Nail Disorders

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

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 It?

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?

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 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

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

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

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.

Herbs

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

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

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

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. 20^th 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. 14^th ed. New York: McGraw-Hill; 1998.

Habif TP. Clinical Dermatology. 3^rd 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. 3^rd ed. Philadelphia PA: W.B. Saunders; 1998.

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

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

Copyright © 2000 Integrative Medicine Communications

The publisher does not accept any responsibility for the accuracy of the information or the consequences arising from the application use or misuse of any of the information contained herein including any injury and/or damage to any person or property as a matter of product liability negligence or otherwise. No warranty expressed or implied is made in regard to the contents of this material. No claims or endorsements are made for any drugs or compounds currently marketed or in investigative use. This material is not intended as a guide to self-medication. The reader is advised to discuss the information provided here with a doctor pharmacist nurse or other authorized healthcare practitioner and to check product information (including package inserts) regarding dosage precautions warnings interactions and contraindications before administering any drug herb or supplement discussed herein.