Nail problems: symptoms, causes & treatment

Nails grow throughout your life, with fingernails measuring an average of three millimeters per month and toenails around one millimeter. This steady growth makes nails a kind of measure of your health: disturbances in your body can manifest as changes in the structure, color, or shape of your nails.

Nail problems occur due to various causes. Local factors such as infections, fungi, trauma, and mechanical irritation often affect one or a few nails at a time. Skin diseases such as eczema and psoriasis can also affect your nails, with nail problems often associated with skin symptoms elsewhere on your body. In addition, underlying disorders in your organs can manifest through your nails, although this is less common.

The function of nails goes beyond just protection. They help you with fine motor tasks, from squeezing acetaminophen out of the comic to picking up a paper clip. When nails become damaged or deformed, you sometimes notice how often you use them in daily life. Nail problems can also be problematic cosmetically, especially when fingernails are visibly changed.

Age plays a role in nail problems. From early adulthood, nails can gradually become brittle, develop grooves and split more easily. These changes accelerate as you get older. Toenails are often more affected than fingernails, simply because they've been through more: years of wearing shoes and walking leaves its mark.

Many nail problems have their origin in daily habits and circumstances. Chronic irritation due to moisture occurs, for example, in people who often work with their hands in water. Repeated minor traumas, such as walking against the front of shoes that are too tight or frequent nail biting, also gradually damage the nail structure. Too frequent manicures, where nails are filed or treated with aggressive agents, also weakens the nail.

Fungal infections are among the most common causes of nail problems. These infections occur when fungi enter or under the nail through minor damage. Once established, they are persistent because the fungus is protected under the nail plate. Humid environments, such as wet shoes or regular swimming, promote mold growth. Bacterial infections mainly affect the nail edge and cuticle. Minor wounds, nail biting, or pushing the cuticle back too enthusiastically create gateways for bacteria. The inflamed area swells, becomes red and sore, and sometimes pus collects.

Skin disorders regularly manifest themselves on the nails. Psoriasis causes characteristic holes in the nail, as if someone had pierced holes with a pin. Nails can also separate from the nail bed or thicken. Eczema can also cause nail problems, resulting in thickening, discoloration and wrinkles. These nail problems often improve when the underlying skin condition comes under control.

Systemic diseases sometimes use the nails as a sign. Lung problems can lead to white discoloration and convex nails. Liver and kidney disorders give characteristic color changes. Treatments such as chemotherapy also leave marks in the nails, resulting in white lines or brittle nails. The body sets priorities differently during illness or treatment, which disrupts nail growth.

Brittleness is a common problem from early adulthood. Nails gradually become brittle, develop longitudinal grooves and unevenness, show thickenings and split at the top. This brittle nail syndrome mainly affects women and often worsens after menopause. The nails break off easily, so they stay short and you have trouble doing tasks that require longer nails.

Nail fungus typically manifest as brownish yellow to dark discoloration. The discoloration often starts at the free edge of the nail and slowly spreads towards the cuticle. Fungal material accumulates under the nail, causing the nail to thicken and to peel off the nail bed. The process is slow but steady, and without treatment, the infection persists. Several toenails are usually affected at the same time, although a single nail can also be infected.

Color changes often tell a story about the cause. Surface discoloration, such as the brown tint in smokers, can easily be scraped off with a normal nail underneath. Green discoloration indicates a bacterial infection, often after prolonged contact with water. A black line in the nail always requires attention because it can indicate a mole under the nail that can sometimes be malignant. Blue discoloration is usually due to blood accumulation after a blow or impact.

Pits in the nail, as if someone had pierced it with a pin, are characteristic of psoriasis. These thimble nails may be associated with thickening and peeling of the nail plate. The wells are often symmetrically distributed over several nails and are mainly found in people who also suffer from psoriasis elsewhere on the body. Infections at the edge of the nail appear as red, swollen and painful areas where the nail and skin meet. Pus may collect that is visible as a yellow cup.

Ingrown nails occur when the edge of the nail grows into the surrounding tissue. This mainly happens to the big toe and causes pain, swelling and often infection. The problem occurs due to incorrect cutting, shoes that are too tight or a genetic predisposition to crooked nails.

Nail problems affect both finger and toenails, although toenails are more commonly affected. This difference is because toenails have more to endure: they are trapped in shoes where heat and moisture promote mold growth, and get knocks and bumps more often while walking. Nail fungus is by far the most common on toenails due to the enclosed, warm and often humid environment in shoes. Fingernails are less likely to become infected, although people who work a lot with water or have weak immune systems are more likely to get fungi on their fingernails.

Cuticle infections, on the other hand, are more common on fingernails. This is because we touch our fingers a lot, making it easier for bacteria to enter through small wounds. Nail biting and excessive manicuring also create gateways for bacteria on the fingers. The big toe is a specific risk location for ingrown nails and nail edge infections.

Skin conditions such as psoriasis and eczema can affect all nails, although often not all nails at the same time or equally seriously. When only one nail is thickened, discolored, or deformed, this indicates a local problem such as an underlying cyst, tumor, or wart pressing against the nail from the bottom.

Treatment depends entirely on the underlying cause. Your doctor starts with a thorough examination where he not only looks at your nails, but sometimes also the rest of your skin, your hair, and asks about other complaints. This broad view helps to determine whether it is a local nail problem or an expression of a wider disorder. If you are unsure about the diagnosis, your doctor may send a sample of the affected nail to the laboratory for fungal cultivation. This research takes a few weeks but provides certainty about the presence of fungi and which type.

Nail fungus requires a thorough consideration between the advantages and disadvantages of treatment. Oral treatment works best but takes months and may cause side effects, including liver problems. That is why your doctor regularly checks your liver function via blood tests during the treatment. Nail polish with antifungal agent only works on slightly affected nails. Unfortunately, the treatment fails in about half of the people, and the nail infection persists or comes back.

In the case of nail problems caused by skin disorders, the treatment of the underlying skin disease is central. When eczema or psoriasis comes under control, nails often also improve. In psoriasis, the nail lesions are sometimes persistent and require specific treatment with ointments or even medication in tablet form. Patience is important because it takes months before improvement is visible as the new, healthy nail grows out.

Ingrown toenails can be treated surgically. Under local anaesthesia, the irritating piece of nail is cut out. This is a small procedure that often provides immediate relief. Prevention through proper cutting and good shoes remains essential to prevent recurrence. In the case of nail problems that result from chronic irritation, removing the cause is paramount. This means wearing protective gloves when working with water or irritants, stopping biting your nails, or choosing other shoes that fit better.

Vitamins and trace elements are regularly touted for stronger nails, but scientific evidence of their effectiveness is lacking. Unless you are actually deficient, which is rather rare, supplements will not improve your nails. Spending money on expensive nail enhancers is usually a waste of money.

Purely cosmetic treatments by pedicures or podiatrists can temporarily improve appearance, but do not cure the underlying condition. Filing away fungal nails does not solve anything, because the fungus is deeper in the nail. However, these professionals can help with daily care and cosmetically soothe deformities, increasing comfort. Ignoring nail problems in the hope that they will go away on their own rarely works. Fungal infections do not disappear spontaneously and usually spread. Ingrown nails also do not resolve on their own and often become more painful.

Self-medication with strong drugs is risky. Some people use bleach or other harsh products on nail fungus, but this damages the skin without killing the fungus under the nail. Effective treatment requires specific antifungal drugs that can penetrate deep into the nail. Continuing to wear artificial nails or gel polish while you have nail problems also often worsens the situation. These products contain moisture and bacteria, which can cause or worsen infections.

Do damaged nails grow back to normal?

This depends on the degree of damage. SuperFICIAL damage usually repairs completely when the new nail grows out. In case of deep damage to the nail root, permanent deformation can occur. It takes months to see if a nail fully recovers because nails grow slowly.

How long does it take for a new nail to grow?

A fingernail grows completely in about six months; it takes twelve to eighteen months for a toenail. This means that when it comes to nail treatments, you have to be patient before you see the end result. Any improvement you see only comes months after the start of treatment.

Can nail problems indicate serious illnesses?

Sometimes, yes. Certain color changes or patterns may indicate liver, kidney, or lung problems. A black line in the nail also always requires attention because of the risk of skin cancer. When several nails change at the same time without a clear external cause, research into underlying disorders makes sense.

Do I always have to go to the doctor with nail problems?

Not all nail problems require immediate medical attention. In case of a single white spot or a small crack, you can wait and see. However, you should go to the doctor if you have painful swelling and redness, if you suspect a fungal infection, a sudden change in several nails, or if you have a black line in the nail.

Can I prevent nail fungus?

Good prevention significantly reduces the risk. Keep your feet dry, change socks daily, wear slippers in communal showers, and let shoes dry thoroughly between wears. If you are predisposed to mold, you can sprinkle preventative antimycotic powder into your shoes. Keeping nails short and gently caring for minor wounds also helps.

Are nail problems inherited?

Some of them do. Brittle nails are more common in certain families, as is a predisposition to nail fungus. Certain nail disorders can also be hereditary. This does not mean that you are powerless, but it does mean that extra care for your nails is wise if nail problems run in your family.

1. Skindr dermatologists
2. Health and Science - Nail Disorders
3. EBPNet - Evidence-Based Practice Network
4. NHG - Dutch Society of General Practitioners, Standard Dermatomycoses
5. Home Doctor - Nail Fungus
6. Home doctor - Ingrown toenail