Tag Archives: Nail (anatomy)

All about our nails

When we were young, fingernails and toenails gave us no trouble . (They may just be a bit dirty). With advancing age, however, they become brittle, hard, fall off or develop infections and become painful. Suddenly, we are forced to notice our nails!

Looks of nails reveals  many things:
Healthy nails are usually smooth and light pink in colour. Blue nails occur when there is a lack of oxygen in the blood (heart and lung disease). Nails can turn black in vitamin B12 deficiency. A horizontal depression or discoloration can develop across the nail due to illness, antibiotics or chemotherapy. The line becomes prominent as the nail grows out and then gradually disappears. Nails may grow brittle if there is anaemia and can also become spoon shaped. The opposite, a bulged out, parrot-beak like club-shaped nail is seen in chronic obstructive airways disease. Splitting and fraying are associated with hypothyroidism and psoriasis.

Click & see…>Healthy nails

Unhealthy nails

Most important, a close examination of the nails can reveal other disease processes such as iron deficiency (anaemia), vitamin B12 deficiency, diabetes, kidney and liver disease and even infection of the heart valves (endocarditis).

In older people (particularly those who have high blood sugar) an infected ingrown toenail (usually the big toe) is a common problem. This occurs when toenails are trimmed too short, blades or knives are used instead of nail cutters or if the edges of the nails are picked and torn.

Growth of nails:
Fingernails grow faster than toenails. The rate of growth depends on health, heredity and sex. Growth slows during illness and with increasing age, but at the same time, the nails become tougher. They are then more difficult to trim.

Nail biting:
In prehistoric times people had to bite their nails to trim them but today it is a social no-no. Biting in itself is harmless but it can cause secondary bacterial infection of the skin around the nail. It can cause and perpetuate worm infestation. It can transmit flu viruses acquired from contaminated surfaces directly to the mouth. Bitten down nails may work against you in job interviews. It is a habit that is arises out of lack of impulse control, and is perpetuated by stress.

Nail Care:
If there is no diabetes, an ingrown toenail can be treated at home by soaking it in warm salted water for 10 minutes and placing a cotton ball soaked in antibiotic ointment under it.

Nails are also prone to fungal infections. This destroys the nails and gives it an “eaten away” appearance. Topical ointments are not very effective. Medicines have to be taken orally until the infection resolves and a healthy nail grows out. This takes anywhere from three to six months. Medical conditions like psoariasis may mimic fungal infection. A proper diagnosis is essential before embarking on treatment.

For taking care of toe nails, it is advised  to wear slippers or open-toed sandals as in worm climate they  are better than shoes. If shoes have to be worn, they should fit properly. Shoes that people wear every day should have plenty of room around the toes so that nails do not hit the end of the shoe. They should also not be too loose as your feet will slide forward while walking or running and hit the end damaging the nails.It is always adviced to wear socks when one wears shoes.

Resources: The  Telegraph (Kolkata, India)
Diagnose Health Issues by Looking at Your Nails:-

Your fingernails and toenails are not just decorations for the ends of your palms and feet; they’re also an effective warning system for our health. So from now on, before you clip or paint your nails, take a look because they might be trying to tell you something.

WARNING – Some of these images may be unpleasant to look at

1. Dark bands on the nail tips
The tips of the nails seem to have dark bands on each one. This may just be a sign of old age. According to Mayo Clinic, it can also indicate “Terry’s nails“, diabetes, liver disease or even cognitive heart failure. If your doctor diagnoses you as diabetic, you may want to consult with a podiatrist on how to cut your nails to prevent harm.

2. White nails
If your nails are white as seen in the picture,WebMD warns that it may indicate liver problems or hepatitis.

 

3. Clubbed nails
According to the NCBI, nails that are round as seen in the picture may indicate lung problems.

4. Yellow Nails
According to WebMD, if your nails have a yellowish tinge, it may indicate a fungal infection, and even thyroid or lung disease.

5. “Spoon” nails
If the nail edges curve upwards and are soft to the touch, the Mayo Clinic says that it may indicate anemia, heart disease, liver problems, or hypothyroidism.

6. Weak nails
The nails split and chip easily and are overall weak. This often indicates abuse of acrylic nail polish. Let your nails “breath” for a few days, it will help them regain their strength.

7. Bitten nails
WebMD confirms that nails that are bitten down often indicate a state of anxiety, stress, or boredom. Applying foul-tasting nail polish can help you stop chewing on them.

8. Nail dents
If your nails have vertical dents, the NHS says that you may be suffering from skin disorders like eczema or psoriasis, as well as arthritis or even alopecia areata.

9. Loose nails
The nails are loose and come off the nail bed with ease? Cedars-Sinai says that it can indicate hyperthyroidism. If you’re a runner, however, it may just indicate that you’re wearing ill-fitting shoes.

10. Blue nails
Nails that are bluish in color are often an indicator of a lack of oxygen to the extremities. This is why surgeons insist on patients removing any nail polish before undergoing anesthesia. Another possible diagnosis is lung problems, according toWebMD.

11. Ingrown toenails
This is one of the most common nail-related ailments, characterizes by the edges of the toenail growing into the flesh of the toe. This condition may be accompanied by infection and pain.WebMD indicates that the most common causes are: Ill-fitting shoes, trauma to the toe or incorrect trimming of the nails.

12. Dark nails
According to AAFP, if your nails take on a dark color in conjunction with a discoloration of the skin, it may be an indication of melanoma (skin cancer).

13. Nail ridges
Vertical ridges along the nail are actually nothing to worry about.

14. Hematoma under the nail
If you notice spots of red/brown/black color under the nail, it’s most likely indicative of a hematoma, caused by mild trauma to the nail. The AOCDsays that the best treatment is to elevate your feet and ice the injured toe.

15. Horizontal ridges
Horizontal ridges along the nail, known as “Beau’s lines”, occur in cases of zinc deficiency, as well as diabetes, and as a result of high fever. (Source:Mayo Clinic)

16. Thin nails
The AAD warns that constant use of gel nail polish and the subsequent use of UV light and other chemicals can result in thinning of the nails. If this is the case, allow some time for the nails to recover before resuming your gel manicure.

17. Cracked / Missing nails
The NCBI warns that if any part of your nail looks similarly to the discolored, cracked nail in the image on the right, it may indicate that you have a fungal infection called onychomycosis.

18. Pincer nails
According to the NCBI, ill-fitting shoes, excessive trimming, a hereditary condition, and in rare conditions – tumors, can result in the formation of curved “pincer nails”.

19. White spots on the nails
Are there white spots on your nails? WebMD says it’s most likely a result of harsh manicure, nail trauma or ever a hereditary trait.

20. Nail pain
If your nails look healthy but are sore or even painful, visit your doctor and have your nails checked. Pain in the nails can be any of the above reasons, so having them looked at by an expert is not a bad idea.

Source:  E-mail  From of a renowned Doctor

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Onychomycosis

 

Definition:
Onychomycosis (also known as “dermatophytic onychomycosis,” “ringworm of the nail,” and “tinea unguium”) means fungal infection of the nail.  It is the most common disease of the nails and constitutes about a half of all nail abnormalities.

Click to see the picture

This condition may affect toenails or fingernails, but toenail infections are particularly common. The prevalence of onychomycosis is about 6-8% in the adult population.

Clasification:
There are four classic types of onychomycosis:

*Distal subungual onychomycosis is the most common form of tinea unguium, and is usually caused by Trichophyton rubrum, which invades the nail bed and the underside of the nail plate.

Click to see the picture

*White superficial onychomycosis (WSO) is caused by fungal invasion of the superficial layers of the nail plate to form “white islands” on the plate. It accounts for only 10 percent of onychomycosis cases. In some cases, WSO is a misdiagnosis of “keratin granulations” which are not a fungus, but a reaction to nail polish that can cause the nails to have a chalky white appearance. A laboratory test should be performed to confirm.

*Proximal subungual onychomycosis is fungal penetration of the newly formed nail plate through the proximal nail fold. It is the least common form of tinea unguium in healthy people, but is found more commonly when the patient is immunocompromised.

*Candidal onychomycosis is Candida species invasion of the fingernails, usually occurring in persons who frequently immerse their hands in water. This normally requires the prior damage of the nail by infection or trauma.

Symptoms:
The nail plate can have a thickened, yellow-brown , or cloudy appearance. The nails can become rough and crumbly  , or can separate from the nail bed. This thickening, discolouration and disfigurement are clearly visible.There is usually no pain or other bodily symptoms, unless the disease is severe.

Dermatophytids are fungus-free skin lesions that sometimes form as a result of a fungus infection in another part of the body. This could take the form of a rash or itch in an area of the body that is not infected with the fungus. Dermatophytids can be thought of as an allergic reaction to the fungus. People with onychomycosis may experience significant psychosocial problems due to the appearance of the nail. This is particularly increased when fingernails are affected.

The effects of onychomycosis aren’t simply cosmetic. A thickened nail may limit usual activities. It may press on the inside of footwear, for example, causing discomfort and pain. This in turn can cause problems when walking, and reduce mobility.

Causes:
Onychomycosis is caused by 3 main classes of organisms: dermatophytes (fungi that infect hair, skin, and nails and feed on nail tissue), yeasts, and nondermatophyte molds. All 3 classes cause the same symptoms, so the appearance of the infection does not reveal which class is responsible for the infection. Dermatophytes (including Epidermophyton, Microsporum, and Trichophyton species) are, by far, the most common causes of onychomycosis worldwide. Yeasts cause 8% of cases, and nondermatophyte molds cause 2% of onychomycosis cases.

•The dermatophyte Trichophyton rubrum is the most common fungus causing distal lateral subungual onychomycosis (DLSO) and proximal subungual onychomycosis (PSO).

•The dermatophyte Trichophyton mentagrophytes commonly causes white superficial onychomycosis (WSO), and more rarely, WSO can be caused by species of nondermatophyte molds.

•The yeast Candida albicans is the most common cause of chronic mucocutaneous candidiasis (disease of mucous membrane and regular skin) of the nail.

Risk Factors:
Risk factors for onychomycosis include family history, advancing age, poor health, trauma, living in a warm climate, participation in fitness activities, immunosuppression (can occur from HIV or certain drugs), bathing in communal showers (such as at a gym), and wearing shoes that cover the toes completely and don’t let in any airflow.

People with diabetes are at greater risk, as are those whose immune system is suppressed.

It’s possible to reduce your risk of onychomycosis by practising good nail care. This reduces the risk of other nail and foot-related problems, too.

Click to see more

Diagnosis:
Onychomycosis (OM) can be identified by its appearance. However, other conditions and infections can cause problems in the nails that look like onychomycosis. OM must be confirmed by laboratory tests before beginning treatment, because treatment is long, expensive, and does have some risks.

•A sample of the nail can be examined under a microscope to detect fungi. See Anatomy of the Nail for information on the parts of the nail.

•The nails must be clipped and cleaned with an alcohol swab to remove bacteria and dirt.

•If the doctor suspects distal lateral subungual onychomycosis (DLSO), a sample (specimen) should be taken from the nail bed to be examined. The sample should be taken from a site closest to the cuticle, where the concentration of fungi is the greatest.

•If proximal subungual onychomycosis (PSO) is suspected, the sample is taken from the underlying nail bed close to the lunula.

•A piece of the nail surface is taken for examination if white superficial onychomycosis (WSO) is suspected.

•To detect candidal onychomycosis, the doctor should take a sample from the affected nail bed edges closest to the cuticle and sides of the nail.

•In the laboratory, the sample may be treated with a solution made from 20% potassium hydroxide (KOH) in dimethyl sulfoxide (DMSO) to rule out the presence of fungi. The specimen may also be treated with dyes (a process called staining) to make it easier to see the fungi through the microscope.

•If fungi are present in the infected nail, they can be seen through a microscope, but the exact type (species) cannot be determined by simply looking through a microscope. To identify what exactly is causing onychomycosis, a technique called culturing is used. Using a fungal culture to identify the particular fungus is important because regular therapy may not work on nondermatophyte molds.

…#The infected nail is scraped or clipped.

…#The scrapings or clippings are crushed and put into containers. Any fungus in the samples can grow in the laboratory in these special containers.

…#The species of fungus can be identified from the cultures grown in the lab.

Click to see the pictures

Treatment:
Medications
In the past, medicines used to treat onychomycosis (OM) were not very effective. OM is difficult to treat because nails grow slowly and receive very little blood supply. However, recent advances in treatment options, including oral (taken by mouth) and topical (applied on the skin or nail surface) medications, have been made. Newer oral medicines have revolutionized treatment of onychomycosis. However, the rate of recurrence is high, even with newer medicines. Treatment is expensive, has certain risks, and recurrence is possible.

•Topical antifungals are medicines applied to the skin and nail area that kill fungus.

…#These topical agents should only be used if less than half the nail is involved or if the person with onychomycosis cannot take the oral medicines. Medicines include amorolfine (approved for use outside the United States), ciclopirox olamine (Penlac, which is applied like nail polish), sodium pyrithione, bifonazole/urea (available outside the United States), propylene glycol-urea-lactic acid, imidazoles, such as ketoconazole (Nizoral Cream), and allylamines, such as terbinafine (Lamisil Cream).

…#Topical treatments are limited because they cannot penetrate the nail deeply enough, so they are generally unable to cure onychomycosis. Topical medicines may be useful as additional therapy in combination with oral medicines.

•Newer oral medicines are available. These antifungal medicines are more effective because they go through the body to penetrate the nail plate within days of starting therapy.

…#Newer oral antifungal drugs terbinafine (Lamisil Tablets) and itraconazole (Sporanox Capsules) have replaced older therapies, such as griseofulvin, in the treatment of onychomycosis. They offer shorter treatment periods (oral antifungal medications usually are administered over a 3-month period), higher cure rates, and fewer side effects. These medications are fairly safe, with few contraindications (conditions that make taking the medicine inadvisable), but they should not be taken by patients with liver disease or heart failure. Before prescribing one of these medications, doctors often order a blood test to make sure the liver is functioning properly. Common side effects include nausea and stomach pain.

…#Fluconazole (Diflucan) is not approved by the Food and Drug Administration (FDA) for treatment of onychomycosis, but it may be an alternative to itraconazole and terbinafine.

•To decrease the side effects and duration of oral therapy, topical and surgical treatments may be combined with oral antifungal management.
Surgery

Surgical approaches to onychomycosis treatment include surgically or chemically removing the nail (nail avulsion or matrixectomy).

•Removing the nail plate (fingernail or toenail) is not effective treatment on its own. This procedure should be considered an adjunctive (additional) treatment combined with oral therapy.

•A combination of oral, topical, and surgical therapy can increase the effectiveness of treatment and reduce the cost of ongoing treatments.

Research:
Most drug development activities are focused on the discovery of new antifungals and novel delivery methods to promote access of existing antifungal drugs into the infected nail plate. Active clinical trials investigating onychomycosis:

Phase III
*A topical treatment, AN2690, is being developed by Anacor Pharmaceuticals.  It is active against Trichophyton species.

*A medicinal nail lacquer, MycoVa from Apricus Biosciences,[40] contains terbinafine as the active ingredient and a permeation enhancer DDAIP which facilitates the delivery of the drug into the nail bed where the fungus resides.

*A comparison of delivery methods for itraconzole

*Safety and tolerability of topical terbinafine

*Laser-based treatments

*Topical IDP-108

*Bifonazole cream application after nail ablation with urea paste

Phase II
*Posaconazole, taken orally.

*A topical treatment, NB-002, is being developed by NanoBio Corporation. It has completed Phase II trials

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose

Resources:
http://en.wikipedia.org/wiki/Onychomycosis
http://www.emedicinehealth.com/onychomycosis/page7_em.htm
http://www.bbc.co.uk/health/physical_health/conditions/onychomycosis1.shtml

http://www.aafp.org/afp/2001/0215/p663.html

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Some Health Quaries & Answers

Fungus on my nails :

Q: I think I have fungal infection of my nails. They are discoloured and break easily. I also have white patches on my skin that have been diagnosed as psoriasis.

A: Psoriasis can cause nail dystrophy. This means the nails may be pitted, discoloured or have ridges, and break easily, crumble or separate from the nail bed. Sometimes this can co-exist with fungal infection of the nail or secondary bacterial infection of the nail bed.

Psoriasis of the nails has no specific treatment. The nails should be kept short. Nail varnish or henna may be used to disguise the appearance. If the psoriasis is complicated by fungal or bacterial infection, specific treatment needs to be taken after consulting a doctor.

Cat bite :

Q: My neighbour’s cat bit me. Please advise.

A: People are aware of the dangers of dog bite and immunise their dogs. Unfortunately, they don’t do the same for cats although these animals are equally likely to transmit rabies.

The wound should be cleaned with soap and water. Then an antiseptic solution (not powder or ointment) must be applied. A dose of tetanus toxoid should be taken. Proceed to take anti rabies treatment. You will need three injections if the cat is alive and healthy after your third shot. If the cat is missing, ill or dead, you need five. The injections have negligible side effects.

Green diet

Q: How much of fruit or vegetables should I eat?

A: Four to six helpings daily is considered ideal and sufficient to provide the required amount of fibre and antioxidants. It also adds bulk to the food, filling the stomach and reducing total calorific intake. You might also try adding one or two tomatoes. Tomatoes contain large quantities of lycopene, a powerful antioxidant. Unlike the nutrients in most fruits and vegetables, lycopene retains its potency after cooking and processing.

Body odour


Q: My aunt has a strange body oder . She bathes daily but the smell is all pervading.

A: Body odour can be due to sweat or disease. If she is an elderly person, it might be worthwhile to arrange a complete physical examination for her to rule out any obvious infection or cancer. She also needs to be evaluated for diabetes, liver and kidney disease. These systemic illnesses can cause altered unpleasant body odour.

Sleepy baby

Q: My baby sleeps most of the time. I am worried she’s sleeping too much.

A: The sleep requirement of infants varies widely and can fluctuate from nine to 19 hours. Some parents complain their child never sleeps while others say theirs is always sleeping. If the baby is feeding well and gaining weight, and doesn’t have constipation or diarrhoea, you probably have nothing to worry about. After all, the sleep patterns of adults too vary from four to eight hours a day.

Sugar control

Q: I read that there are several new and improved diabetic medicines in the market. But my doctor insists on the same old metformin. My diabetes is not under very good control.

A: Good control of diabetes requires dieting and exercise. If you aren’t compliant, don’t eat in a measured way and refuse to walk or exercise, your diabetes will probably stay uncontrolled. Try to correct these factors first.

Metformin is a tried and tested medication. It does not cause the blood sugars to drop to dangerously low levels. The biggest advantage is it is taken after food. Indians tend to fast on certain days. If a person administers insulin or takes medication after fasting, the sugars may drop to dangerously low levels.

School shoes

Q: My son’s school issues “regulation shoes”. These give him painful shoe bites.

A: Ensure the shoes are of the correct size and are always worn with socks. Rub a piece of Lifebuoy or Hamam soap on the dry feet before wearing them. Do not wash it off. This will prevent shoe bites.

Source: The Telegraph ( Kolkata, India)

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Hope for Clumsy Clods

Right handed or left? Worldwide, about 90 per cent of the people prefer to use their right hand for doing things. Not surprisingly, life in all cultures is geared to the right-handed individual. Implements like nuts and bolts are difficult to handle for the left-handed. Incidentally, “right” also means “correct”. The word “left” is derived from the Anglo-Saxonlyft” which means “weak” or “useless”.
……………CLICK & SEE
Our brains are wired for handedness. During the process of evolution, the centre for language moved to the left hemisphere in the majority of the people. The human brain functions such that the left and dominant hemisphere controls the right side of the body, making the majority (80 per cent) totally right-handed. The dominance does not extend to the use of the hand alone — such people are also are “right sided”. Their dominant eye, ear and leg are on the same side of the body.

Problems arise in 20 per cent of the population that doesn’t have a dominant hemisphere to determine laterality or handedness. Their brains are “cross wired”, giving them mixed handedness or laterality, cross dominance, mixed dominance or cross laterality. In short, the right hand may be matched with the left foot or the left hand with the right eye. This leads to confused, crossed signals in the brain when complex tasks are performed. The electrical and chemical signals have to criss-cross the midline before they eventually reach their final destination in the designated area of the brain. Therefore, such individuals are accident prone, and have things around them explode, collapse, catch fire or fall apart. Day-to-day objects are misplaced, and navigation from one place to another (with left to right confusion) — even along familiar roads — becomes a nightmare.

These adults evolved from clumsy children, who kept bumping into things and frequently fell down. Their bodies have scars and evidence of healed fractures. Their school projects get “excellent” for imagination and “zero” for execution. Life is difficult for people with mixed laterality. Career choices are affected, with professions like driving or piloting a plane remaining distant dreams.

People with mixed laterality alternate hands when writing and legs when kicking. They hold the telephone to the ear opposite to their writing hand. They subconsciously use one hand first and then the other to perform complex tasks. Earlier, such people were considered ambidextrous, but true ambidexterity is almost unknown.

The uncertainty also extends to the mental image of their own limbs or body surface. This causes an inability to rapidly execute commands to turn right or left. The march past becomes a formidable hurdle, with everyone doing a “right turn”, while the affected individual wanders off in the wrong direction. Hesitation is evident if they are asked to perform complicated tasks with alternating hands initiating the movement. Slowed reactions preclude split second decisions, causing frequent accidents. Also, people with mixed laterality do not perform well in track and field events. Their feet do not alternate quickly enough. Running is slow and uncoordinated. The good news, however, is that they excel in games involving a bat (such as hockey, cricket, tennis, badminton and table tennis). This is because the bat is held across the body on the dominant side.

Mixed laterality also has its advantages. The criss-crossing of brain signals uses and strengthens many normally unused brain synapses and pathways. Hence such people are exceptionally talented, creative and artistic. If portraits or photographs of some famous artists — such as Leonardo da Vinci and Rembrandt — are scrutinised, you will see that they may paint with one hand, while tilting the head to the other side and crossing the opposite leg. This demonstrates mixed laterality.

To check your laterality, figure out —

* Which hand you use to write, pick up objects or dial the telephone

* Which leg you use to kick or which is uppermost when your legs are crossed (this remains constant all through life)

* If you cannot hear clearly, to which side you tilt your head

* The side of your jaw you use to chew (this is also constant unless there is a dental problem)

If you have mixed laterality, it is possible to overcome the “defects” and strengthen both sides equally, in a way that it “compensates” for mixed laterality. These exercises, that require 10 repetitions, may be of help

CLICK & SEE

• While walking, clench and unclench your hands, alternating them with the foot you use to step forward (right hand and left foot)

• Standing on one leg at a time

• Close one eye first and then the other

• Close one ear at a time

• Doing yogic breathing through one nostril at a time.

If a child is “left” handed, that may be the “right” laterality for him or her. Punishment, ridicule or forceful correction messes up the brain connections. Desist from interference, or you might just have sabotaged the emergence of the next Einstein.

CLICK & SEE


Source:
The Telegraph (Kolkata, India)

Why do Fingernails Grow Faster than Toenails?

Dermatologists confirm that the rate of fingernail growth outstrips that of toenails, with the former lengthening anywhere from slightly faster to perhaps three times as fast. The American Academy of Dermatology puts the average rate of fingernail growth at about 0.1mm a day.

Click to see the pictures..>....(01).....(1)……...(2)…….(3)

The reason for the difference is uncertain but speculation is it is because of blood circulation which is better in the hands than in the feet. According to biopsy reports, the further down in the leg, the slower things are to heal, with an even slower cell turnover rate as you go further down to the toes.

Fingernail cells are formed in the matrix, under the cuticle, and are gradually extruded, dying, hardening and becoming mashed together as they are pushed out by the new cells. The root of the fingernail produces most of the volume of the nail and the nail bed beneath it. The bed contains the blood vessels, nerves and melanocyte cells responsible for skin colour. As the nail is produced by the root, it streams down along the nail bed, making it thicker. Nail growth is also affected by hormones, age, climate and time of year. Hair seems to grow a little faster in summer and the same is true for nails.

Sources: The Telegraph ( Kolkata, India)

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