Healthy, well-groomed fingernails are one of the hallmarks of a person. If a nail shows deformation and discoloration, this usually indicates a disease. Nail deformations should therefore be examined medically.
What are nail deformities?
From a physiological point of view, fingernails and toenails are plates made of corneal cells that protect the ends of the fingers and feet from injuries and make gripping and running movements easier or even possible in the first place. The nails grow inevitably and are thus constantly renewed. The renewal process for fingernails takes about half a year, and for toenails, which are much thicker, about a year. See photionary for Histiocytosis 101.
The healthy nail is characterized by a relatively smooth surface structure, it is semi-circular and appears slightly pink in color. Nail deformation is any change in the fingernail or toenail. This includes changes in the relief (formation of furrows or pits) or changes in the shape of the nail (formation of a spoon or watch nail).
In addition, a contact disorder of the nail plate can occur, which causes the nail to grow out of the nail pocket incorrectly. As a result, the nail can split (onychoschisis), tear (onychorrhexis) or the nail can detach completely (onycholysis).
The causes of nail deformation can be very different. One of the most common causes of nail deformation is a fungal infection (nail fungus, nail mycosis). For example, fungi can penetrate the nail bed via a damaged nail plate and cause nail deformation there.
Another common cause of nail deformities 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, repetitive injury to the nail, such as prolonged nail biting.
People who frequently come into contact with chemical solvents also tend to develop nail deformities. Other general diseases can also be considered as other causes of deformed nails: psoriasis, warts, vitamin and iron deficiency, heart, lung and gastrointestinal diseases as well as an HIV infection or the onset of cirrhosis of the liver.
Symptoms, Ailments & Signs
Nail deformations are primarily expressed through the visible deformations of the fingernails or toenails. The affected toenails are either deformed, discolored, thicker or thinner than before, or damaged by cracks. Partial or complete detachment of the nail plate is also conceivable. Nail deformities can be limited to one fingernail or toenail, but occasionally all nails are affected.
When there is a defect underlying the deformities, the deformities usually appear on all nails and toes. A clear sign of nail deformation is white or gray spots on the nails. This occurs especially when there is an iron deficiency. If the deformed nails are caused by a serious illness, serious physical problems can develop later on.
For example, deformed nails are the first warning sign of cirrhosis of the liver, which later becomes noticeable in the form of jaundice . If neurodermatitis is the cause, skin changes such as redness and itching will occur after a short time. In addition, the affected skin areas flake severely. Since deformed nails can have various causes, the external symptoms are not sufficient for a cause, and a further diagnosis by means of an ultrasound examination or a blood test must always be carried out.
Diagnosis & History
If nail deformation occurs, the doctor will first diagnose the cause of this. He will first ask about underlying diseases or clarify whether the patient frequently comes into contact with chemical solvents.
In order to be able to precisely characterize the nail deformation, the doctor will use a dermatoscope to take a close look at the nail and thus get an initial indication of the cause of the deformation. A blood test or a swab of the nail bed followed by a laboratory test will provide information about a fungal or bacterial infection.
If growths of the nail have occurred, laboratory tests are also carried out to determine whether the growths are malignant. Malignant growths or nail bed tumors only occur very rarely.
Nail deformations as such hardly lead to complications. However, they often occur as an accompanying symptom of various diseases. Therefore, most of the complications related to nail deformities are due to the underlying medical conditions. However, psychological problems can occur as a direct result of nail deformation.
This is especially true for people who already suffer from low self-esteem and also bite their fingernails. Since chewing does not result in successful treatment, a vicious circle often develops, leading to depression or even suicidal thoughts. In these cases, psychological counseling and therapy is urgently recommended.
However, in order to exclude 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 can also be present. Once the cause of the nail deformation has been eliminated, the nail can be built up. Drugs and antibiotics for fungal infections are applied to the nail.
This usually leads to quick success and also does not cause any side effects or complications. Within a few days, the nail deformities disappeared with this treatment. However, it can happen that the nail is completely destroyed. In these cases, parts of the nail may have to be surgically removed. Here, too, the nail is usually rebuilt 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 disease that requires medical care, this can only be determined by an assessment by a doctor.
If the nail deformation occurs after an accident or a slight bruise, a doctor’s visit is necessary if pain occurs or if the finger or toe is misaligned. Slight injuries and deformities do not need to be examined by a doctor, as they usually grow out of their own accord over the coming months as a result of the natural growth process. If the nail deformations lead to emotional or mental stress, a doctor is needed. The visual flaw can lead to mental disorders, which should be prevented in good time.
A doctor should be consulted if there are other symptoms such as a change in the appearance of the skin, a reduced grasping function or a decrease in physical strength. Discoloration or slight breakage of the nails are indicators of a disease or nutrient deficiency that should be evaluated and treated.
Treatment & Therapy
The treatment of nail deformation depends on the cause. In the case of harmless deformations, nail therapy that is applied to the nail and stimulates growth is usually sufficient to correct the deformation of the nail.
Infections are treated with antiseptics. By means of an incision in the affected nail plate, the antiseptic is applied directly to the focus of infection. If that alone does not help, the doctor will prescribe an antibiotic in the case of a bacterial infection, and an antifungal in the case of a fungal infection.
In the case of particularly severe nail deformities, it may be advisable to remove parts of the nail or the entire nail so that it can then grow back normally. To do this, the doctor will numb the finger or toe locally and loosen the nail or cut out the diseased areas. The wound is then bandaged with an antiseptic. The procedure is generally not painful.
Outlook & Forecast
Nail deformities can result from many different diseases and conditions. The prognosis depends on the causative disease. In principle, most nail deformations can be treated symptomatically. A normal nail pattern can be restored by cosmetic means, surgical interventions or drug treatment. Careful care of the nails and avoidance of typical triggers such as soaps, hormonal imbalance or medication is often sufficient.
Those affected usually do not suffer physically from the deformed nails. However, the external blemish can have a negative effect on well-being. If the symptoms are due to a serious illness such as liver cirrhosis or a thyroid disorder, the prognosis is less positive. Life expectancy is based on the disease that caused it, although the deformed nails themselves can be treated relatively well.
Only the doctor responsible can provide the exact prognosis. Due to the large number of possible causes that can have cracks, discoloration or adhesions in the nail area, specialist doctors should be consulted. With the help of a therapist, any psychological problems that have occurred as a result of nail deformation can be worked through. As a rule, this also improves well-being.
To avoid nail deformation, everyone who frequently comes into contact with chemical solvents should wear gloves. Nail deformations that occur due to iron deficiency can also be prevented by taking an iron supplement.
The best way to prevent an infection with a fungus or a bacterium is to protect the nail from the invaders in the case of minor injuries – for example with a plaster. Persistent nail biting can also be treated or stopped with appropriate medications that are applied to the nails and taste bad.
When nail deformities have healed or the therapeutic process is successfully coming to an end, aftercare measures become more important. The respective cause of the patient’s nail deformation is always relevant, provided this is known. Because the cause of the disease results in the most important measures that are important after nail deformation.
If the deformations are caused by fungal infections, thorough hygiene must be observed from now on, for example when visiting public baths. Deformations as a result of mechanical stress can only be permanently healed if the damaging influences no longer affect the nail. This must be taken into account, for example, at work, during sports or household chores.
Some deformities of the nails are sometimes caused by ill-fitting shoes, so that the aftercare also includes the purchase of shoes that fit perfectly. Ingredients in nail polishes or removers can also damage the nail. If this is the cause of the nail deformation, 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 always make sense. These measures can prevent new deformation of the fingernails or toenails. Check-up appointments with the attending dermatologist or orthopedist can be appropriate to continuously check the healing of the deformity.
You can do that yourself
Deformations of the nails represent not only the disease value but also an optical flaw. This leads to discomfort, emotional problems or stress in many of those affected. Various self-help methods can be used to alleviate the symptoms.
Mental strength is important in everyday life. Healthy self-confidence is necessary for nail deformities so that emotions such as shame or disgust do not arise. In addition, when dealing with the disease openly, unpleasant looks or comments from other people can be avoided or answered well. Enlightening the people from the immediate vicinity leads to a great deal of relief for everyone involved. The situation is often uncomfortable for them too and they are overwhelmed.
Many of those affected find it helpful to wear clothing that allows them to hide their hands and fingers. Long-sleeved tops with a wide cuff on the arm help to quickly hide hands and fingers if necessary. Cosmetic instruments such as nail polish or artificial nails are not recommended for most existing diseases. Nevertheless, consultation with the doctor should be sought to clarify this. If there are no objections from a medical point of view, both women and men can help by painting their nails or using artificial nails to make corrections.