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• Protect your nails and the skin surrounding them, especially when they are immersed in water, by wearing rubber or synthetic gloves over white cotton gloves (or rubber gloves into which you have sprinkled talcum powder).

• Don’t use strong soaps on your hands or feet. Strong soaps can dry out the nails as well as the skin. Use a moisturizer after washing. Over-the-counter creams are available that are formulated to moisturize the nails and make them resistant to damage.

• Don’t push back or cut your cuticles; they prevent germs from getting under your nail and causing infections.

• Nail polish remover makes nails brittle and weak. Don’t use it more often than once a week.

• Keep nails short to prevent them from splitting.

• Trim your nails regularly. If you can’t trim them yourself, have someone else, such as a family member or podiatrist, trim them.

• Cut your toenails straight across to avoid damaging the skin at the corners of the nail.

• Wear loose-fitting shoes and socks to avoid putting pressure on your toenails.

• If you have pain, redness, or swelling around a nail (especially if you have poor circulation or diabetes), see your doctor. Nail infections, particularly toenail infections, must be treated early to avoid complications.

Other Nail Problems

Nails can become abnormally shaped, discolored, or ingrown from a number of factors. Because some nail abnormalities can result from underlying disorders, always have any unusual nail condition evaluated by a doctor.

Deformed nails

Injury to the nail-forming area beneath the cuticle can lead to thickening of the whole nail. This thickening is most obvious in the toenails, where it results from poorly fitting shoes or decreased circulation from atherosclerosis (see page 557) or diabetes (see page 889). Many disorders such as psoriasis (see page 1064), lichen planus (see page 1071), and paronychia (see previous page) can cause the trimmed end of a nail to separate from the underlying skin. Iron deficiency anemia (see page 610) can make nails spoon-shaped. Congenital heart disease (see page 558), a chronic lung infection, or lung cancer (see page 646) can cause clubbing or knobby enlarged ends of the fingers and toes that also affect the shape of the nail (see page 127). Alopecia areata (see page 1076) may cause pitted fingernails. Poor nail growth can produce a temporary side-to-side groove in the nails.

Discolored Nails

Nails can be stained yellow or brown by tobacco or nail polish. Bruises can cause black and blue spots. The nail bed appears pale in anemia and bluish gray in some heart and lung disorders. If bacteria enter the space between the nail and the skin, the nail may turn blackish green. Small, black, splinterlike areas under the nails may indicate an infection of a heart valve. A vitamin or mineral deficiency or an injury to a nail can produce one or more small white patches in the nail (which will grow out with the nail).

Ingrown toenails

The nail of the big toe can curve under at the sides and catch in the skin, causing pain as the nail grows. If the nail continues to cut into the skin, infection can result because the area never has time to heal. Ingrown nails often result from pressure from poorly fitting shoes, from an injury, or from improper trimming.

Diagnosis and Treatment

See your doctor about a nail deformity or discoloration that doesn’t grow out with the nail. Nails badly damaged by injury usually grow in again naturally in about 9 months.

See your doctor if you have an ingrown toenail. If the nail is not infected, he or she may place a piece of cotton between the nail and the toe, which usually relieves the pain. The cotton may be treated with a liquid (called collodion) that holds the cotton in place, protects the skin, and makes the cotton waterproof. If the nail is infected, your doctor may remove the ingrown edge of the nail and the toenail’s fold next to it. To prevent ingrown toenails, follow the steps on the previous page to protect your nails.

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Cosmetic