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MANAGEMENT OF COMMON NAIL DISORDERS
ORLANDO, FL (March 2, 1998) - For many, nails are an important part of their appearance. Short or long, manicured or bitten, nails protect the fingers and toes from injury. Society has come to enjoy nails as an art form and a fashion statement. Stores and salons nationwide offer various press on nails, nail sculptures, tips and jewels. Millions apply nail polish, nail sunscreens, and the latest strengtheners and quickdries. However, finger and toe nails are an often neglected appendage that suffer a variety of disorders requiring dermatologic treatment. To a dermatologist, the most important statement made by nails points to the inner health of the individual.
Speaking at the American Academy of DermatologyÃs 56th Annual Meeting, in Orlando, Richard K. Scher, MD, Professor of Clinical Dermatology at New YorkÃs Columbia University, spoke about the management of common nail disorders. Dr. Scher is an expert in the field of nail diseases and nail surgery.
"Dermatologists can improve the appearance of the nail, recommend cosmetics that can maintain nail health, treat nail disease, and even diagnose other conditions of medical importance, based upon the appearance of the nails," Dr. Scher said.
Dermatologists view the nail as a mirror of inner health. For example, patients suffering circulation problems may experience a bluish/purple nail bed. Psoriasis sufferers may have tiny dents in the nail plate, and fungal infections may be revealed in a misshapen, thickened nail plate. In addition, broken blood vessels beneath nails may signal lupus, and a discolored nail plate may indicate liver or kidney disease. Chemotherapy may present horizontal grooves in the nail plate.
The development of the finger nail unit begins at about the ninth week of gestation and is completed sometime after the 22nd week. Toenail development takes longer. The nail plate is composed mainly of protein and water. Contrary to public belief, calcium plays a very small role in nail hardiness and comprises little of its substance.
It has been reported that 50% of the nearly five million Americans suffering from skin psoriasis, report psoriatic nail involvement. Nail psoriasis is difficult to treat and responds slowly to therapy. It affects children as well as adults and the elderly. "The clinical manifestations of psoriasis of the nail unit may range from minimal--in the form of simple pitting--to extensive changes involving virtually the entire nail," Dr. Scher said.
Nail psoriasis without psoriasis elsewhere on the body is rare. The lesions commonly seen on psoriatic nails are in the following frequency: pits; discoloration of the nail bed; onycholysis; subungual thickening (hyperkeratosis); nail plate abnormalities such as crumbling and grooving of nails, and splinter hemorrhages.
Corticosteroids, 5-fluorouracil, systemic agents such as photochemotherapy, oral retinoids, and methotrxate as well as nail avulsion (surgical removal) are among the therapeutics being utilized.
One common nail disorder is onychomycosis, a fungal infection which affects the finger and toe nails, and accounts for about 50% of all nail diseases. Often afflicting the elderly, onychomycosis causes the nails to become thickened, hard to cut and painful. The disorder is made worse by moisture, warmth, trauma, communal bathing, and other activities that lead to exposure to the fungus. Treatment with new antifungal drugs such as itraconazole, terbinafine, and fluconazole are successfully being used.
"There is a constant reservoir of fungi in the nail that can reinfect the patient, or be passed on to others. It is important that treatment is not neglected. These medications, coupled with new dosing regimens, offer new and improved ways to treat this disorder," said Dr. Scher.
The American Academy of Dermatology is the largest medical society representing over 10,000 physicians who specialize in treating skin, hair, and nail conditions. # # #
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