Nail problems Dr Rob Hicks From time to time, most people notice a change in the appearance of their nails. There are various causes but usually no reason to worry.

In this article

White spots Pitting Nail thickening

Separation Vertical splitting Black nail

Ridging Hang nail Fungal nail infection

White spots are extremely common and usually caused by minor trauma such as the nail being knocked. These are more likely to appear if you regularly work with your hands. Some people get white spots every now and then simply because it runs in the family. No treatment is needed - the white spot will grow out with the nail.

This is when a nail starts to look a little like a sewing thimble. Pitting can run in the family or be caused by trauma. It can also occur as a result of certain illnesses, for example, psoriasis, eczema and arthritis. Sometimes treating the underlying condition helps to eliminate the pitting, but not always.

Fungal nail infections and skin conditions such as psoriasis are commonly responsible for nail thickening. When fungal infections are treated the nail usually returns to normal. When skin conditions are treated, the nail sometimes returns to normal but it's not guaranteed. Trauma and the ageing process may also cause thickening.

When the nail separates from the underlying tissue (nail bed) it appears as if the white part of the nail is extending backwards and becoming larger. Most commonly this is caused by psoriasis or repeated exposure to detergents. Catching the nail accidentally on something is also a common explanation, causing the nail to be levered off the nail bed. Typing on a keyboard may have the same effect over time.

Getting older or having your hands in water makes your nails softer and often results in vertical splits extending from the tip backwards towards the cuticle. A good supply of iron and zinc is needed in the diet to keep the nails strong. Massaging almond oil into the nails helps strengthen and protect them too.

Looking after your nails

1. Try not to bite or pick at your nails
2. Protect the nails of the fingers and thumbs with rubber gloves if your hands spend a lot of time in water
3. Cut the nails by following the shape of the fingers, thumbs and toes - often easier after they've been soaked in water
4. File the edges smooth
5. Get plenty of iron and zinc in your diet

Black nail, or subungual haematoma to give it its medical name, is very common. It's caused by acute trauma, most commonly jamming a finger or thumb in a door, stubbing a toe - or when the wrong sort of nail gets hit with a hammer.

Subungual means 'under the nail', haematoma means bruise. As with all bruises in time it will disappear. Sometimes the nail will fall off because of the damage but it usually grows back. When the build up of pressure under the nail causes pain, making a small hole in the nail relieves it. The doctor or chiropodist can do this.

Vertical ridging usually appears in middle age and is simply a sign of ageing. The ridges extend from the tip of the nail backwards and become more numerous with time. If the appearance of the nails is a problem they can be gently smoothed with an emery board or nail file.

Ridges that go from one side of the nail to the other are known as transverse ridges or 'Beau's lines'. These appear when a temporary interruption of nail growth occurs. This interruption may be caused when the body experiences an illness, such as a heart attack or pneumonia, or any other shock to the system. Trauma to the nail can also be responsible. The ridges generally grow out in time. How quickly this happens depends on the speed at which the nails usually grow.

Most often this is self-inflicted. Biting or picking at the nails leaves ragged cuticle edges that catch on clothing and may allow infection to develop. Overzealous and aggressive self-manicuring can result in the same problem. Cold weather that dries out the skin or having the hands in water a lot can also cause hang nails to appear.

The fungus spreads from the tip or side of the nail backwards, causing it to become yellowy-white in colour, thickened and crumbly. Usually nail clippings are sent to the laboratory to confirm that fungal infection is responsible. If so then treatment is needed to resolve the infection and this can be prescribed by the doctor.

Ask your chiropodist/podiatrist, pharmacist, doctor or beauty therapist for advice if you're worried about your nails.

This article was last medically reviewed by Dr Rob Hicks in July 2006.