Nail Changes

WHEN TO SEE YOUR DOCTOR

* You notice long-lasting and unexplained changes in the color of your nail unrelated to an injury.

What Your Symptom Is Telling You

A black or blue nail tells the world that you and your hammer will probably never appear on "This Old House." Reddish yellow nails demonstrate that you change your nail polish nearly as often as the channel on your TV set. Nails that split and break can be a sign that you're spending too much time with your hands in the sink. Nails that take on a convex, spoonlike appearance may mean respiratory deficiency or simply that you're not getting enough iron. Nibbled nails and hangnails can betray your anxiety level.

And then there are the nail changes that seem like they're out of your hands.

Grooved nails (called Beau's lines) are caused by trauma, an illness or an accident that actually damages the nail's matrix—the production center for the new nail.

Chalky or crumbly nails signal a close encounter of the fungal kind. And the skin condition psoriasis can cause tiny pits in fingernails.

"There is a whole host of conditions that manifest themselves through nail changes," says Mark Scioli, M.D., an orthopedic surgeon at the Center for Orthopedic Surgery in Lubbock, Texas. "The nail is really a picture of the health of the body."

Symptom Relief

Once you've identified the source of your symptoms, try these treatments for nicer nails.

Chalk Talk

Unfortunately, chalky, crumbly fingernails and toenails are much worse than they're cracked up to be.

Tenacious bacteria and fungi sometimes attack a nail or its matrix after it's been damaged. They can also be a problem in anyone with a propensity toward skin problems such as psoriasis. Fungal infections often spread to other nails, says Dr. Scioli.

Here are some steps toward fungus-free nails.

Take a test. Instead of relying on your doctor's observation, ask him to have your nail tested for the exact cause of your problem, says Richard K. Scher, M.D., professor of dermatology and nail specialist at Columbia Presbyterian Medical Center in New York City. "Samples taken from the nail can confirm what type of fungus is afflicting you," he says.

Buy a counterpart for your clippers. Instead of using the same clippers for cutting all nails, you can help prevent the spread of fungus to other nails by purchasing an extra pair and using the old one on just the infected nail. Clean both pairs with alcohol after use, says Dr. Scher.

Take a little (or a lot) off the top. Armed with a pair of the appropriate nail clippers—fingernail clippers for fingernails, toenail clippers for toenails—carefully trim as low as possible, says Dr. Scher.

Attack with an antifungal. After the infected portion of the nail has been removed, apply an ointment containing fungus-fighting ingredients such as imidazoles, says Dr. Scher.

Use griseofulvin with caution. Because topical antifungal cream is often ineffective against nail fungus, your doctor may prescribe griseofulvin for a stubborn case. Taken orally, this antibiotic slows the growth rate of the fungus while helping the body fight it. But be patient: It usually takes 4 to 6 months to clear fungus on the fingernails and 12 to 18 months for toenails. And be careful: Although it's been on the market for over 30 years, extended use of the drug has been found to cause liver problems like jaundice in a very small of number of patients, says Martin L. Kabongo, M.D., Ph.D., dermatology coordinator for the family practice residency program at Bon Secours Hospital in Grosse Point, Michigan. If your doctor prescribes griseofulvin, make sure he also intends to monitor your white blood cell count for blood abnormalities after you start taking the drug.

Substitute those socks. If you sweat a lot, which creates a breeding ground for fungus and bacteria, change your socks more than once a day, says Dr. Scioli.

Pat on some powder. An over-the-counter antifungal foot medication like Tinactin or Lotrimin sprayed or sprinkled on your feet and in your shoes twice a day may also aid in the fungus-banishing effort, says Myles Schneider, D.P.M., an Annandale, Virginia, podiatrist and coauthor of How to Doctor Your Feet without a Doctor. (For more tips on fighting the fungus that causes itchy feet, see page 190.)

Strategies to Stop Splitting

Nails can split when moisture robbers like harsh chemicals and cold weather steal their strength. But protecting them is easy. Here's how.

Go soak. Soaking your nails for 15 minutes at bedtime in plain warm water can help prevent splitting, says Dr. Scher.

Take time to trim. Nails are less likely to split if trimmed after a soak, says Dr. Scher.

Lay on the lanolin. Smoothing a moisturizer with lanolin on nails after a soak helps seal in moisture and keeps the nail from drying, says Dr. Scher.

Glove yourself. Because repeated wetting and drying of hands helps weaken nails, wear rubber gloves with cotton lining when washing dishes, says Dr. Scioli.

Keep an eye on biotin. Large doses of this little-known B vitamin reportedly reduced the brittleness of nails in two-thirds of the patients participating in a Columbia University study, according to Dr. Scher. The study began after researchers in Switzerland discovered that biotin supplements helped prevent race horses' hooves from splitting. The connection: "Hooves and nails are basically made of the same thing—keratin," says Dr. Scher.

Although more work needs to be done, researchers believe biotin somehow helps strengthen the keratin in the nail, he says. Until research is done on people, however, he recommends that you be content with the biotin that you'll find in good multivitamin supplements.

Preventing Polish Problems

Prudent nail polish policies can pay off before you develop dry or yellowed nails, or cracked cuticles. Consider these tips.

Buff 'em up. Gently buffing the surface of the nail with an emery board after removing the polish will keep your nail color natural-looking, says Dr. Scher.

Lay on another layer. An extra layer of colorless base coat will protect the nail and prevent discoloration, says Dr. Scher.

Never on Sunday. To help prevent your nails from drying out if you wear polish, enjoy the color for six days and then allow your nails to go bare for a day. Another important anti-drying aid: Use a nail polish remover that contains acetate rather than acetone, he says.

Be alert to allergies. "If you have any allergies, check with your dermatologist or family physician before you embark on any artificial nail use," says Dr. Scioli. "If you have allergic reactions, I wouldn't advice using things like lacquers or adhesives. They can cause chronic cuticle problems."