One of the most common chief complaints in my practice is, “ugly nails.” This is frequently followed up with a comment about how the topical nail fungus solution that has been applied for over a year is not working. Unfortunately, nail fungus is a very difficult and lengthy process to treat. In many cases, however, the cause of the “ugly nail” is not fungus at all. This is why it is important to obtain a nail biopsy before commencing treatment for nail fungus.
Other Causes of Ugly Nails
Trauma
Trauma does not always mean dropping a heavy weight on your nail, and in the worse case scenario having the nail fall off. If you have ever lost a nail, it is likely that the nail has since grown back thickened or with a ridge in it. Nail trauma can also involve the constant pressure of your nail against the inside of a tight shoe, children and pets stepping on them, or even stubbing a toe. These types of injuries can be treated with trauma prevention and emollients that will help the nail to grow in softer and more regular.
Systemic Disease
Diseases such as Diabetes, peripheral arterial disease, and thyroid disease, frequently cause changes in the appearance of nails. The nails may change color, becoming white, yellow, or even dark. In many cases the nail also becomes brittle and difficult to cut. Nail clubbing can be associated with lung and heart disease.
Psoriasis
If you have Psoriasis of your skin, you are at a greater risk of Psoriatic disease in your nails as well. This will present with nail pitting, white spots, or splintering of the nail.
Drug Interactions
- Chemotherapy can leads to thick transverse grooves in the nail called “Beau’s Lines.”
- Tetracycline can lead to Black nails.
- Arsenic poisoning shows up as transverse white lines called “Mee’s Lines.”
Subungual Melanoma
This is a malignant lesion that requires immediate treatment involving excision of the melanoma. This most commonly appears as a vertical, dark line through the entire nail and into the skin where the nail attaches. This is referred to as “Hutchinson’s Sign.”
In cases where the nail biopsy is positive for fungus, there are treatment options. These treatments include both topical and/or oral medications. If you are concerned about fungus in your nails, call Hollowbrook Foot Specialists today at (845) 298-9074 for an appoint. We are here for all of your foot needs, serving the Hudson Valley from Wappingers Falls!
By: Samantha DelRegno D.P.M.
