There are a variety of types of nail disorders, and fungal infection is the most common. In 80 percent of cases of fungal infection, the toenails are affected. With proper treatment, most damaged nails can regrow into healthy nails.

Signs and Symptoms of Nail Disorders

Nail disorders are accompanied by the following signs and symptoms.
- Discoloration or spotting
- Painful, red swelling
- Pits, ridges, scars
- Lesions
- Brown-black band

What Causes Nail Disorders?

Nail disorders are caused by infections, skin diseases, benign or malignant tumors, or certain system-wide diseases. They also may be self-induced.

Who’s Most At Risk for Nail Disorders?

The following are risk factors for nail disorders.
- Genetic predisposition
- Excessive exposure to water, heat, and humidity
- Tight-fitting shoes
- Chemical damage
- Diabetes
- Skin diseases
- Tumors
- Overmanicuring
- Habits involving picking at the skin surrounding a nail
- Soil contamination
- Human immunodeficiency virus (HIV), the virus that causes AIDS

What to Expect at Your Health Care Provider’s Office

If you are experiencing symptoms associated with a nail disorder, you should see your health care provider. A combination of a physical exam, lab tests such as fungal or bacterial cultures, and imaging procedures in the case of a suspected tumor are used for making a diagnosis.

Treatment Options for Nail Disorders

Prevention
- Keep your toenails cut short.
- Make sure your shoes fit properly.
- Avoid walking barefoot at public showers and swimming facilities.
- Throw out old, worn footwear.

Treatment Plan for Nail Disorders

The infected nail may be removed, and medication you take by mouth as well as medication you apply to the nail is usually prescribed.

Drug Therapies

Your provider may prescribe the following antifungal or antibacterial medications.
- Terbinafine
- Itraconazole
- Fluconazole
- Steroids
- Antibiotics

Surgical and Other Procedures

Lesions may be removed or drained, blood clots may be drained, and sometimes the nail must be surgically removed.

Complementary and Alternative Therapies

A comprehensive treatment plan for nail disorders may include a range of complementary and alternative therapies.

Nutrition for Nail Disorders

Consume adequate protein and minerals for general nail health. Increase the amount of nuts, seeds, whole grains, legumes, fresh vegetables, sea vegetables, and cold-water fish that you eat. Avoid sugars, alcohol, caffeine, and refined foods.

Potentially beneficial supplements to counteract nutrient deficiencies include the following.
- Vitamin A (10,000 IU per day)
- Zinc (15 to 30 mg per day)
- Essential fatty acids (i.e., flax, borage, or evening primrose oil) 1,000 to 1,500 mg twice a day
- Iron (ferrous glycinate 100 mg per day)
- Vitamin B12 (1,000 mcg per day)
- Digestive enzymes and/or free-form amino acids may help with compromised digestion or malabsorption.

Herbal Remedies for Nail Disorders

Herbal remedies may offer relief from symptoms. Herbs are generally available as dried extracts (pills, capsules, or tablets), teas, or tinctures (alcohol extraction, unless otherwise noted). Dose for teas is 1 heaping tsp. per cup of water steeped for 10 minutes (roots need 20 minutes).
- With nutritional deficiencies, take 15 to 20 drops of the following tincture three times per day or drink two to three cups of tea daily: ginger (Zingiber officinalis), nettles (Urtica urens), dandelion herb (Taraxecum officinalis), horsetail (Equisetum arvense), spearmint (Mentha spicata), and hawthorn (Crataegus monogyna) in equal parts.
- With bacterial or viral infection, combine equal parts of coneflower (Echinacea purpurea) and goldenseal (Hydrastis canadensis) with one-half part of ginger. Take 20 drops tincture four times per day.
- With fungi, molds, or yeast infection, combine equal parts of coneflower, oregano (Origanum vulgare), spilanthes (Spilanthes acmella), usnea (Usnea barbata), Oregon grape root (Mahonia nervosa), and myrrh (Commiphora molmol). Take 20 drops tincture four times per day.
- Apply undiluted grapefruit seed extract or tea tree oil to affected nail. Do not allow contact with skin.

Homeopathy for Nail Disorders

Some of the most common remedies include calcarea carbonica, graphites, and sulfur. Acute dose is three to five pellets of 12X to 30 C every one to four hours until symptoms are relieved.

Acupuncture

Acupuncture may be help to enhance immune function, normalize digestion, and address disease conditions.

Massage

Massage can help stimulate circulation, which aids the transport of nutrients to the nail bed.

Prognosis/Possible Complications for Nail Disorders

Toenail regeneration generally takes 8 to 12 months, while fingernail regeneration takes half as long. Relapses or permanent damage sometimes occur. Complications may include cellulitis (tissue inflammation) and the embarrassment caused by unsightly nail appearance.

Following Up

Follow-up with your health care provider may be needed in the case of drug side effects or interactions.

Supporting Research on Nail Disorders

Burton Goldberg Group. Alternative Medicine: The Definitive Guide. Tiburon, CA: Future Medicine Publishing, Inc.; 1997: 951,952.

Cecil RI, Plum F, Bennett JC, eds. Cecil Textbook of Medicine. 20th ed. Philadelphia, PA: W.B. Saunders; 1996.

Dambro MR. Griffith’s 5-Minute Clinical Consult. 1999 ed. Baltimore, MD: Lippincott Williams & Wilkins, Inc.; 1999.

Fauci AS, Braunwald E, Isselbacher KJ, et al, eds. Harrison’s Principles of Internal Medicine. 14th ed. New York: McGraw-Hill; 1998.

Habif TP. Clinical Dermatology. 3rd ed. St. Louis, MO: Mosby-Year Book; 1996.

Morrison R. Desktop Guide to Keynotes and Confirmatory Symptoms. Albany, Calif: Hahnemann Clinic Publishing; 1993.

Rakel RE, ed. Conn’s Current Therapy. 51st ed. Philadelphia, PA: W.B. Saunders; 1999.

Roberts JR, ed. Clinical Procedures in Emergency Medicine. 3rd ed. Philadelphia, PA: W.B. Saunders; 1998.

Scalzo R. Naturopathic Handbook of Herbal Formulas. 2nd ed. Durango, Colo: Kivaki Press; 1994: 40.

Scher RK. Novel treatment strategies for superficial mycoses. J Am Acad Dermatol. 1999; 40(6).

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