There are a number of relatively minor disorders of the nails and the surrounding skin. These are fairly common in the community, and for this reason will be mentioned. Most of the more major disorders are fortunately less common, so only some of these will be discussed.
Paronychia is the most common nail condition seen in medical practice. It is an infection of the nail-fold caused by bacteria and yeast, and only very rarely by fungi. Most commonly, it affects people whose hands are frequently immersed in water. Women are more often affected than men, and diabetics more often than non-diabetics. It is particularly common among housewives, barmen, cooks, and cleaners. The predisposing factor is the loss of cuticle, which has most likely been damage by constant wetting or manicuring. This allows organisms to enter the exposed space between the nail-fold and the underlying nail. One or several fingers may be involved, but the index and middle fingers of the right hand are the most commonly affected.
As a result, the nail-fold becomes red, swollen, and painful. Pus will discharge from beneath, and the nail become discoloured and ridged. Treatment involves keeping the nails dry until the cuticle reforms and is able to exercise its protective function.
This means minimizing contact with water, soap, detergents and other irritants—a formidable undertaking for the housewife with young children. Loose rubber gloves with cotton linings should be used for all wet work. Unlined rubber gloves should be avoided, as they increase the softening of the skin by making the hands sweat. When getting the hands wet is unavoidable, then a drying spirit lotion should be immediately applied to the nail-fold after thorough drying of the hands. Overnight, an antibiotic cream effective against both bacteria and yeast should be applied.
Hangnails are splits in the skin along the sides of the nails, resulting in pieces of skin breaking away. They are due either to nail biting or to excessive dryness of the skin. Because dried skin loses its elasticity and tends to crack, the tendency is to pick at it. Often the cause of the dryness is repeated washing and/or inadequate drying of the hands. Protection of the hands, adequate drying, and careful manicuring followed by the application of softening ointments, will help prevent hangnail developing.
Nail biting is an extremely common habit, particularly amongst children. Often several members of the family may be nail biters. The patient is usually somewhat anxious, and the family background may contain elements of insecurity. Usually all fingernails are bitten, frequently right back to where the nail plate separates from the nail-bed. Consequently paronychia, nail deformities, hangnail and warts are very common. Occasionally, the application of foul-tasting paint to the nails may discourage the habit, although it is rarely an effective treatment. Some form of psychotherapy is probably the most useful treatment for adults.
*87\44\4*
