Clive Anderson
NAIL DISEASES can significantly affect a person's social interactions and overall health. As a society, we are very aware of our nails' health, and good nail care is an important aspect of grooming. Nails have become an important fashion accessory and are being adorned with ever increasing creativity. Because of the important role which the nails play in protecting our fingertips, they are vital to good health. This is especially the case in persons with some chronic diseases like diabetes. Alterations in the colour of the nails may be due to a disease process.
Yellow nails - this is frequently a sign of infection by fungi, yeast or both. It also occurs in some skin diseases like psoriasis and chronic eczema. In the case of psoriasis, the yellowing affects the whole nail at once, whereas in infection the discoloration usually starts from the edges of the nail and extends slowly to the base.
The big toenail is usually the first to be infected; often there is a history of some preceding injury. The fungus invades first the nail bed then spreads to the plate. The fungus-infected nail becomes thickened and brown. It may break easily and debris accumulates below the nail. The treatment of fungal nail infection is with oral antifungals or the application of a lacquer to the nail.
Yellow nails are not uncommon in the elderly.
Green nails - green colouring of the nails often means infection by a bacterial agent Pseudomonas aeruginosa or Klebsiella. The green colouring is due to the presence of the pigment, pyocynin, produced by the bacteria. This infection requires antibiotic treatment.
Brown/black nails - this colour change is usually seen in bands running down the nail. Not uncommonly, the whole nail becomes uniformly darker. This is due to an increase in the population of melanin-producing cells in the nail matrix or to extra melanin production.
In black people, this is common and is a variant of the norm. When the brown/black pigment affects only one nail, is irregular or extends to the surrounding finger, the possibility of a type of cancer a melanoma must be ruled out.
Any severe trauma to the nail bed will result in bleeding under the nail. The hematoma that forms will subsequently becomes dark in colour. Quick first aid to pierce the nail and allow the blood to escape will prevent months of looking at a black nail.
White nails - this is the most frequent alteration of nail colour. If the white colour is superficial and may be scraped off, it may be due to a superficial fungus. A dotted white discoloration may be produced by trauma to the nail and is often seen after removing artificial nail.
In onycholysis the nail plate separates from the nail bed. This is often due to some form of trauma to the nail as can occur in the big toenails from too tight footwear. It may also be seen when artificial nails are removed improperly. Prolonged or repeated immersion in water may also cause this lifting. Persons who suffer from sweaty hands and feet may also notice this condition. In 'half-and-half nails', the part of the nail nearest to the base is white while the rest is pink or brown. This change may be a sign of kidney disease but is not uncommon in healthy elderly persons.
These are but a few of the more common changes in nail colour. Because the nails grow very slowly, only 0.05 - 0.1 mm per day, these changes may develop slowly and the treatment is agonisingly slow. Watch your nail colour. This is especially important to those who sport artificial nails. Your real nail story may be obscured.
Dr. Clive Anderson is a dermatologist and venereologist; email: yourhealth@gleanerjm.com.
