2023-07-10 08:20:07
By Lorea Bagazgoitia, dermatologist.
Although it may not seem like it, the nails are there for a reason. Beyond their role in the aesthetics of the hands or feet, the nails physically protect the distal part of the fingers, help to grasp small objects and improve fine sensitivity.
Its changes in color or shape, as well as pain, are frequent reasons for consultation both at the dermatologist and at the pharmacy. Let us clarify, then, in this article, the most relevant points on the physiological and pathological functioning of the nails, as well as the therapeutic approach in the different situations.
How does the nail work?
The growth of the nail originates through its matrix, which is located in the most proximal area of the nail, hidden by a skin fold. The complete cycle of fingernails lasts approximately six months, while in the case of toenails it lasts one year. The growth rate of the nails decreases as we get older and can stop as a result of diseases, traumas or some medications (for example, some chemotherapy).
As a consequence of this speed of growth, diseases that affect the nails usually have a progressive course. Its evolution, both in terms of appearance and healing, usually takes several months. Unfortunately, not all nail manifestations have a solution.
We will review below the tables that most frequently come to our consultations.
Fungus
Onychomycosis is the infection by fungi, usually dermatophytes (the most frequent, trichophyton rubrum) or yeasts (the most frequent candida) of the nail plate. It is characterized by a change in color, thickness and even deformity in the nail, which usually progresses from the distal to the proximal area.
It is estimated that fungal infection is the cause of up to 60% of acquired anomalies in the nails, being more frequent in adults than in children. It is also more common on the toenails than on the fingernails. Although its frequency is high, let’s remember that not every nail disorder is a fungal infection and, therefore, it seems important to me to highlight the role of a dermatological assessment before starting treatment.
Topical treatment with nail lacquers containing antifungals (amorolfine, ciclopirox) is indicated exclusively for minor onychomycosis limited to the distal part of the nail. It can also be used in people who want a treatment, but have a contraindication for oral use. The application of the lacquer must be prolonged for several months, until the nail grows without the signs of onychomycosis. In general, it is usually a very unsatisfactory pattern. Oral treatment is more effective. Terbinafine is the drug of choice for dermatophytes and itraconazole for yeasts (Candida, for example).
However, treatment of onychomycosis is not mandatory. This is considered in cases where the patient wishes for aesthetic reasons, in people with a high risk of cellulite in the lower extremities or if it produces very annoying symptoms or pain.
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