Nail Bed Disorder

What are Nail Bed Disorders

Nail bed disorders comprise a range of conditions affecting the nail bed, the area of skin beneath the nail plate.

The nail bed is necessary for healthy nail growth, serving as a protective barrier for underlying tissues against trauma, infection, and moisture. Due to this role, it is prone to various disorders and infections.

These disorders may present as discomfort, pain, or swelling around the nails. Ignoring these issues might lead to complications, making daily activities challenging.

Types of Nail Bed Disorders

Nail bed disorders encompass a variety of conditions, each with distinct characteristics and implications for nail health.

Nail Psoriasis

This autoimmune disorder causes rapid skin cell reproduction, leading to a rash. It results in alterations such as changes in nail bed colour, pitting or dents on the nails, and the development of horizontal grooves known as Beau’s lines.

Brittle-splitting Nails (Onychoschizia)

Characterised by brittle, soft, splitting, or thin nails, this condition often arises from prolonged exposure to hot water, iron deficiency, or certain medical conditions such as low thyroid levels.”

Paronychia

A skin infection around the nails, paronychia occurs due to bacteria, fungi, or viruses entering the skin. It is marked by redness, swelling, pain, and the formation of pus-filled blisters or abscesses.

Onycholysis

This refers to the painless separation of the nail from the nail bed. It can result from nail bed injury, psoriasis, or fungal infections and is noticeable by the visible separation and potential discolouration of the nail.

Ingrown Toenail

Occurring when the edge of a nail grows into the surrounding skin, this condition can cause pain, swelling, and infection. Factors such as genetics, improper nail trimming, tight footwear, and nail bed injury contribute to its development.

Symptoms

Nail bed disorders manifest through a variety of symptoms, each indicative of the underlying condition.

• Discolouration of the Nails: Nails may change colour, displaying hues of yellow, brown, or green, often signalling an underlying issue.
• Curvature or Thickening of the Nails: Alterations in nail shape, such as curvature or thickening, are notable signs of nail bed disorders.
• Brittle, Soft or Textured Nails: Nails may become brittle, soft, or develop ridges and grooves.
• Pain and Swelling: These symptoms are especially prevalent in conditions like paronychia and ingrown toenails, where infection and inflammation occur.
• Separation from the Nail Bed (Onycholysis): A visible gap between the nail and the nail bed, sometimes accompanied by discolouration.
• Pus or Abscess Formation: In cases of infection, such as paronychia, pus-filled blisters or abscesses can form around the nail.

Causes and Risk Factors

Nail bed disorders can stem from a multitude of causes and risk factors, which include:

• Infections
  Bacterial, fungal, or viral infections can affect the nail bed, leading to conditions like paronychia and onycholysis.
• Trauma or Injury
  Damage to the nail bed from physical trauma can result in disorders such as onycholysis or deformities in nail growth.
• Certain Medical Conditions
  Certain systemic conditions, such as psoriasis or thyroid disorders, may manifest in the form of nail bed disorders.
• Exposure to Moisture or Harsh Chemicals
  Prolonged exposure to moisture or harsh chemicals can lead to nail bed issues, particularly fungal infections or brittle nails.
• Genetic Predisposition
  Some nail bed disorders, like ingrown toenails, may have a genetic component, influencing their development.
• Poor Nail Hygiene
  Neglecting proper nail care can predispose individuals to various nail bed disorders.

Non-Surgical Treatment Options

Non-surgical treatments for nail bed disorders include a range of options, tailored to address the specific type and severity of the disorder.

• Topical Medications
  Commonly used for conditions like nail psoriasis and fungal infections, these include antifungal creams, ointments, or nail polishes.
• Corticosteroids
  Topical corticosteroids may be prescribed for inflammatory conditions like nail psoriasis. This can help reduce swelling and irritation.
• Injections
  In severe cases of nail psoriasis, injections of biologic medications such as etanercept or adalimumab can be administered around the affected nails.
• Oral Medications
  Oral antifungals or antibiotics are used for more extensive infections or when topical treatments are inadequate.
• Phototherapy
  Utilising ultraviolet light, phototherapy can be effective in treating nail psoriasis by slowing cell growth and reducing inflammation.
• Laser Therapy
  Certain nail conditions, particularly fungal infections, may be treated with laser therapy, which targets and destroys the fungus without damaging the nail or surrounding tissue.
• Warm Water Soaks
  Useful in managing paronychia, these soaks aid in reducing swelling and discomfort.

Surgical Treatment Options

In certain cases of nail bed disorders, surgical intervention may be necessary, particularly when non-surgical treatments are ineffective or when the condition is recurrent or severe.

Nail Avulsion

This procedure involves the removal of the entire nail or a part of it. It’s often used in cases of severe fungal infections or ingrown toenails.

Drainage of Abscesses

In cases of paronychia with abscess formation, surgical drainage may be required to remove pus and alleviate pain.

Prevention Strategies

Preventing nail bed disorders involves adopting habits and practices that promote nail health to reduce the risk of infections or injuries.

• Maintaining Nail Hygiene: Regular cleaning and trimming of nails can prevent the accumulation of bacteria and reduce the risk of infections.
• Moisturising the Nails Regularly: Using moisturisers helps prevent dryness and brittleness, especially in conditions like brittle-splitting nails.
• Wearing Protective Gear to Protect the Nails: Wearing gloves while handling harsh chemicals or doing household chores can protect the nails from damage.
• Proper Footwear to Protect the Toenails: Choosing comfortable, well-fitting shoes reduces the risk of ingrown toenails and trauma.
• Avoid Nail-Biting and Picking: These habits can lead to nail bed damage and increase the risk of infections.
• Avoid Prolonged Exposure to Water: This can weaken nails and make them more susceptible to disorders.