Healthy, well-groomed fingernails are one of the figureheads of a person. If a nail shows deformations and discolorations, this usually indicates a disease. Nail deformities should therefore be examined medically.
What are nail deformities?
Finger and toenails are – physiologically speaking – plates consisting of corneal cells that protect the ends of the fingers and feet from injury and simplify gripping and walking movements or make them possible in the first place. Nails grow indispensably and are thus constantly renewed. In the case of fingernails, the renewal process takes about half a year, and in the case of the much thicker toenails, about a year. The healthy nail is characterized by a relatively smooth surface structure, it is half round and looks slightly pink in color. Nail deformation is understood as all changes in the fingernail or toenail. This includes changes in the relief (furrow or dimple formation) or the change in the shape of the nail (formation of a spoon or watch nail). In addition, a nail plate attachment disorder may occur, which causes the nail to already grow incorrectly out of the nail pocket. As a result, splitting of the nail may occur (onychoschisis), tearing may occur (onychorrhexis), or the nail may detach completely (onycholysis).
Causes
The causes of nail deformity can vary widely. One of the most common causes of nail deformation is a fungal infection (nail fungus, nail mycosis). For example, fungi can enter the nail bed through a damaged nail plate and cause nail deformation. Another common cause of nail deformation is injury to the nail matrix as a result of minor accidents. Bacteria can also cause nail deformities. Nail deformities can also occur due to permanent, repeatedly inflicted injury to the nail, such as persistent nail biting. People who frequently come into contact with chemical solvents also tend to develop nail deformities. Other common causes of nail deformities include psoriasis, warts, vitamin and iron deficiencies, heart, lung and gastrointestinal diseases, and HIV infection or incipient cirrhosis of the liver.
Symptoms, complaints, and signs
Nail deformities are primarily manifested by the visible deformities of the finger or toe nails. The affected toenails are either deformed, discolored, thicker or thinner than before, or damaged by tearing. Partial or complete detachment of the nail plate is also possible. Nail deformities may be limited to one fingernail or toenail, but occasionally all nails are affected. If there is an underlying deficiency, the deformities usually occur on all nails and toes. A clear sign of nail deformities are white or gray spots on the nails. These occur mainly when there is an iron deficiency. If the nail deformations are based on a serious disease, serious physical complaints may develop in the further course. Nail deformations, for example, are the first warning sign of liver cirrhosis, which in the further course becomes noticeable as jaundice. If neurodermatitis is the cause, skin changes such as redness and itching occur after a short time. In addition, the affected areas of the skin flake badly. Since nail deformations can have diverse causes, the external symptoms are not sufficient for a cause, and a more extensive diagnosis must always be carried out by means of ultrasound examination or blood tests.
Diagnosis and course
If a nail deformity occurs, the doctor will first diagnose the cause. Thus, he will first ask about underlying diseases or clarify whether the patient frequently handles chemical solvents. In order to be able to characterize the nail deformation precisely, the doctor will take a close look at the nail using a dermatoscope and thus obtain an initial indication of the cause of the deformation. A blood test or a smear of the nail bed with subsequent examination in the laboratory will provide information about a fungal or bacterial infection. If growths of the nail have occurred, laboratory testing will also determine if the growths are malignant. Malignant growths or nail bed tumors occur very rarely.
Complications
Nail deformities as such rarely lead to complications. However, they often occur as concomitant symptoms of various diseases. Therefore, most complications associated with nail deformities are due to the underlying diseases. However, psychological problems can occur as a direct consequence of nail deformities. This particularly affects people who already suffer from lowered self-esteem and additionally bite their fingernails. Since the success of the treatment fails to materialize due to the biting, it is not uncommon for a vicious circle to develop, leading to depression or even suicidal thoughts. In these cases, psychological counseling and therapy are urgently recommended. However, to rule out organic complications, it is first necessary to treat the underlying disease. In addition to fungal infections, liver cirrhosis, iron deficiency, skin eczema, heart disease, circulatory disorders, tumors and much more may be present. When the cause of nail deformities is eliminated, nail reconstruction can be performed. In this process, medications and, in the case of fungal infections, antibiotics are applied to the nail. This usually leads to quick success and also does not cause side effects and complications. Within a few days, the nail deformities disappear with this treatment. However, it may happen that the nail is completely destroyed. In these cases, parts of the nail may need to be surgically removed. Again, the nail usually rebuilds quickly without complications.
When should you go to the doctor?
Since nail deformities are important signs of an existing underlying disease, they should always be presented to a doctor for clarification. Although there is often no need for treatment and it is not a condition that requires medical attention, this can only be determined by an evaluation by a physician. If the nail deformities occur after an accident or a slight bruise, a visit to the doctor is necessary if pain develops or there is a malposition of the finger or toe. Minor injuries and deformations do not need to be examined by a doctor, as they usually grow out on their own in the coming months due to the natural growth process. If the nail deformations lead to emotional or mental stress, a doctor is needed. Psychological disorders can develop due to the optical blemish, which should be prevented in time. In case of further complaints such as a change in the skin appearance, a reduced gripping function or a decrease in physical strength, a doctor should be consulted. Discoloration or easy breaking of the nails are indications of a disease or nutrient deficiency that should be investigated and treated.
Treatment and therapy
The therapy of nail deformation depends in each case on the cause. In the case of harmless deformation, nail therapeutics, which are applied to the nail and stimulate growth, are usually sufficient to correct the deformation of the nail. Infections are treated with antiseptics. Using an incision of the affected nail plate, the antiseptic is applied directly to the site of infection. If this alone does not help, the doctor will prescribe an antibiotic in case of a bacterial infection, and an antifungal in case of an infection with a fungus. In the case of particularly serious nail deformities, it may be advisable to remove parts of the nail or the entire nail so that it can subsequently grow back normally. For this purpose, the doctor will anesthetize the finger or toe locally and loosen the nail or cut out the diseased areas. The wound is then dressed antiseptically. The procedure is generally not painful.
Outlook and prognosis
Nail deformities can result from many different diseases and conditions. The prognosis is based on the causative condition. In principle, most nail deformities can be treated symptomatically. A normal nail appearance can be restored by cosmetic means, surgical interventions or drug treatment. Often, careful care of the nails and avoidance of typical triggers such as soaps, hormonal imbalance or medication is sufficient. Those affected do not usually suffer physically from the nail deformities. However, the external blemish can have a negative impact on well-being.If the complaints are based on a serious disease such as cirrhosis of the liver or thyroid disease, the prognosis is less positive. Life expectancy is based on the triggering condition, although the nail deformities themselves can be treated relatively well. The exact prognosis can only be given by the doctor in charge. Due to the large number of possible causes that can have cracks, discoloration or adhesions in the area of the nails, specialists should be consulted. With the help of a therapist, any mental discomfort that may have occurred as a result of nail deformation can be worked through. This usually also improves the well-being again.
Prevention
To prevent nail deformities, anyone who frequently comes into contact with chemical solvents should wear gloves. Also, nail deformities that occur due to iron deficiency can be prevented with the supplemental intake of an iron supplement. Infection with fungus or bacteria is best prevented by protecting the nail from intruders in the case of minor injuries – for example with a plaster. Persistent nail biting can also be treated or prevented with appropriate medications that are applied to the nails and taste bad.
Aftercare
When nail deformities have healed or the therapy process is successfully approaching an end, aftercare measures become more important. The respective cause of the nail deformation in the patient is always relevant, provided it is known. This is because the most important measures that are significant after a nail deformation result from the cause of the disease. If the deformations are caused by fungal infections, thorough hygiene should be observed from then on, for example when visiting public bathing establishments. Deformations as a result of mechanical stress can only be permanently cured if the damaging influences no longer affect the nail. This should be taken into account, for example, at work, during sports or activities in the household. Some deformations of the nails are sometimes caused by ill-fitting footwear, so aftercare also includes the purchase of optimally fitting shoes. Also ingredients of nail polishes or removers can damage the nail. If this is the cause of the nail deformations, this should be considered in the future and the use of corresponding decorative cosmetics should be restricted. In principle, higher hygienic standards and the avoidance of mechanical stress after nail deformation are always sensible. These measures can prevent new deformations of the finger or toe nails. Control appointments with the treating dermatologist or orthopedist may be appropriate to continuously check the healing of the deformation.
What you can do yourself
Deformations of the nails represent, in addition to the disease value, also a visual blemish. This leads to discomfort, emotional problems or stress in many sufferers. In the context of self-help, various methods can be used to achieve relief from the discomfort. It is important to have psychological strength in everyday life. In the case of nail deformities, a healthy self-confidence is necessary so that emotions such as shame or disgust do not arise. In addition, if the disease is dealt with openly, unpleasant looks or comments from fellow people can be avoided or answered well. Informing people in the immediate vicinity leads to great relief for everyone involved. Often the situation is also uncomfortable for them and they are overwhelmed. Wearing clothing that allows hands and fingers to be well concealed is found helpful by many of those affected. Long-sleeved tops with a wide cuff on the arm help to quickly conceal hands and fingers when needed. Cosmetic instruments such as nail polish or artificial nails are not recommended for most conditions present. Nevertheless, consultation with the doctor should be sought to clarify this. If there are no objections from a medical point of view, painting the nails or using artificial nails will help both women and men to make corrections.