Foot Care – Fungal Toenails /h2>

Psoriatic Nails

About 50 percent of persons with active psoriasis have psoriatic changes in fingernails and/or toenails. In some instances psoriasis may occur only in the nails and nowhere else on the body. Psoriatic changes in nails range from mild to severe, generally reflecting the extent of psoriatic involvement of the nail plate, nail matrix (tissue from which the nail grows), nail bed (tissue under the nail), and skin at the base of the nail. Damage to the nail bed by the pustular psoriasis can result in loss of the nail.

Nail changes in psoriasis fall into general categories that may occur singly or all together:

The nail plate is deeply pitted, probably due to defects in nail growth caused by psoriasis.
The nail has a yellow to yellow-pink discoloration, probably due to psoriatic involvement of the nail bed.
White areas appear under the nail plate. These are air bubbles marking spots where the nail plate is becoming detached from the nail bed (onycholysis). There may be reddened skin around the nail.
The nail plate crumbles in yellowish patches (onychodystrophy), probably due to psoriatic involvement in the nail matrix.
The nail is entirely lost due to psoriatic involvement of the nail matrix and nail bed.

Thick Toenails (Onychogryphosis)

These type of nails are caused by damage to the cells that grow the nail. This can be sudden acute damage such as dropping a heavy object onto the toe or can be due to a gradual damage over the years with the toes impacting into the toe box of the shoes or with various sporting activities. This Gryphosis can be mistaken for a fungal infection of the nail and treated with expensive drugs inappropriately (see signs of fungal nail infections below).

The Treatment for the thickened toenail depends on the severity and whether it causes you any pain or difficulty with wearing shoes. Fundamentally the treatment is to reduce the thickness by cutting and filing the nail so that it is more manageable in future. Ultimately the nail can be removed under local analgesia, but the nail root matrix has to be destroyed since the damaged cells will continue to produce a thick new toenail if the nail is just removed and the nail root (Germinal Matrix) is left intact.

Surgical procedures which involve cutting the germinal matrix out used to be common place but this quite often left remnants of the matrix which could regenerate a nail across some parts of the area which leads to small spikes of growing nail popping out across the surface of the old nail area.

More commonly now the technique of using a saturated solution of Phenol after the nail is removed is used as it is a liquid the treatment reaches all parts of the germinal matrix and has a high success rate. The disadvantages lie with an increased healing time and care must be taken not to allow the phenol to damage surrounding skin.