Nail Disorders

Nail disorders cover anything that changes the colour, shape, thickness or attachment of fingernails and toenails. The common ones are fungal infection, nail psoriasis, ingrown toenails, trauma-related changes, brittle nails and infections of the nail fold.

Nails grow slowly, about 3 mm a month for fingers and 1 mm for toes, so any treatment takes months to show. A changed nail can also be a sign of a general illness or, rarely, a tumour under the nail, which is why a persistent single abnormal nail deserves a proper look.

Symptoms

• Thick, crumbly, yellow or white nails, typical of fungal infection
• Pitting, salmon-coloured patches or lifting of the nail, typical of psoriasis
• Nail separating from the nail bed (onycholysis)
• A toenail edge digging into red, swollen, painful skin
• Ridges, splitting and brittleness
• Spoon-shaped nails or clubbing of the fingertips
• A brown or black band along one nail

Causes and risk factors

Fungal infection accounts for roughly half of abnormal nails and is favoured by age, sweaty footwear, athlete's foot, diabetes and poor circulation. Psoriasis, lichen planus and eczema affect the nail matrix. Repeated wetting, nail cosmetics, tight shoes and cutting nails too short cause brittleness, lifting and ingrowing. Iron deficiency, thyroid disease, lung and heart disease and some medicines leave their own marks. A pigmented band is usually harmless, but a new, widening or irregular band in one nail in an adult needs to be checked for melanoma.

How it is diagnosed

• Clinical examination: A dermatologist looks at all twenty nails, the surrounding skin, scalp and joints, because the pattern across nails often gives the diagnosis.
• Nail clippings for microscopy and culture: Confirms fungus before months of tablets are prescribed. Many thick nails are not fungal, so testing first avoids pointless treatment.
• Dermoscopy of the nail: Magnified examination of pigment bands and the nail fold to decide whether a biopsy is needed.
• Nail matrix or nail bed biopsy: A small sample under local anaesthetic when a tumour, melanoma or an inflammatory disease is suspected.
• Blood tests: Iron studies, thyroid function and glucose when the nail changes suggest a general cause.

Treatment options

• Oral antifungal tablets: Terbinafine or itraconazole for confirmed fungal infection, typically 6 weeks for fingernails and 12 weeks for toenails, with liver blood tests where indicated.
• Medicated nail lacquers: Amorolfine or ciclopirox for mild infection limited to the far end of the nail. Used for many months.
• Treatment of nail psoriasis: Strong steroid preparations, steroid injections into the nail fold, or systemic and biologic drugs if skin or joints are also affected.
• Ingrown toenail surgery: Partial nail removal with chemical destruction of the nail root edge under local anaesthetic. Walking is possible the same day.
• Nail care measures: Short nails, gloves for wet work, breaks from gel and acrylic products, well-fitting shoes and treating athlete's foot.

When it is urgent

Seek urgent local care for a rapidly spreading red, hot, swollen finger or toe, red streaks up the limb, fever, or pus with severe throbbing pain, especially if you have diabetes or poor circulation. A crushed fingertip with a large painful collection of blood under the nail should be seen the same day.

Travelling to Türkiye for treatment

Most nail problems are slow and are best managed by a dermatologist or podiatrist near you, since results are judged over 6 to 12 months. A visit can be useful for a firm diagnosis with clippings, dermoscopy or biopsy, and ingrown toenail surgery fits easily into a short stay. It is not worth a dedicated trip for fungal nail treatment alone.

Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.

الأسئلة المتكررة