Nail care refers to the proper maintenance of the fingernails and toenails. Nail care is important because it helps prevent nail problems, such as fungal nail infections and ingrown toenails. However, in some cases, nail problems are symptoms of an underlying medical condition, such as an infection throughout the body.
The fingernails and toenails help protect the fingers and toes. The nails are made up of several different parts. The nail plate is the largest and most visible part of the nail. It is the hard part that covers the tips of the fingers. The nail bed is the skin that is beneath the nail plate. The nail folds are the skin that surrounds the three sides of each nail. The cuticle is the thin u-shaped tissue that overlaps the nail plate at the base of the nail. It protects new nail as it grows from the nail bed. The lunula is the white-colored half-moon shape at the base of the nail beneath the nail plate.
The nails start growing underneath the cuticle, in what is called the matrix. As new cells grow, older cells harden and are pushed out to become part of the nail plate. On average, nails grow about 0.1 millimeters daily. In other words, if a nail falls off, it takes about 4-6 months for it to completely grow back.
Nails are considered healthy if they are smooth and uniform in color and consistency. Healthy nails do not have ridges or grooves, and they do not have spots or discoloration.
In order to maintain healthy nails, it is recommended that individuals keep the nails clean, trimmed, and moisturized. Moisturizing the nails helps prevent the nails from becoming brittle and breaking or cracking. Although nail biting does not usually cause nail problems, it is not recommended. In some cases, nail biting may worsen a nail condition, such as an infection around the nail bed.
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Keep the fingernails clean: It is important to keep the fingernails clean. Individuals can soak the feet and hands in warm soapy water to help keep the nails clean. The nails can also be gently scrubbed with a soft brush under warm soapy water. This helps prevent infections from developing. Nails are at risk of becoming infected because they are frequently exposed to germs that can easily become trapped under the nails.
Protect the nails: Wear gloves when performing activities that may damage nails, such as gardening. It is also recommended that individuals wear cotton-lined rubber gloves when handling harsh chemicals or soaps for extended periods of time. This is because soaps and chemicals may weaken the nails, making them susceptible to breakage.
Trimming (adult): The fingernails and toenails should be trimmed weekly. Soaking the toenails in warm salt water (one teaspoon of salt added to one pint of water) for 5-10 minutes before trimming may help soften toenails that are thick and difficult to cut. Applying a 10% urea cream to the nails before trimming is also recommended. Moisturizers help prevent the nails from breaking or cracking when they are trimmed. They also help soften tough or thick nails, making it easier to trim them. A nail clipper or a pair of nail scissors may be used. The nails should be cut in a straight line, with only slight rounding at the tip.
Most experts do not recommend cutting or pushing back the cuticles because it may damage the nail bed and increase the risk of an infection.
Once trimming is complete, jagged edges should be smoothed with a nail file or emery board.
If any hangnails or loose strips of torn skin near a fingernail or toenail are present, they should be clipped off. Hangnails should not be pulled off because this usually results in the removal of living tissue.
Trimming (infant): It is important to trim babies' fingernails and toenails because they have weaker immune systems than adults and are more prone to developing infections. Also, if the nails are too long, a baby may scratch himself or herself. Baby's nails are generally soft. Nail clippers or manicure scissors designed for infants are preferred to trim infants' nails, as the tips are rounded for safety. Using one hand to hold the baby's finger or toe and pressing the skin under the nail down and out of the way reduces the likelihood of a pinch or cut. Then, the parent's other hand can be used to trim the nail and round off any sharp edges. For fingernails, it is typically recommended to follow the nail's natural shape. Toenails are most often trimmed straight across. When all nails are trimmed, any rough edges can be smoothed with a soft emery board.
Moisturize the nails: Healthy nails require moisture. When applying lotion to the hands, make sure to rub some onto the nails. Individuals should apply moisturizer after washing the hands with soap and after bathing or showering.
Manicures and pedicures: Individuals can receive any of the above treatments, as well as many other aesthetic treatments, at a salon. When the fingernails are groomed, it is called a manicure. When the toenails are groomed, it is called a pedicure.
A standard manicure or pedicure usually includes filing and shaping of the nails and the application of polish. Some manicurists and pedicurists remove or push back the cuticles of the nails. Most experts do not recommend cutting or pushing back the cuticles because it may damage the nail bed and increase the risk of an infection. Individuals can ask that the cuticles be kept intact, if they want.
Many pedicures also involve washing nails in a footbath with warm, soapy water. They may also use foot scrubs and massage the feet with moisturizing lotions.
Some specialty manicures and pedicures, such as the French manicure, may also be offered. Others may include painting pictures or designs on the nails or applying small decals (decorations) or imitation jewels. Although these do not improve the health of the nails, they are often performed for cosmetic reasons. Applying nail polish and artificial jewels is generally considered safe. However, nail polish should not be applied if the patient has a nail infection or open cuts or sores on the nail folds or cuticles.
A manicurist may apply treatments to real nails. Other services for fingernails include the application of artificial nails such as nail tips, acrylics, and artificial nail gels. However, some of these treatments may increase the risk of infection. In some cases, a gap develops between the acrylic nail and the natural nail. For example, if the acrylic nail is bumped or jarred, it may separate from the natural nail. This gap provides a moist, warm environment in which bacteria and fungus can grow. If such an infection occurs, the natural nail may become thickened and discolored. However, the changes in the natural nail may not be visible underneath the acrylic nail. Therefore, if the nails or fingers become swollen and painful, individuals should visit a dermatologist or qualified health professional.
Hot oil manicure: A hot oil manicure may performed to clean, neaten, and soften the cuticles. During the treatment, which usually lasts about one hour, the hands are soaked in warm oils that are designed to moisturize the cuticles, nail beds, and fingers. After this nail treatment, most individuals receive a manicure.
Paraffin treatments: In this method, the hands may be dipped in melted paraffin (beeswax substitute made from petroleum) or wax as a proposed way to draw out toxins, bacteria, and microbes, and remove dead skin. This treatment is performed to help smooth the skin. It may also increase circulation and improve skin color. Practitioners apply heat to relax the skin and make it more able to absorb lotion, which is sometimes rubbed on the hand before being placed in the paraffin. The hand is usually dipped more than once to allow a thicker wax coat to form, in order to make the coating stay warm for longer and less likely to break or tear too soon. After the hands have been dipped in the wax, they are wrapped in either plastic or tin foil and then covered with cloth to retain warmth. The hands remain covered in paraffin until the substance returns to body temperature. The paraffin is then peeled off.
common nail problems
Fungal infections: Individuals who do not take proper care of their nails have an increased risk of developing fungal nail infections, such as onychomycosis or fungal paronychia. Although fungal nail infections can be spread to other people, they are not very contagious, and it is uncommon to acquire an infection from someone else.
Onychomycosis is a fungal infection of the nail bed. The infection is most often caused by a group of fungi called dermatophytes (especially the Epidermophyton, Microsporum, and Trichophyton species). However, other fungi, including yeasts and nondermatophyte molds, may also cause an infection. The fungi that cause the infection prefer warm, moist environments. Therefore, patients are most likely to develop onychomycosis if their nails are frequently exposed to environments such as sweaty socks or shower floors. Because toenails are exposed to these types of environments often, they are more likely to be affected than fingernails.
Nail fungus may have a yellowish, greenish, or even brownish appearance. Whitish spots on the nails may indicate a fungal infection. Often, the nails are brittle and have uneven edges. The nails may be painful or emit a foul odor. The nails may have irregular surfaces or edges. The nails may appear unusually thick. The skin around the nails may be red. In some cases, infected nails may separate from the nail bed, causing a condition called onycholysis.
Fungal paronychia is a fungal infection of the skin near the nail beds. It causes the skin around the fingernails or toenails to become red and swollen. It may also cause pus-filled blisters to form. Fungal paronychia is commonly caused by a group of fungi called dermatophytes. Because these fungi may also cause fungal infections of the nails, fungal paronychia is common among patients with onychomycosis. Fungal paronychia is also common among diabetics and those who frequently get their hands wet for long periods of time (e.g., swimmers). Biting the nails, hangnails, or pushing back the cuticles also increases the risk of an infection. In addition, nail polish, nail wax, and artificial nails may trap fungi, increasing the risk of infection.
Patients respond well to treatment with medications called antifungals. However, it may take several months for the infection to be completely cured.
Bacterial infections: Although paronychia can be caused by fungus, most cases are caused by bacteria. The bacteria can enter skin around the nail that has been damaged by trauma, such as nail biting, finger sucking, or chemical irritants or solvents.
Symptoms of bacterial paronychia are generally the same as those of fungal paronychia. However, bacterial paronychia is generally much easier to treat. Antibiotics are not usually necessary for bacterial nail infections. Instead, patients soak the infected nails in warm water and bacterial soap 3-4 times daily until symptoms subside.
Vertical ridges: Vertical ridges, which are tiny lines or ridges that run from the cuticle to the tip of the nail, may occur in some people. Vertical ridges are relatively common, and they tend to become more noticeable with age. Although these ridges occur for unknown reasons, they are not considered a health concern. However, patients should visit their healthcare providers immediately if the nails start to change in color or develop horizontal ridges. These may be signs of serious health problems, such as lung disease, poor nutrition, or heart attack. This is because some illnesses affect many parts of the body, including the nails.
Ingrown toenails: An ingrown toenail is a common condition that occurs when part of the toenail starts to grow into the skin of the toe. Ingrown toenails occur most often on the big toe. As a result, individuals typically experience pain, swelling, and redness.
Ingrown toenails may occur if the toenails are trimmed too short, if the toenails are unusually curved, if shoes are worn that crowd the toes, or if the toenail becomes injured.
Ingrown toenails are most common among older adults. This is because the nails naturally thicken with age, which changes the curvature of the nails.
Ingrown toenails can often be treated at home. However, if quick action is not taken, an infection may develop. If the infection is not treated, it may spread into the bone and cause a serious bone infection. Bone infections are usually difficult to treat and require the use of intravenous antibiotics. Diabetics are most likely to experience serious complications of ingrown toenails, because they have poor circulation and decreased sensations in the feet. Therefore, an ingrown toenail is more likely to go unnoticed and develop an infection in someone who has diabetes.
Individuals should visit a doctor if they experience severe pain or inflammation near the ingrown nail or if the symptoms start to worsen. These may be signs of an infection.
Weak or brittle nails: Even though the nails typically thicken with age, the nails are generally not as strong in older individuals. The nails are usually weaker, more brittle, and prone to breakage in older adults. However, if symptoms develop suddenly and are accompanied by discoloration of the nail or other symptoms, individuals should visit a healthcare provider. These may be signs of an underlying condition.
Signs of underlying health problems: Unhealthy nails that are discolored, weak, brittle, or inconsistent in shape may be symptoms of underlying medical conditions. For instance, weak and brittle nails in combination with weight loss, pale skin, and hair loss may indicate poor nutrition.
Nails may also become yellow or green as a result of swelling in the hands caused by lymphedema (an accumulation of lymph fluid) or a lung condition such as bronchitis.
Small indentations across the nails, called Beau's lines, occur when nail growth beneath the cuticle is interrupted. This may occur after an injury or severe illness such as a heart attack. It may also indicate poor nutrition.
Spoon nails, also called koilonychias, occur when the nails become soft and curve upwards around the sides (like a spoon). This condition may indicate iron deficiency anemia.
Drug-induced nail problems:
Nail-related problems may occur as a result of drug therapy, specifically cancer treatments, including both chemotherapy and radiation. These nail changes do not happen with every type of cancer treatment, but nail changes are a fairly common result of chemotherapy and radiation. Some of these nail problems include hyperpigmentation (color changes), Beau's lines, Mee's lines, half-and-half nails, or onycholysis (nail detachment). Mee's lines are single or multiple white lines that extend across the nail. Medications that have produced Mee's lines include doxorubicin, cyclophosphamide, and vincristine. With half-and-half nails, nails appear reddish brown at the base and are abnormally white toward the tip of the nail. In some cases, nails may completely fall off (this is called onychomadesis). These nail changes can occur with both fingernails and toenails and may involve one or multiple nails. Many of these changes occur with multiple drugs and cancer treatments. However, some specific agents may cause nails to change certain colors. Patients may have nails change to blue in color after administration of bleomycin or 5-fluorouracil. Adriamycin, bleomycin, doxorubicin, doxorubicin, mitoxantrone, and idarubicin have all been known to cause nails to become brown in color. These changes often resolve once drug treatment is complete and the damaged nail grows out.