Introduction:

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

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?:

• 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

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 oils in foods, 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.

You may address nutritional deficiencies 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. Some probiotic supplements may need refrigeration. Check the label carefully.
• 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. Fish oils may increase bleeding in sensitive individuals, such as those taking blood thinning mediations (including aspirin).
• 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° F) 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.