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Nail disorders

• Signs and Symptoms
• What Causes It?
• Who's Most At Risk?
• What to Expect at Your Provider's Office
• Treatment Options
• Prognosis/Possible Complications
• Following Up
• Supporting Research

There are several types of nail disorders, and a fungal infection is the most common. Most of the time, toenails are affected by a fungal infection. Following proper treatment, a fungal nail infection is cured by the growth of new, non-infected nails.

Signs and Symptoms

Nail disorders have the following signs and symptoms:

• Discoloration or spotting
• Painful, red swelling
• Pits, ridges, scars
• Lesions
• Brown-black band

What Causes It?

Nail disorders are caused by infections, skin diseases, benign or malignant tumors, or certain system-wide diseases. They also may be self-induced.

Who's Most At Risk?

The following are risk factors for nail disorders.

• Genetic predisposition
• Excessive exposure to water, heat, and humidity
• Tight-fitting shoes
• Chemical damage
• Diabetes
• Skin diseases
• Tumors
• Over-manicuring
• Habits involving picking at the skin surrounding a nail
• Soil contamination
• Human immunodeficiency virus (HIV), the virus that causes AIDS

What to Expect at Your Provider's Office

If you have symptoms of a nail disorder, you should see your health care provider. Your health care provider will make a diagnosis based on a physical exam, lab tests such as fungal or bacterial cultures, and imaging procedures if a tumor is suspected.

Treatment Options

Prevention

• Keep your toenails cut short.
• Make sure your shoes fit properly.
• Avoid walking barefoot at public showers and swimming facilities.
• Throw out old, worn footwear.

Treatment Plan

The infected nail may be removed, and medication you take by mouth as well as medication you apply to the nail is usually prescribed.

Drug Therapies

Your provider may prescribe the following antifungal or antibacterial medications.

• Terbinafine
• Itraconazole
• Fluconazole
• Steroids
• Antibiotics

Surgical and Other Procedures

Your health care provider can remove or drain lesions, drain blood clots, and sometimes surgically remove the nail.

Complementary and Alternative Therapies

A comprehensive treatment plan for nail disorders may include a range of complementary and alternative therapies.

Nutrition and Supplements

Following these nutritional tips may help reduce symptoms:

• Eliminate potential food allergens, including dairy, wheat (gluten), corn, preservatives, and food additives. Your health care provider may want to test for food sensitivities.
• Eat calcium rich foods, including beans, almonds, and dark green leafy vegetables (such as spinach and kale).
• Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes), and vegetables (such as squash and bell peppers).
• Avoid refined foods such as white breads, pastas, and sugar.
• Eat fewer red meats and more lean meats, cold-water fish, tofu (soy) or beans for protein.
• Use healthy cooking oils, such as olive oil or vegetable oil.
• Reduce or eliminate trans-fatty acids, found in commercially baked goods such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
• Avoid coffee and other stimulants, alcohol, and tobacco.
• Drink 6 - 8 glasses of filtered water daily.
• Exercise at least 30 minutes daily, 5 days a week.

Nutritional deficiencies may be addressed with the following supplements:

• A multivitamin daily, containing the antioxidant vitamins A, C, E, the B-complex vitamins and trace minerals such as magnesium, calcium, zinc and selenium.
• Probiotic supplement (containing Lactobacillus acidophilus) , 5 - 10 billion CFUs (colony forming units) a day, for maintenance of gastrointestinal and immune health. You should refrigerate your acidophilus products.
• Omega-3 fatty acids, such as fish oil, 1 - 2 capsules or 1 tablespoonful of oil one to two times daily, to help decrease inflammation. Cold-water fish, such as salmon or halibut, are good sources.
• Grapefruit seed extract ( Citrus paradisi ), 100 mg capsule or 5 - 10 drops (in favorite beverage) three times daily, for antibacterial/antifungal activity and immunity.
• L-glutamine, 500 - 1,000 mg three times daily, for support of gastrointestinal health and immunity.

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to get your problem diagnosed before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.

• Green tea ( Camellia sinensis ) standardized extract, 250 - 500 mg daily, for inflammation and antibacterial or antifungal effects. You may also prepare teas from the leaf of this herb.
• Cat's claw ( Uncaria tomentosa ) standardized extract, 20 mg three times a day, for antibacterial or antifungal effects.
• Reishi mushroom ( Ganoderma lucidum ) standardized extract, 150 - 300 mg two to three times daily, for immunity. You may also take a tincture of this mushroom extract, 30 - 60 drops two to three times a day.
• Milk thistle ( Silybum marianum ) seed standardized extract, 80 - 160 mg two to three times daily, for detoxification support.
• Topical: Tea tree oil ( Melaleuca alternifolia ), apply undiluted to affected nail (using a cotton swab) 3-4 times daily, for antibacterial/antifungal activity.

Homeopathy

Few studies have examined the effectiveness of specific homeopathic remedies. A professional homeopath, however, may recommend one or more of the following treatments for nail disorders based on his or her knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.

• Calendula -- for reddish, scaly rashes
• Graphites -- for cracking skin and nails with oozing fluid caused by fungal infections; symptoms improve with open air
• Sulphur -- for fungal disorders that itch, particularly if warmth worsens symptoms

Acupuncture

Acupuncture may help to enhance immune function, normalize digestion, and address disease conditions.

Massage

Massage can help stimulate circulation, which aids the transport of nutrients to the nail bed.

Hydrotherapy

Alternating hot and cold foot baths can be used to bring blood and immune cells to infected nails. Fill one bucket with hot water (be sure the water temperature is not so hot as to burn, but similar to a Jacuzzi -- about 100 degrees) and one with cold water. Place feet in hot water for 3 minutes, then immediately into cold water for 1 minute. Repeat this series three times, then vigorously rub feet with a dry towel. You can add seven drops of essential oil of lavender to the hot water to increase its stimulating effects. Patients with vascular disease or any other type of compromised circulation or peripheral neuropathy should NOT do hydrotherapy without their doctor's supervision.

Prognosis/Possible Complications

Regenerating a toenail usually takes 8 - 12 months, while regrowing a fingernail takes half as long. Infection relapses or permanent damage sometimes occur. Complications may include cellulitis (tissue inflammation) and the embarrassment caused by unsightly nail appearance.

Following Up

Follow-up with your health care provider if you have any drug side effects or interactions.

Supporting Research

Bagg J, Jackson MS, Petrina Sweeney M, Ramage G, Davies AN. Susceptibility to Melaleuca alternifolia (tea tree) oil of yeasts isolated from the mouths of patients with advanced cancer. Oral Oncol. 2006;42(5):487-92.

Burton Goldberg Group. Alternative Medicine: The Definitive Guide . Tiburon, CA: Future Medicine Publishing, Inc.; 1997: 951,952.

Cabrera C, Artacho R, Gimenez R. Beneficial effects of green tea--a review. J Am Coll Nutr . 2006;25(2):79-99.

Cecil RI, Plum F, Bennett JC, eds. Cecil Textbook of Medicine . 20 ^th ed. Philadelphia, PA: W.B. Saunders; 1996.

Cummings S, Ullman D. Everybody's Guide to Homeopathic Medicines. 3 ^rd ed. New York, NY: Penguin Putnam; 1997: 270-271.

Cvetnic Z, Vladimir-Knezevic S. Antimicrobial activity of grapefruit seed and pulp ethanolic extract. Acta Pharm . 2004;54(3):243-50.

Das M, Sur P, Gomes A, Vedasiromoni JR, Ganguly DK. Inhibition of tumor growth and inflammation by consumption of tea. Phytother Res . 2002;16 Suppl 1:S40-4.

Dambro MR. Griffith's 5-Minute Clinical Consult . 1999 ed. Baltimore, MD: Lippincott Williams & Wilkins, Inc.; 1999.

Fauci AS, Braunwald E, Isselbacher KJ, et al, eds. Harrison's Principles of Internal Medicine . 14 ^th ed. New York: McGraw-Hill; 1998.

Gonclaves C, Dinis T, Batista MT. Antioxidant properties of proanthocyanidins of Uncaria tomentosa bark decoction: a mechanism for anti-inflammatory activity. Phytochemistr y. 2005;66(1):89-98.

Habif TP. Clinical Dermatology . 3 ^rd ed. St. Louis, MO: Mosby-Year Book; 1996.

Hartford O, Zug KA. Tea tree oil. Cutis . 2005;76(3):178-80.

Heggers JP, Cottingham J, Gussman J, et al. The effectiveness of processed grapefruit-seed extract as an antibacterial agent: II. Mechanism of action and in vitro toxicity. J Altern Complement Med . 2002;8(3):333-40.

Jonas WB, Jacobs J. Healing with Homeopathy: The Doctors' Guide. New York, NY: Warner Books; 1996: 259.

Jong, S. C. and Birmingham, J. M. Medicinal benefits of the mushroom Ganoderma. Adv.Appl Microbiol . 1992;37:101-134.

Morrison R. Desktop Guide to Keynotes and Confirmatory Symptoms . Albany, Calif: Hahnemann Clinic Publishing; 1993.

Rainone F. Milk thistle. Am Fam Physician . 2005;72(7):1285-8.

Rakel RE, ed. Co nn's Current Therapy . 51st ed. Philadelphia, PA: W.B. Saunders; 1999.

Roberts JR, ed. Clinical Procedures in Emergency Medicine . 3 ^rd ed. Philadelphia, PA: W.B. Saunders; 1998.

Rotsein OD. Oxidants and antioxidant therapy. Crit Care Clin . 2001;17(1):239-47.

Schelz Z, Molnar J, Hohmann J. Antimicrobial and antiplasmid activities of essential oils. Fitoterapia . 2006;77(4):279-85.

Scher RK. Novel treatment strategies for superficial mycoses. J Am Acad Dermatol . 1999; 40(6).

Simopoulos AP. Omega-3 fatty acids in inflammation and autoimmune diseases. J Am Coll Nutr . 2002;21(6):495-505.

Yoon JH, Baek SJ. Molecular targets of dietary polyphenols with anti-inflammatory properties. Yonsei Med J . 2005;46(5):585-96.

Wischmeyer PE. Clinical applications of L-glutamine: past, present, and future. Nutr Clin Pract . 2003;18(5):377-85.

• Review Date: 8/6/2006
• Reviewed By: Ernest B. Hawkins, MS, BSPharm, RPh, Health Education Resources; Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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