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 re-grow into healthy nails.
Signs and SymptomsNail disorders are accompanied by the following signs and symptoms.
- Discoloration or spotting
- Painful, red swelling
- Pits, ridges, scars
- 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
- Skin diseases
- 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 OfficeIf 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.
- 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 PlanThe infected nail may be removed, and medication you take by mouth as well as medication you apply to the nail is usually prescribed.
Drug TherapiesYour provider may prescribe the following antifungal or antibacterial medications.
Surgical and Other ProceduresLesions may be removed or drained, blood clots may be drained, and sometimes the nail must be surgically removed.
Complementary and Alternative TherapiesA comprehensive treatment plan for nail disorders may include a range of complementary and alternative therapies.
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)
- Vitamin C (250 to 500 mg two times per day)
- Vitamin E (400 IU per day)
- Digestive enzymes and/or free-form amino acids may help with compromised digestion or malabsorption.
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.
There have been few studies examining the effectiveness of specific homeopathic remedies. A professional homeopath, however, may recommend one or more of the following treatments for nail disorders based on his or her knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type. In homeopathic terms, a person's constitution is his or her physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.
- Calendula — for reddish, scaly rashes
- Graphites — for cracking skin and nails with oozing fluid caused by fungal infections; symptoms improve with open air
- Sulphur — for fungal disorders that itch, particularly if warmth worsens symptoms
Acupuncture may be help to enhance immune function, normalize digestion, and address disease conditions.
Massage can help stimulate circulation, which aids the transport of nutrients to the nail bed.
Prognosis/Possible ComplicationsToenail 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 UpFollow-up with your health care provider may be needed in the case of drug side effects or interactions.
Antibiotics. NMIHI. Accessed at http://drugs.nmihi.com/antibiotics.htm on March 17, 2018.
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. 20th ed. Philadelphia, PA: W.B. Saunders; 1996.
Cummings S, Ullman D. Everybody's Guide to Homeopathic Medicines. 3rd ed. New York, NY: Penguin Putnam; 1997: 270-271.
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. 14th ed. New York: McGraw-Hill; 1998.
Fluconazole. NMIHI. Accessed at http://www.nmihi.com/f/fluconazole.html on March 17, 2018.
Habif TP. Clinical Dermatology. 3rd ed. St. Louis, MO: Mosby-Year Book; 1996.
Jonas WB, Jacobs J. Healing with Homeopathy: The Doctors' Guide. New York, NY: Warner Books; 1996: 259.
Morrison R. Desktop Guide to Keynotes and Confirmatory Symptoms. Albany, Calif: Hahnemann Clinic Publishing; 1993.
Nail fungus. MFMER. Accessed at https://www.mayoclinic.org/ on March 17, 2018.
Nail Diseases. MedlinePlus. Accessed at https://medlineplus.gov/naildiseases.html on March 17, 2018.
Rakel RE, ed. Conn's Current Therapy. 51st ed. Philadelphia, PA: W.B. Saunders; 1999.
Roberts JR, ed. Clinical Procedures in Emergency Medicine. 3rd ed. Philadelphia, PA: W.B. Saunders; 1998.
Scalzo R. Naturopathic Handbook of Herbal Formulas. 2nd ed. Durango, Colo: Kivaki Press; 1994: 40.
Scher RK. Novel treatment strategies for superficial mycoses. J Am Acad Dermatol. 1999; 40(6).
Terbinafine. NMIHI. Accessed at http://www.nmihi.com/t/terbinafine.html on March 17, 2018.
Tips for Healthy Nails American Academy of Dermatology Accessed at https://www.aad.org/ on March 17, 2018.