Archive | June, 2013
29 Jun

Do you suffer from psoriasis under the toenails?

Psoriasis under the toenails can result in severe thickening, discoloration and pitting of the toenails. Learn how to make your toenails better!

 

arth7 psoriasis Psoriasis Under The Toenails

Psoriasis under the toenails and fingernails

Causes of psoriasis under the toenails

The cause of toenail psoriasis is unknown. What we do know is that a good percentage of people suffering from psoriasis also develop nail problems as well. The reports vary with some saying only about 10-15% suffer from them, but other studies claim much higher numbers. The average seems to be around the 25% range.

You are more likely to have psoriasis under your toenails if:

Symptoms of psoriasis under the toenails:

Toenail psoriasis displays the following symptoms:

  • A discoloration beneath the nail. It is described as an “oil spot”.
  • The nail is much more thick.
  • The nail is extremely rough.
  • The nail displays characteristic pitting.
  • The distal part of the nail appears abnormal.
  • Beau’s lines – these are horizontal ridges.
  • Callus formation under the nail.
  • Loosening of the nail.

Diagnosis of psoriasis under the toenails:

The toenails are graded by a system known as the Nail Psoriasis Severity Index (NAPSI). It is a numberical and reproducible system for monitoring the toenail psoriasis. The system is based on assigning numerical values for some of the symptoms listed above.

Home treatment for psoriasis under the toenails:

Some quick tips for home care:

  • Keep your nails short and smooth. They are susceptible to bacterial and fungal infections which could make them look much worse.
  • Wear gloves to protect your nails while you are performing activities to keep your nails protected.
  • Wear properly fitted shoes to avoid excess pressure on your nails. Even light irritation and inflammation can make things worse.
  • Make sure to dry your nails properly after bathing.
  • Nail psoriasis is hard to treat, as nails grow very slowly. Be careful with them! They only grow 1mm per month.
  • You can try topical steroid cream temporarily to improve nail appearance.
  • Taking Vitamin D Vitamins may help.
  • Moisturizing ointments at night before bed work well.
  • Soak nails in vegetable oil while watching TV. You can then use an emery board or nail file to take the nails down a little bit.
  • Synthetic nail hardeners can make the nails look much better. These are glossy covers, no one will know the difference!
  • Acrylic nails are dangerous because you are more susceptible for nail fungus already with your psoriasis– I don’t recommend these.
  • Salicylic ointment can work great for your psoriatic nails. Follow directions of your prescriptions.
  • A mutlivitamin- while not completely proven through medical trials, has been recommended by many specialists.

Podiatrist treatment

There are many advances that are occuring in this field, so get excited! The outlook for psoriasis, while still dim is looking better and better every year.

Treatments focus on managing symptoms with a rheumatologist. Individualized plans can included topical and intralesional creams and injections. You can combine these with systemic and combination oral medication therapies.

 

For more information about psoriasis under the toenails visit this link.

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28 Jun

Do you experience the toe nail coming off the nail bed?

The most common causes of the big toe nail coming off the nail bed is due to a traumatic injury, light rubbing of the toenail within your shoe that you never even noticed, a very severe fungal infection or in some cases we may never know the reason it fell off. The nail will almost always grow back and you shouldn’t get too worried as it is usually something that can be treated or corrected if you follow the treatment guide below. The nail usually appears discolored because it is filling up with blood underneath the nail as it is separating from the skin underneath it. Once the separation has began it is a normal process and at this point there are a few things that you can do to limit more pain or injury.

 Toe nail Coming Off The Nail Bed? This is what to do!

 

Trauma is the number one cause of nail loss
First confirm that you have actually experienced trauma, this is usually pretty evident because you stubbed your toe really hard or dropped something really heavy onto your toe. You will experience the following symptoms:

  • Pain
  • Bleeding under the nail bed leading to red streaks or discoloration under the nail.
  • Eventual loosening of the nail from the nail bed as the blood fills under the nail and you are able to evaluate the damage.

If you suspect another cause:

  • Fungal infection causing separation – The nails would have been thick, hard and discolored yellow or orange for a period of time before the nail separated. This is a very common and treatable cause of nail separation.
  • Jogger’s Toe If you spend alot of time on your feet and you think it may have been possible that your toenail has been pressuring up against the front of your shoe then this is highly possible. This results in blistering under the toenail leading to the detachment of the nail- with or without pain!

Home treatment for the toe nail coming off the nail bed
The priority in this situation is to accept that the nail has been lost and that you will need to wait until you can grow out a new nail.

  1. Accept that the nail is gone and you will have to wait for it to grow back 1 millimeter per month or so. This means 6-9 months if the entire toenail has fallen off (the fingernails grow back a little bit faster). Unfortunately there is not too much that can be done to speed up the growth of the nail beyond leading a healthy lifestyle and getting lots of exercise and sun(basically anything that boosts your metabolism).
  2. If the toe is really painful – apply ice for 15-20 mins until it starts to get numb. Take some anti-inflammatory medication like ibuprofen or aspirin to prevent long lasting pain. Initially elevate the foot to decrease the pain as well. Once the pain is low enough you will be able to start trimming the nail down.
  3. The nail should be trimmed back as far as it is still attached, the danger here is that if you hit the nail again it will bend back and rip out with the tissue attached to it. OUCH! Avoid this serious and painful complication by trimming back early.
  4. If you cannot get to all the blood underneath the nail out and it is not painful then it is ok to let it just grow out over the next 6-9 months, but if it is really painful over a period of time then you should go to the podiatrist to get the blood drained(pain is due to pressure under the nail).
  5. Use a nail file, emery board or pumice stone to smooth out the remainder of the nail after it has been trimmed back so that it doesn’t get caught on your socks.
  6. Apply some antibiotic ointment- neosporin and triple antibiotic ointment work very well here. Use some water to wash out the bloody area and apply the antibiotic ointment and then cover it with a band-aid.
  7. If you are going to continue running or working on that foot put some heavy duty duct tape or athletic tape over the band-aid
  8. If the toe is getting red hot and swollen, you experience nausea, fever or redness moving up the toe or throbbing pain that lasts past the icing, anti-inflammatory medication and elevation then you likely have an infection. Get yourself to a podiatrist or a emergency room as soon as possible.
  9. Unless you damaged the nail matrix(the base of the nail) then it should grow back every time. The long term problems may be that the nail does not look exactly as it once did. It may curve more or be thicker- it is essential a scar of the nail bed. There are ways to treat it at this point. check out our guide on how to handle long nails.

Home prevention

  • Treat your fungal nails or joggers toe as outlined above.
  • Get fitted for for your proper shoe size
  • Trim your toenails straight across
  • Get proper socks
  • Use athletic tape or duct tape to cover the nail

To learn more about the toe nail coming off the nail bed, please visit this link. 

25 Jun

Do you have red spot under toenail?

Red spot under toenail – this is usually caused by bleeding under the toenail, even if not painful! Learn what to do about it right here!

 

 Red Spot Under Toenail

 

Causes of red under the toenail:

Red under the toenail is more commonly known as a subungual hematoma. This is nothing more than a buildup of blood underneath the toenail or the fingernail. The downward constant pressure of wearing shoes or a traumatic injury can cause the vessels under the nail to rupture and bleed.  The blood then pools underneath the nail plate. This can sometimes lead to pain, but the majority of the time there is not severe pain.

 

Most common in runners and joggers:

The most common cause is in runners or joggers. Thus this injury is sometimes called runner’s or jogger’s toe.  This is due to poorly fitting shoes and not enough space underneath the front of the shoe.

  • Poorly fitted shoes.
  • Not enough space in the front of the toenail.
  • Morton’s foot – short 1st toe puts pressure on the 2nd toe.

 

56 subungual hematoma 10 Red Spot Under Toenail

 

Diagnosis of red under the toenail:

  • It can look black, red or even brown.
  • It can be painful or not hurt at all.
  • If it does hurt, the pain is a throbbing type.
  • It can be small or take up the entire nail.
  • There can be a large traumatic incident before the spot appears.
  • There can be a history of new shoes being worn.
  • There can be a history of new exercise or job being started recently.
  • Running or jogging.
  • Slamming toe or fingernail.

Consider 4 other causes to black toenails:

 

Home treatment of red under the toenail:

If you are feeling extreme throbbing try the 5 following things:

1) Ice the toenail!

The first step is to take some ice and apply it to the jammed toenail to decrease the inflammation in the area.

instant ice pack Red Spot Under Toenail

  • This will help decrease the immediate pain.
  • This will also help decrease the healing time over the next few days.
  • It will increase the odds of your toenail not falling off.

 

2) Put some pressure on it.

acebandage Red Spot Under Toenail

  • Wrap it to stop the Toe From Swelling.
  • Don’t make it too tight.
  • You still want to feel the toe.

3) Anti-inflammatory medication.

If you are healthy enough(with podiatrist or pharmacist), it is a good idea to take some anti-inflammatory medications. These will help decrease the swelling and the pain.

 Red Spot Under Toenail

  • Decreases the pain.
  • Increases the healing time.
  • Increases chances of keeping the nail.

 

4) If it is still hurting – go see a podiatrist to have the blood drained.

The podiatrist can drill through your toenail and drain the blood out the bottom if the pain is still hurting. This is considered the ultimate treatment!

 

5) Prevention is the best medicine!

footmeasure Red Spot Under Toenail

  • Get your shoes fitted properly.
  • Try a Brannock Device
  • Measure the arch length, foot length and the foot width.
  • Cut your toenails properly.
  • Don’t leave the toenails too long.

 

To learn more about red spot under the toenail visit this link. 

22 Jun

Do you have black spot under the toenail?

A black spot under the toenail is usually caused by one of four common problems: Learn what to do below!

Black spot under the toenail causes:

There are four common causes that I have seen of a black spot under the big toenail, here they are listened in order from most common to least common:

 

1) Jogger’s toe.

Jogger’s toe is essentially just “overuse toe”. The trick with this one is it sneaks up on people without any pain! Be aware that you can still have bleeding underneath your toenail and it doesn’t have to be extremely For example I just saw a woman had a scary black toenail without any cause. But the more I talked to her I realized she bought new shoes and started Zumba classes. She was exercising more, had small shoes and was not suffering from any pain!

 

dsc00500i Black Spot Under The ToenailBlack spot under the toenail

 

Diagnosis:

  • Sometimes no pain.
  • Small shoes.
  • New shoes.
  • New exercise regimine.
  • Heavy running or work.
  • Traumatic injury.
  • Dropping something on your foot.
  • It will grow out over time.
  • It will not get bigger over time.

 

2) Subungual melamona (black streak or mole).

This is as a result of a mole! These can appear underneath your toenail or around the toenail. The first step is to keep an eye on these and see if they are getting bigger. These can be dangerous, so if they are getting bigger or growing into the skin- go see a podiatrist or foot doctor immediately!

 

 Black Spot Under The Toenail

 

Diagnosis

  • No Pain.
  • It is getting bigger.
  • It has been there a long time.
  • No cause for its appearance.
  • It may be growing into the tissue.
  • See our “Is it dangerous guide?

 

3) Pseudomonas bacterial infection.

 

M onc2 1 Black Spot Under The ToenailGreenish-black spot under the toenail

 

This is different than toenail fungus– this is an bacterial infection. This means it comes quick and strong, then gets cured for good once you see a podiatrist. This goes against toenail fungus which is very slow and resistant.

Pseudomonas is a bacteria that loves oxygenated moist environments like wet mud and pond water. If you have been around any of these recently and you start getting greenish-black toenails, it may be this!

You should go see your podiatrist or foot doctor for some antibiotics!  It can also be confirmed by it’s sweet smelling grape-like odor.

 

Diagnosis:

  • No Pain
  • Greenish-black.
  • Appears quickly.
  • Sweet, grape-like odor.

 

4) Black toenail fungus.

Toenail fungus usually doesn’t present as a black spot under the toenail, but I had heard people describe it this way! So if this is you, here you go. Toenail fungus can present as many different types. It can grow from the front, the base, the sides or invade the entire nail. Visit our complete guide to learn more:

toenail 1 Black Spot Under The Toenail

The complete toenail fungus guide.

Diagnosis

  • Thick Toenails.
  • Yellowish-green.
  • Crumbling toenails.
  • Discolored.
  • Appear slowly and last forever.
  • No Pain.
  • Usually associated with older age, smoking and diabetes.

 

I hope that information on this  page may help you solve problem with your black spot under the toenail! For more information see this link.

22 Jun

Do you see white patches on toenails?

White patches on toenails are usually due to dehydration (especially from nail polish) – Learn what all the causes are and learn what to do about them!

Causes of white toenail patches

  • White patches on the toenails are most commonly caused by dehydration and drying.
  • This is most commonly seen after the removal of toenail polish!
  • It can be a type of nail fungus, but don’t worry it usually is not.
  • These white patches can also be caused by simply stubbing your nail against something, this is called Leukonychia. Don’t worry, leukonychia is harmless as well. These white marks will grow out normally.
  • In cases after pedicures and manicures, and if you are sick- it is possible to catch white fungus. This is called white superficial onychomycosis.
  • The least common and most severe cause of white stains on your toenails is due to systemic diseases.

 

Are white toenail patches dangerous?

In most cases toenail patches are not dangerous. The only time you should really be worried is if you have it due to systemic causes. But in most cases you probably knew that there was something wrong anyway, so the white marks themselves are no big deal.

It is very easy to treat these white stains and rehydrate them in most cases. If it is a cases of superficial toenail fungus, it is very easy to treat as well.

 

by nail polish leading are “keratin granulations” that are frequently misdiagnosed as superficial white onychomycosis but there are other reasons white stains can occur on the toenails and fingernails. The other causes of white stains on your toenails are due to scraping or hitting your nails, nail fungus or due to other systemic problems. The systemic problems option should not be suspected unless you rule out all the other options, so don’t worry!

 

Home treatment guide for white patches on toenails

1) Keratin granulations from nail polish

Skip straight to the keratin granulation treatment guide

 

keratin granulationz White Patches On ToenailsWhite patches on toenails

 

Nail polish can dehydrate the nail leading to what is called “keratin granulations”. This is an extremely tricky diagnosis as almost everyone will think that this is a common type of nail fungus called superficial white onychomycosis. It is more likely to occur the older you get, but have no fear, there is an easy treatment that works in most people!

 

Home treatment guide:

  1. Buy some cutical oil or any other emollient and apply it daily to the nail until it starts to get better.
  2. You can use any moisturizing agent to perform this function, they do not add water to the skin or the nail, but simply prevent water water loss from the cells.
  3. Nail polish really dries out the nail, so oils help reverse those dehydrating effects.
  4. The nail should get better in a matter of days or weeks.
  5. If you let your nails grow out because the moisturizing agent is not working; the bad news is that toenails and fingernails only grow at a rate of 1 millimeter per month. This means 6-9 months for toenails and potentially even longer for fingernails.
  6. It is very difficult to make the nails grow any faster. There are many gimmicks out there that report stronger nails, but really all you can do is increase your metabolism and health by getting some more sun and exercising. Fun Fact: Nails grow up to 50% faster in the summer over the winter.

For more on keratin granulations:

 Keratin granulation treatment guide

 

2) White patches due to trauma

White Patches can also occur due to damage to the keratin(the substance that makes up the nails) and it is usually irreversible and you should just wait until it grows out. Think of this as a scar that happens to your nail plate.

 

white spots fingernail leukonychia punctata White Patches On ToenailsWhite patches on toenails

Home treatment guide

  1. The bad news is that toenails and fingernails only grow at a rate of 1 millimeter per month.
  2. This means 6-9 months for toenails and potentially even longer for fingernails.
  3. It is very difficult to make the nails grow any faster.
  4. There are many gimmicks out there that report stronger nails, but really all you can do is increase your metabolism and health by getting some more sun and exercising.
  5. Fun Fact: Nails grow up to 50% faster in the summer over the winter.

3) White stains that are due to superficial white onychomycosis (nail fungus)

Nail fungus can look very similar to keratin granulations. It is very difficult to differentiate these from keratin granulations. One factor that may lead you more to this is if you can try and scrape off the fungus.

 

afp20010215p663 f4 White Patches On ToenailsWhite patches on toenails

 

Home treatment guide

  1. Go see your podiatrist to make sure.
  2. If you treat your nails as keratin granulations and they don’t get better after 1-2 weeks, suspect this.
  3. If you are immune suppressing medication, suspect this.

Click on this link to our comprehensive nail fungus home treatment guide. Always be sure to see a podiatrist if you are ever unsure!

 

4) White nails due to systemic problems

If the nail does not seem like described in the above three situations, it may be due to a vitamin deficiency or systemic problem

Consider these scenarios for white patches on toenails:

  • Do you have any systemic medical conditions
  • Are you are many medications?
  • Has your diet decreased.
  • Do you not get enough vitamins and nutrients?

If this applies to you go see your podiatrist or foot doctor.

 

I hope that with all information presented here you will be able to take care and solve problem with your white patches on toenails!

 

For more information about white patches on toenails see this link.

19 Jun

Do you see black streaks under your toenails or fingernails?

Black Streaks under the nails (fingernails or the toenails) can be very dangerous. Follow our diagnosis guide to see if you should be worried!

 

70628 fx1 Black Streaks Under the Nails

Black streaks under the nails.

 

Most people should not be worried!

A thick black dark streak could be a subungual melanoma– a type of skin cancer. Don’t be too worried though, the odds are low that you actually have this tough, but better safe than sorry!

Watch the following video to get a better idea if this is what you have:

Dangerous causes black streaks under the fingernails or toenails:

  • Subungual melanoma is the most dangerous cause. It is a very rare form of skin cancer; it is usually seen between ages forty to seventy. It is not due to sun exposure or trauma. It just appears one day without any incident. If your dark spot appears after an injury then you are most likely on the safe side.

 

Safe causes of black streaks in the fingernails and toenails:

  • The odds of the streak in your fingernail are actually pretty low because a lot of people, especially African Americans normally have light thin streaks of dark pigment that that form a vertical line down their nail which is completely normal. It is very easy to predict whether the streak is dangerous or safe.
  • Normal vertical streaks of pigment that are not melanoma. This is especially common in non-white individuals. These are usually thin lines in a very normal looking nail; check the guide below to see if you are on the safe side or if you should go get it checked out.
  • Trauma and loss of fingernail leading to a streak of blood. But this should eventually grow out at 1mm per month. If the blood is not advancing then you should get it checked out just to be safe!

 

 

Probably safe (but should still visit the podiatrist) if:

  • The streak is less than 3 millimeters in width.
  • The streak is uniform in length and of continuous color as it progresses down the nail.
  • The streak or pigment is only present in the nail and not in the skin.
  • The nail is not deformed, bloody or cracked in that area.
  • The nail looks normal compared to the other nails.

 

nail melanoma 300x203 Black Streaks Under the Nails

Black Streaks Under the Nails.

 

Visit a podiatrist for a biopsy immediately if:

  • The black streak is over 3 millimeters in width.
  • The streak is widest at the start of the nail origin.
  • The streak is not uniform or appears disrupted.
  • The streak changes color the further you get.
  • The streak continues from under the nail into the skin, termed “Hutchinson’s sign”.
  • The nail becomes deformed, bloody or starts to crack in the area of the streak.
  • The nail looks very unusual compared to the other nails.
  • The streak is more common in the thumb and the big toe.
  • The streak may even be white; in this case be aware of a nodule or irregularity that is forming under the nail plate.
  • If you have ever considered that there may be a wart underneath your nail that is just not healing.

 

Subungual Melanoma:

  • The outlook is usually very good if the cancer is confined to just the toe.
  • Most people that suffer from this disease have avoided seeking treatment for many, many years. It has usually spread far throughout the body.
  • If you are cautious and follow up on the streaking and ulcerating in a reasonable amount of time, you will most likely be safe.
  • The cure consists of excising the lesion or amputation the tip of your fingernail.
  • See your podiatrist as soon as possible!

 

To learn more about the black streaks under the nails visit this link!

18 Jun

Do you require permanent ingrown toenail removal surgery?

AKA partial nail avulsion

Removing the outside edge of the nail plate in a procedure known as a partial toenail avulsion is is the best permanent ingrown toenail removal surgery. The nail matrix is then permanently inhibited from ever growing that nail edge back. When performed correctly this procedure is shown to be the greatest possible option for keeping your ingrown toenail away.

 Permanent Ingrown Toenail Removal SurgeryPermanent ingrown toenail removal surgery

 

Prior to surgery- See our complete guide for Ingrown Toenails

See our complete home remedy guide on removing ingrown toenails at home. We discuss how to perform soaks to soften the skin, how to cut down the nail with very little pain and then prevent an infection from occurring in the area.

 

Option prior to permanent ingrown toenail removal surgery

1) Complete or partial toenail avulsion

– This refers to the removal of the nail in the podiatrist’s office. The big toe is first numbed up with anesthetic so that you won’t feel a thing. The edge of the nail is then cut out, or if something is really wrong with the nail- the whole nail may be removed and allowed to then grow back. In some cases it does grow back and a nail avulsion with inhibition of the nail matrix must be attempted. In most cases this is unnecessary as the nail will grow back normally.

 

2) Partial toenail avulsion with nail matrix inhibition.

– If the nail regrows in the painful position, the avulsion should be attempted with chemicals or electricity to stop the nail from re-growing. Most offices will use phenol which works very well, but some people advocate that newer techniques such as using electricity or a laser to stop the nail from re-growing are the best options. Research is limited on this opinion, but the claims are decreased inflammation and more regular healing when using electricity.

 

3) Complete excision of the nail in the operating room.

– Although this method is the most guaranteed to work, it is usually only used if you are going into the OR for a second larger procedure like a bunion or hammertoe surgery. The cost to benefit ratio doesn’t really make sense otherwise.

 

Ingrown toenail removal surgery

Supplies:

Sterile gloves, Iodine solution, Syringe with lidocaine, gauze, spatula, 2 straight hemostats, sterile rubber band, Nail splitter (English Anvil), electrocautery unit.

 

Procedure description:

1) Patient’s toe is prepped with povidone-iodine solution. Digital block is performed with lidocaine(2-3ml of lidocaine on each side of the toe).

2) The toe should be given 10 minutes to become numb.

3) The rubber band should be tied at the base of the toe to reduce bleeding during the procedure. Clamp it tight with a hemostat

4) A drape should be placed to obstruct the patient’s view to prevent fainting.

5) The outside edge of the nail should be loosened underneath with a spatula, and then the nail splitter should cut the edge all the way back to the base of the nail. The hemostat should then turn the nail in and remove it from the base. Make sure that no nail spicules remain in that area.

6) The electrocautery unit or phenol should then be applied to the nail matrix for 10-30 seconds. Make sure there is no blood in the area.  If there excess granulated tissue to the area, this can then be treated as well at this point electrically or cut out.

7) Apply antibiotic ointment and put on a dressing.

8) Prescribe an anti-inflammatory medication.

 

To learn more about removal of ingrown toenails see this link.