Health

What is causing the deep horizontal ridges and swollen cuticles in my client’s nails?

May 20, 2013 | Bookmark +

I have a client who has deep horizontal ridges in her nails. Her cuticle area is kind of swollen and irritated also. I’m thinking Beau’s lines, but I just want to see what an expert has to say.

Answer

This client has a chronic paronychia with resultant nail dystrophy and possibly a habit tic deformity. You are right to have noticed that the cuticle is swollen or boggy. That is because the cuticle barrier has been compromised and when that occurs water can enter the nail unit. Once moisture accumulates, yeast will take up residence because yeast thrives in warm moist environments. The cuticle directly overlies the nail matrix and that is why the nail is growing in abnormally — because the matrix is what grows into the actual nail plate. Therefore any inflammation or trauma in the area of the cuticle is going to potentially result in a damaged nail. Your client’s cuticle is being compromised somehow. I would ask her if she pushes back on it with her index finger (habit tic). It is also possible that the cuticle is being removed. I always tell my patients that the cuticle is like the grout in your bathtub. It prevents water from seeping into the cracks. The cuticle is an important and amazing protective structure. Your client should not touch her cuticles and she should see a dermatologist. She will likely need a prescription medication to treat the current issue. The beauty of this diagnosis is that if treated properly, the nail will grow in normally.

— Dana Stern, M.D. is a board-certified dermatologist specializing in nails. She works in private practice in New York City.

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What’s the cause of the pinkish-red oval area on the pad of my client’s toes?

I have a client who has a recurring problem with her fourth toes during the winter months. Both of her “ring finger” toes develop a pinkish-red oval area on the pad. Then a month later, when I see her again, the skin has become dry and hard like a callus, with the layers of skin peeling away to reveal a deeper, dark epicenter.  It’s extremely painful for her and, needless to say, we do not touch it. But it clears up in the summer when she’s wearing open-toed sandals, so I suspect it has to be due to the boots she wears in the winter. Plus she never puts lotion on her feet or uses a foot file in between visits. What do you think causes this?

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What are the big white spots on my natural-nail client’s nails?

I have a client who has been with me for about two years. She used to wear acrylic nails but has been a natural nail client for eight months or so. She has these white spots on her nails — big spots that are dry, but not flaky, right in the middle of the nail. I did try to buff them lightly but they do not come off or grow off. I had a new client come in last week who had the same on her toenails. She said it started after she had a pedicure done at another salon. Can you help?

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