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Nail Update: Keeping Your Nails Healthy

(press release from The American Academy of Dermatology)

CHICAGO, July 20 -- Healthy nails are an important part of overall health. When nails are in good physical shape, they are not only aesthetically pleasing, but they make it easier to perform everyday tasks. However, not many of us put a lot of thought into our nails, either finger or toe, until there appears to be something wrong.

Speaking at ACADEMY '05, the American Academy of Dermatology's summer scientific session in Chicago, dermatologist Richard K. Scher, M.D., professor of clinical dermatology, Columbia University, New York, N.Y., discussed common nail problems and how to keep them healthy.

"The nails can be windows to a patient's overall health, and while the nail itself is dead tissue, the areas under the cuticle and beneath the nail are alive," stated Dr. Scher. "These areas are particularly vulnerable to infection and damage, which is why it is important to see a dermatologist with any nail changes, so that the problem can be diagnosed and treated."

Cosmetics

Keeping the nails healthy and neat looking has become an important grooming ritual for both men and women as the number of consumers that frequent nail salons and use nail cosmetics at home has increased.

"Nail cosmetics and salon services are generally quite safe, but there are potential problem areas associated with the use of nail cosmetics and salon services: infection, allergic reactions and mechanical damage to the nail," said Dr. Scher. "While these are fairly rare occurrences, they can be serious and consumers should take some simple measures to guard against these potential health concerns."

Contracting an infection is the most serious health risk related to nail cosmetics, particularly from manicure and pedicure tools and implements that have not been properly sterilized. Viral, bacterial and fungal infections may be transmitted to unsuspecting consumers from improperly sterilized implements.

Most nail salons take sanitation very seriously and follow strict sanitation and disinfection guidelines, but consumers should not be afraid to ask how implements are cleaned. "Look at the salon with cleanliness in mind and ask yourself these questions: Are the stations clean? Does the nail technician wash her hands between clients? Are there dirty implements lying around? If the salon does not appear clean, then move on," recommended Dr. Scher, who also recommended that consumers bring their own tools and implements to be used at the salon in order to protect against infection.

Allergic reactions occur when a nail cosmetic ingredient sensitizes the skin which may results in itching, redness, blisters and pain every time the ingredient is used. Some of the more common ingredients that can create an allergic reaction are the acrylic materials found in a wide variety of nail products. Another potential allergen is tosylamid formaldehyde resin, an ingredient found in some nail polishes. If consumers experience itching or burning of the skin following a nail salon service or the application of nail cosmetics at home, Dr. Scher recommends removing the product as soon as possible and visiting a dermatologist to determine which ingredient is responsible for the allergic reaction.

Fungus

Fungal infections, known as onychomycosis or tinea unguium, make up approximately 50 percent of all nail disorders and since the infection occurs under the nail plate or in the nail bed, it can be difficult to treat. Fungal infections often cause the end of the nail to separate from the nail bed, the skin on which the nail rests. Fungus - colored white, green, yellow or black - may build up under the nail plate and discolor the nail bed. Toenails are more susceptible to fungal infections because they are confined in a warm, moist, weight-bearing environment. Candida or yeast infections are common in fingernails especially if the hands are always in water, as they are in professions such as fishermen, dishwashers or those who work at aquariums or aquatic theme parks.

Fungal infections are contagious and organisms can sometimes spread from one person to another especially where the air is often moist and people's feet are bare. This can happen both at home and in public places like shower stalls, bathrooms or locker rooms or they can be passed around by sharing a nail file or emery board. In fact, a recent study noted an increase in athlete's foot, a fungal infection that can grow and multiply on human skin, at boarding schools where students share the same living spaces.

"One way to reduce the risk of contracting toenail fungus is to always wear shower slippers in public showers, lockers rooms and around swimming pools," recommended Dr. Scher.

The Psoriatic Nail

Approximately 50 percent of patients with psoriasis, a disease of the immune system which causes skin lesions that range from patches of mild scaling to extensive thick, red, scaling plaques, have psoriatic changes in their finger and toenails.

"Nail changes in psoriasis fall into general categories that may occur singly or all together," stated Dr. Scher. "These changes can include a deeply pitted nail plate, yellow or yellow-pink discoloration of the nail, white areas under the nail plate or a nail plate that flakes off in yellow patches."

In some cases, the nail is entirely lost due to psoriatic involvement of the nail matrix, where the nail and cuticle meet, and nail bed. Psoriasis of the fingernails also can resemble other conditions such as chronic infection or inflammation of the nail bed or nail fold, the hard skin overlapping the base and sides of the nails. Psoriasis of the toenails can resemble a chronic fungal infection.

Psoriatic nails can be treated by the dermatologist as part of the overall treatment of the disease and dermatologists are beginning to study the use of biologic treatments. "Therapies for the psoriatic nail have been limited because topical treatments do not penetrate down into the nail fold where the psoriasis is actually disfiguring the nail plate," said Dr. Scher. "The introduction of biologic therapies to control skin psoriasis also may be beneficial for patients with psoriatic nails since these treatments work with the body's immune system to prevent the body from triggering a psoriasis flare."

Nail Malignancies

Subungal, or under the nail, melanoma appears as a brown to black-colored streak underneath the nail, which is often mistaken for a bruise or the nail streaks that frequently occur in people with dark skin. Subungal melanoma accounts for approximately 2 percent of melanomas in Caucasians, and 30 to 40 percent of melanomas in patients with skin of color. Subungal melanoma occurs with equal frequency in males and females, appears most often in people over 50 years of age, but can develop at any age and is seen most often under the nail of the thumb or the big toe.

"Subungal melanoma should be suspected whenever a nail streak appears without known injury to the nail, the nail discoloration does not gradually disappear as would a bruise or the size of the nail streak increases over time," said Dr. Scher. "It's important to see a dermatologist immediately if any changes are noticed on the nail since treatment for this condition should begin as soon as possible."

"Overall, it's important when caring for the nails at home or having a service in a salon, to make sure that the nails are being treated gently and safely," said Dr. Scher. "Paying careful attention to the nails can help ensure that any infections or diseases are identified early and that treatment is begun as soon as possible."

Headquartered in Schaumburg, Ill., the American Academy of Dermatology (Academy), founded in 1938, is the largest, most influential, and most representative of all dermatologic associations. With a membership of more than 14,000 physicians worldwide, the Academy is committed to: advancing the diagnosis and medical, surgical and cosmetic treatment of the skin, hair and nails; advocating high standards in clinical practice, education, and research in dermatology; and supporting and enhancing patient care for a lifetime of healthier skin, hair and nails. For more information, contact the Academy at 1-888-462-DERM (3376) or www.aad.org .

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