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The Nail Doctor: Grooved Nails and Lifted Plates

byDr. Richard K. Scher, M.D. | June 1, 1997

Q: When the cuticle is pushed over-vigorously, can the nail then be affected by both onycholysis and leukonychia at the same time?

A: It is true that injury to the middle third of the nail matrix causes leukonychia, or white spots on the nail. The most common causes of this abnormality are over-vigorous pushing back of the cuticle with metal or wooden instruments and excessive cutting of the cuticles. If, at the same, the underside of the nail is excessively cleaned or poked, onycholysis can result. It is possible that a client can have leukonychia and onycholysis at the same time. Cuticle injury will not, as a rule, case onycholysis, but it can injure the nail matrix, resulting in an abnormal nail plate.

Q: I have a client who’s had very pretty natural nails until recently. Suddenly, her nail plates appear grooved. She does not wear artificial nails, is not on any medication, and is in good health. What caused this to happen and what can I do to fix her nails?

A: Nails may be grooved in two directions: from side to side or from the cuticle outward. When the grooves are from the cuticle outward, they are called longitudinal grooves of the nail, and these are most commonly caused by a cyst, or a little growth in the skin next to the proximal nail fold. To treat this type of cyst, called a myxoma, some form of surgery is typically performed.

When the grooves are from side to side, which is by far much more common, they are referred to as Beau’s lines. The most common cause of this disorder is a yeast infection of the skin around the cuticle. This infection injures the nail matrix; because of this type of injury, the matrix cannot produce a smooth nail but instead produces a grooved one. An infected cuticle is referred to as chronic paronychia, and is most commonly caused by the yeast fungus candida. Considering that your client is in good health and not on any medication, a doctor must first provide a diagnosis and treatment. If it is the common yeast infection, then it can be treated with antifungal creams or pills.

Q: How does a nail affected with onycholysis become reattached? One of my clients wants to know if her separated nail will reattach itself or if she will need surgery. How long does it typically take to reattach, or are there some nails that never do?

A: Onycholysis (separation of the nail plate from the nail bed) is a disorder with many different causes. The more common causes that I see in my practice include fungal infection (particularly the yeast fungus candida), psoriasis, or perhaps a sensitivity to certain nail products. Usually, nails will not reattach on their own unless the causative factor is eliminated, and surgery is not a recommended treatment for lifting nails. Sometimes cutting back the nails and removing the lifted portion and then treating the nail bed or skin underneath can be helpful, but it is difficult to know which treatment is correct unless the patient is evaluated medically with proper tests that point to a specific diagnosis.

Once the diagnosis is made and the client is treated for the disorder, it usually takes anywhere between three to six months for the nails to reattach, depending upon the extent of the lifting. Sometimes the nails never reattach. If the cause of the lifting is allowed to continue affecting the nail, it can eventually create a scar in the nail bed, and the nails won’t be able to reattach. Scar tissue typically accumulates over a very long period of time.

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Q: I have a client with arthritic hands. She doesn’t have much pain, but she has bone spurs on her first knuckles of all but one finger. On that one finger is the only healthy-looking nail. All the other nails appear to have disintegrated. I don’t think they are infected with fungus, and I’ve tried various protein-based nail strengtheners as well as fiberglass wraps to protect her nails. She doesn’t want long nails; she just wants them to look nice. I’m trying paraffin treatments on her, but they don’t seem to help. Is it her arthritis that is causing this?

A: It is unlikely that your client’s disintegrating nails are related to arthritis in the hands or fingers. Arthritis, as a rule, does not have a particular effect on the nails, nor do bone spurs. This client needs to see a dermatologist to determine what is causing her nails to disintegrate. It is not possible to diagnose the presence or absence of fungal infections of the nails just by looking at them. A doctor or medical lab must take a specimen from the nails to diagnose them as infected with fungus. All of your different efforts to help make this client’s nails improve are commendable but not likely to be effective if there is an underlying disease or nail disorder. Before you proceed any further with your services on her, your client’s needs to have her nails evaluated by a dermatologist.

Q: My client has ringworm under one of her nails. She went to a dermatologist, but none of the over-the-counter treatments he prescribed are working. Her nail has not grown for six months now, and it peels constantly; it looks deformed. Should I be working on her, and if so, what services can I perform? Can I spread this to other clients? Should she get a second opinion?

A: Ringworm of the nails is a fungal infection of the nails. This form of onychomycosis is known as tineaunguium. I assume that her dermatologist took samples of the nails to prove that the condition is actually a fungal infection, in which case your client has two choices. The first is to use an external medication in the form of a cream, gel, or lotion. Local medications, however, will not always be effective for fungal infections of the nails and internal treatment might be required. Presently, there are three internal medications for fungal infections available by prescription only. Itraconazole (Sporanox), terbinafine (Lamisil), and fluconazole (Diflucan) work well on ringworm of the nail, and should have cleared up the problem by now. She should return to her dermatologist and have her nails re-evaluated or, as you suggest, consider obtaining a second opinion.

While the infection is present, it is not a good idea to be working on her nails. Although disinfected implements should prevent the spread you could inadvertently spread the infection to her other fingers. You can apply nail polish but be sure not to push or trim the cuticles, as you can worsen the infection if you break the skin.

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