Nail Care
Wellness Goals

Nail Care

Explore the available health information, treatment context, and integrative evidence for Nail Care.

Background
  • 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 a day. In other words, if a nail falls off, it takes about four to six 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.
Treatment
  • Oral antifungals: Patients with fungal nail infections typically take antifungals by mouth. These medications, such as terbinafine (Lamisil®), fluconazole (Diflucan®), or itraconazole (Sporanox®), kill the fungus and allow a new nail to grow that is not infected with the fungus. Treatment generally lasts about six to 12 weeks. However, results will not be apparent until the new nail has completely replaced the old, infected nail. Treatment does not cause the infected toenail to fall off. This may take anywhere from four to six months. Once treatment is over, individuals should try not to expose the nails to warm, moist environments because this may cause the infection to return.
  • Some antifungal medications that are taken by mouth may cause liver damage. This is because they are strong medications that must be broken down by liver before they can be absorbed into the body. Ketoconazole (Nizoral®) and amphotericin B (Fungizone®, Abelcet®, AmBisome®, or Amphotec®) are the most likely to cause liver damage. Therefore, blood tests should be performed regularly during treatment to monitor liver function. Patients who experience nausea, vomiting, weakness, fatigue, abdominal pain (especially near the liver), dark urine, or jaundice (yellowing of the skin and eyes) should consult their healthcare providers immediately. These are all signs of liver damage.
  • According to the U.S. Food and Drug Administration (FDA), two oral antifungals, called itraconazole (Sporanox®) and terbinafine (Lamisil tablets®), have been associated with rare cases of liver failure and death. Itraconazole that is taken by mouth may weaken the heart and should not be prescribed for long-term use if a patient has a history of heart disease or heart failure.
  • Antifungal lacquer: Rather than taking oral antifungals, some individuals who have mild to moderate fungal nail infections may be treated with an antifungal lacquer, such as ciclopirox (Penlac®). Once a day the lacquer is painted onto the nails like nail polish. After seven days, all of the lacquer is wiped off with alcohol. The treatment is then repeated. However, this treatment may be less effective than oral antifungals. According to human studies, daily use of Penlac® cured fungal nail infections in 10-30% of patients. Therefore, some doctors may prescribe an antifungal lacquer in combination with an oral antifungal.
  • Topical antifungals: Topical antifungals may be used in combination with oral antifungals. Unlike antifungal lacquers, topical antifungals are applied to the nails as well as the surrounding skin. Topical antifungals usually do not cure fungal nail infections on their own, which is why they are usually used in combination with oral antifungals. Patients may be asked to use topical antifungals in combination with other creams that contain urea. The urea-containing creams may help speed up the absorption of the medication.
  • Soaking the foot: Individuals who have minor ingrown toenails are encouraged to soak the foot in warm water for 15-20 minutes. Then, a dry cotton ball should be placed under the ingrown corner of the nail. This may help the nail start to grow above the skin. Signs that an ingrown toenail is not healing include increased pain, swelling, and drainage of pus or blood from the affected area.
  • Individuals who have bacterial paronychia should soak the infected nails in warm water and antibacterial soup three to four times a day for 15 minutes. This should be continued until signs and symptoms are gone. If the condition does not improve in a few days, patients should visit their healthcare providers.
  • Non-steroidal anti-inflammatory drugs (NSAIDs): Patients with mild ingrown toenails may also take over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Motrin® or Advil®) or naproxen (Aleve®) to help reduce pain and inflammation. If pain is severe or worsens, patients should visit their healthcare providers because this may be a sign of an infection.
  • The frequency and severity of side effects vary. The most common side effects include nausea, vomiting, diarrhea, constipation, decreased appetite, rash, dizziness, headache, and drowsiness. The most serious side effects include kidney failure, liver failure, ulcers, heart-related problems, and prolonged bleeding after an injury or surgery. About 15% of patients who receive long-term NSAID treatment develop ulcers in the stomach or duodenum.
  • Minor surgery: If an ingrown toenail does not improve with the treatment mentioned above, minor surgery may be necessary. A doctor first numbs the affected toe with an anesthetic. Next, the toenail that is growing into the skin is cut and pulled out of the skin.
  • In some cases, a liquid solution or small electrical charge may be applied to the nail bed. This non-permanent procedure, called ablation, helps prevent the nail from growing back into the skin. A permanent procedure, called nail matrix ablation, can be performed to prevent the nail from growing back at all. This procedure is usually only performed in patients who experience frequent ingrown toenail or in individuals who have a high risk of experiencing complications (such as diabetics).
  • After surgery, patients are typically advised to soak the foot in warm water each day. An antibiotic ointment may be prescribed to help prevent an infection. Nail treatments, including painting the nail with nail polish, are not recommended during the healing process.
  • Patients who experience frequent ingrown toenails may have part of the toenail and nail bed removed in order to prevent that part of the nail from growing back.
  • Individuals who have fungal or bacterial paronychia may have to have abscesses drained. In serious cases, the entire nail may need to be removed.
  • Antibiotics: If an ingrown toenail causes an infection, antibiotics are prescribed. These medications kill the bacteria that are causing the infection.
  • Most cases of bacterial paronychia do not require antibiotics. These medications are used when there is extreme swelling and pain that does not respond to other treatments.
  • Nail hardeners: Nail hardeners may be applied to nails in patients who have weak or brittle nails that are caused by nail dehydration. Nail hardeners typically contain acetates, toluene, nitrocellulose, acrylic, and polyamide resins. Some products, called fibered nail hardeners, contain 1% nylon fibers. Other additives may include glycerin, hydrolyzed proteins, modified vegetable extracts, propylene glycol, and metal salts.
  • Patients should avoid products that are made with formaldehyde or sulfonamide because they may irritate the skin. Nail hardeners should not be used if a nail infection is suspected.
  • Limit use of nail polish remover: Individuals who have naturally weak or brittle nails should limit their use of nail polish remover. In general, individuals should not use nail polish remover more than twice a month. Many nail polish removers contain harsh solvents, such as acetone, alcohol, ethyl acetate, or butyl acetate. Individuals should avoid nail polish removers that contain acetone because this product dries up nails, making them even weaker and more brittle. Individuals can purchase acetone-free nail polish at local drug stores.
Prevention
  • In order to maintain healthy nails, it is recommended that individuals keep the nails clean, trimmed, and moisturized.
  • Trim the nails and toenails regularly. Do not cut the nails, especially the toenails, too short. This may cause the nail to grow into the tissue.
  • Most experts do not recommend cutting or pushing back the cuticles because it may damage the nail beds and increase the risk of infection.
  • Diabetics or individuals who have poor circulation should visit their podiatrists regularly in order to prevent complications, such as infected ingrown toenails, from developing. These individuals should also consider having their nails professionally trimmed.
  • Individuals should wear shoes that fit properly. If there is too much pressure on the toes, the nails may end up growing into the skin.
  • Individuals should wear protective footwear, such as steel-toed boots, if they are at risk of injuring their toes at work.
  • 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 times. This is because soaps and chemicals may weaken the nails, making them susceptible to breakage.
  • Avoid application of polish or other nail treatments to nails suspected of infection. Such areas may appear red, discolored, or swollen.
  • Individuals should not use nail polish remover more than twice a month. Avoid nail polish removers that contain acetone. This product dries up nails, making them even weaker and more brittle. Individuals can purchase acetone-free nail polish at local drug stores.
References
  1. American Academy of Dermatology (AAD). . Accessed May 26, 2009.
  2. American Podiatric Medical Association (APMA). . Accessed May 26, 2009.
  3. Gunnoe RE. Diseases of the nails. How to recognize and treat them. Postgrad Med. 1983 Sep;74(3):357-62. View Abstract
  4. Mainusch OM. Common disorders and diseases of the nails. Anatomy, physiology, disorders, clarification and therapy. Article in German. Hautarzt. 2004 Jun;55(6):567-79; quiz 580-1. View Abstract
  5. Mayeaux EJ Jr. Nail disorders. Prim Care. 2000 Jun;27(2):333-51. View Abstract
  6. Mirza B, Ashton R. Recognising common nail conditions: a guide. Practitioner. 2000 Oct;244(1615):873-4, 876-8, 882-3. View Abstract
  7. National Institutes of Health (NIH). . Accessed May 26, 2009.
  8. Natural Standard: The Authority on Integrative Medicine. . Copyright © 2009. Accessed May 26, 2009.
  9. No authors listed. Guidelines of care for nail disorders. American Academy of Dermatology. J Am Acad Dermatol. 1996 Mar;34(3):529-33. View Abstract
  10. Omura EF. Histopathology of the nail. Dermatol Clin. 1985 Jul;3(3):531-41. View Abstract
  11. Scher RK. Toenail disorders. Clin Dermatol. 1983 Jul-Sep;1(1):114-24. View Abstract