitis which can show up first as an eyelid/facial eczema. The only way to confirm such an allergy is to perform patch testing. Common allergens include –
- methylisothiazolinone (or MI for short) – used in some wet wipes in the prep phase of a nail treatment
- toluene sulfonamide formaldehyde resin (or TSFR for short) – a chemical in many nail polishes and nail hardeners
- acrylates – a chemical used in the binding process and seen in nail polishes and artificial nails
- Tinea (fungal infection) of the nail plate typically leads to a thick, crumbling and discoloured nail plate. It’s always best to prove there is a fungal infection present by taking a good quality nail clipping of the affected area and send for fungal culture. If fungal infection is proven, then a course of oral anti-fungal tablets is required (can be a 3-6 month treatment). Typically, topical anti-fungal paints/tinctures are not effective when the nail plate is heavily infected. If you are going to salons for your mani/pedi, be careful to ensure instruments are sterilised properly; or better yet, bring your own set of instruments.
- Thrush infection of the nail plate can cause discoloured nails and lifting of the nail plate and may need treatment with oral anti-yeast tablets.
- Pseudomonas (bacterial infection) of the nail plate can cause the nail to have a black/green discolouration. Dilute white vinegar soaks can help to improve the appearance of the nail.
Onycholysis (lifting) of the nail plate
- Too much manipulation of the nail can lead to lifting of the nail plate – manicures/pedicures with soaking of the nails, inserting instruments to clean under the nail, trauma (from footwear and running for example)…all these factors influence the “adhesiveness” of the nail plate to the underlying nail bed.
- Another cause of nail plate lifting can be psoriasis of the nail; with other features seen including pitting of the nail, discoloured red/yellow nails and thick crumbling nails. Nail psoriasis can sometimes be mistaken for tinea (fungal infection).
- This refers to very thick nails that can resemble a scallop shell with layers upon layers of keratin deposited over many years. Often patients are concerned about tinea infection of the nail but nail clippings do not grow any tinea. Management of this condition is cutting back and filing down the nail (with podiatry help if needed) and getting good supportive footwear to prevent the condition worsening.
Longitudinal melanonychia (pigmentation) of the nail
- These present as long brown/black streaks on the nail plate and in most cases, is benign. Longitudinal melanonychia is seen often in patients with darker skin (Asians, Africans, Indians, Mediterranean backgrounds). It is thought to be due to a mole or a freckle residing around the area of the nail matrix and hence, as the nail grows, pigment is deposited along the nail plate.
- We always need to be on the lookout for melanoma of the nail unit. Features which are suspicious for melanoma include asymmetry of the pigment band, asymmetrically placed globules and dots, pigment bands of uneven thickness and uneven colour, and pigmentation on the skin at the base of nail (periungual fold).
Brittle nails/splitting of the nails
- can be dietary related and hence bloods to check on general health could be helpful
- General weathering of the nails from ageing, wet work, trauma etc can lead to brittle nails. We would recommend using a good quality hand cream and ensure the cuticles are not damaged.
- Nail supplements containing biotin (vitamin B) may be helpful.
- These are rare but can present as a split in the nail, a sore lump under the nail, or a lump that discharges fluid under the nail or around the nail fold. Treatment for these types of lumps is usually surgical excision via dermatologist or plastic surgeon.