Related Terms

• Antifungal lacquer, antifungals, Beau's line, brittle fingernails, brittle toenails, cuticle, dermatophytes, finger nails, fingernails, fungal paronychia, hangnail, half and half nails, half-and-half nails, hot oil manicure, hyperpigmentation, ingrown toenail, lunula, manicure, manicurist, matrix, Mee's lines, nail bed, nail biting, nail folds, nail hardeners, nail loss, nail plate, nail polish remover, onycholysis, onychomadesis, onychomycosis, paraffin treatments, pedicure, pedicurist, toenails, vertical nail ridges.

Background

• Nail care refers to the proper maintenance of the fingernails and toenails. Nail care is important because it helps prevent nail problems, such as fungal nail infections and ingrown toenails. However, in some cases, nail problems are symptoms of an underlying medical condition, such as an infection throughout the body.

• The fingernails and toenails help protect the fingers and toes. The nails are made up of several different parts. The nail plate is the largest and most visible part of the nail. It is the hard part that covers the tips of the fingers. The nail bed is the skin that is beneath the nail plate. The nail folds are the skin that surrounds the three sides of each nail. The cuticle is the thin u-shaped tissue that overlaps the nail plate at the base of the nail. It protects new nail as it grows from the nail bed. The lunula is the white-colored half-moon shape at the base of the nail beneath the nail plate.

• The nails start growing underneath the cuticle, in what is called the matrix. As new cells grow, older cells harden and are pushed out to become part of the nail plate. On average, nails grow about 0.1 millimeters daily. In other words, if a nail falls off, it takes about 4-6 months for it to completely grow back.

• Nails are considered healthy if they are smooth and uniform in color and consistency. Healthy nails do not have ridges or grooves, and they do not have spots or discoloration.

• In order to maintain healthy nails, it is recommended that individuals keep the nails clean, trimmed, and moisturized. Moisturizing the nails helps prevent the nails from becoming brittle and breaking or cracking. Although nail biting does not usually cause nail problems, it is not recommended. In some cases, nail biting may worsen a nail condition, such as an infection around the nail bed.

Nail Maintenance

• Keep the fingernails clean: It is important to keep the fingernails clean. Individuals can soak the feet and hands in warm soapy water to help keep the nails clean. The nails can also be gently scrubbed with a soft brush under warm soapy water. This helps prevent infections from developing. Nails are at risk of becoming infected because they are frequently exposed to germs that can easily become trapped under the nails.

• Protect the nails: Wear gloves when performing activities that may damage nails, such as gardening. It is also recommended that individuals wear cotton-lined rubber gloves when handling harsh chemicals or soaps for extended periods of time. This is because soaps and chemicals may weaken the nails, making them susceptible to breakage.

• Trimming (adult): The fingernails and toenails should be trimmed weekly. Soaking the toenails in warm salt water (one teaspoon of salt added to one pint of water) for 5-10 minutes before trimming may help soften toenails that are thick and difficult to cut. Applying a 10% urea cream to the nails before trimming is also recommended. Moisturizers help prevent the nails from breaking or cracking when they are trimmed. They also help soften tough or thick nails, making it easier to trim them. A nail clipper or a pair of nail scissors may be used. The nails should be cut in a straight line, with only slight rounding at the tip.

• Most experts do not recommend cutting or pushing back the cuticles because it may damage the nail bed and increase the risk of an infection.

• Once trimming is complete, jagged edges should be smoothed with a nail file or emery board.

• If any hangnails or loose strips of torn skin near a fingernail or toenail are present, they should be clipped off. Hangnails should not be pulled off because this usually results in the removal of living tissue.

• Trimming (infant): It is important to trim babies' fingernails and toenails because they have weaker immune systems than adults and are more prone to developing infections. Also, if the nails are too long, a baby may scratch himself or herself. Baby's nails are generally soft. Nail clippers or manicure scissors designed for infants are preferred to trim infants' nails, as the tips are rounded for safety. Using one hand to hold the baby's finger or toe and pressing the skin under the nail down and out of the way reduces the likelihood of a pinch or cut. Then, the parent's other hand can be used to trim the nail and round off any sharp edges. For fingernails, it is typically recommended to follow the nail's natural shape. Toenails are most often trimmed straight across. When all nails are trimmed, any rough edges can be smoothed with a soft emery board.

• Moisturize the nails: Healthy nails require moisture. When applying lotion to the hands, make sure to rub some onto the nails. Individuals should apply moisturizer after washing the hands with soap and after bathing or showering.

• Manicures and pedicures: Individuals can receive any of the above treatments, as well as many other aesthetic treatments, at a salon. When the fingernails are groomed, it is called a manicure. When the toenails are groomed, it is called a pedicure.

• A standard manicure or pedicure usually includes filing and shaping of the nails and the application of polish. Some manicurists and pedicurists remove or push back the cuticles of the nails. Most experts do not recommend cutting or pushing back the cuticles because it may damage the nail bed and increase the risk of an infection. Individuals can ask that the cuticles be kept intact, if they want.

• Many pedicures also involve washing nails in a footbath with warm, soapy water. They may also use foot scrubs and massage the feet with moisturizing lotions.

• Some specialty manicures and pedicures, such as the French manicure, may also be offered. Others may include painting pictures or designs on the nails or applying small decals (decorations) or imitation jewels. Although these do not improve the health of the nails, they are often performed for cosmetic reasons. Applying nail polish and artificial jewels is generally considered safe. However, nail polish should not be applied if the patient has a nail infection or open cuts or sores on the nail folds or cuticles.

• A manicurist may apply treatments to real nails. Other services for fingernails include the application of artificial nails such as nail tips, acrylics, and artificial nail gels. However, some of these treatments may increase the risk of infection. In some cases, a gap develops between the acrylic nail and the natural nail. For example, if the acrylic nail is bumped or jarred, it may separate from the natural nail. This gap provides a moist, warm environment in which bacteria and fungus can grow. If such an infection occurs, the natural nail may become thickened and discolored. However, the changes in the natural nail may not be visible underneath the acrylic nail. Therefore, if the nails or fingers become swollen and painful, individuals should visit a dermatologist or qualified health professional.

• Hot oil manicure: A hot oil manicure may performed to clean, neaten, and soften the cuticles. During the treatment, which usually lasts about one hour, the hands are soaked in warm oils that are designed to moisturize the cuticles, nail beds, and fingers. After this nail treatment, most individuals receive a manicure.

• Paraffin treatments: In this method, the hands may be dipped in melted paraffin (beeswax substitute made from petroleum) or wax as a proposed way to draw out toxins, bacteria, and microbes, and remove dead skin. This treatment is performed to help smooth the skin. It may also increase circulation and improve skin color. Practitioners apply heat to relax the skin and make it more able to absorb lotion, which is sometimes rubbed on the hand before being placed in the paraffin. The hand is usually dipped more than once to allow a thicker wax coat to form, in order to make the coating stay warm for longer and less likely to break or tear too soon. After the hands have been dipped in the wax, they are wrapped in either plastic or tin foil and then covered with cloth to retain warmth. The hands remain covered in paraffin until the substance returns to body temperature. The paraffin is then peeled off.

Common Nail Problems

• Fungal infections: Individuals who do not take proper care of their nails have an increased risk of developing fungal nail infections, such as onychomycosis or fungal paronychia. Although fungal nail infections can be spread to other people, they are not very contagious, and it is uncommon to acquire an infection from someone else.

• Onychomycosis is a fungal infection of the nail bed. The infection is most often caused by a group of fungi called dermatophytes (especially the Epidermophyton, Microsporum, and Trichophyton species). However, other fungi, including yeasts and nondermatophyte molds, may also cause an infection. The fungi that cause the infection prefer warm, moist environments. Therefore, patients are most likely to develop onychomycosis if their nails are frequently exposed to environments such as sweaty socks or shower floors. Because toenails are exposed to these types of environments often, they are more likely to be affected than fingernails.

• Nail fungus may have a yellowish, greenish, or even brownish appearance. Whitish spots on the nails may indicate a fungal infection. Often, the nails are brittle and have uneven edges. The nails may be painful or emit a foul odor. The nails may have irregular surfaces or edges. The nails may appear unusually thick. The skin around the nails may be red. In some cases, infected nails may separate from the nail bed, causing a condition called onycholysis.

• Fungal paronychia is a fungal infection of the skin near the nail beds. It causes the skin around the fingernails or toenails to become red and swollen. It may also cause pus-filled blisters to form. Fungal paronychia is commonly caused by a group of fungi called dermatophytes. Because these fungi may also cause fungal infections of the nails, fungal paronychia is common among patients with onychomycosis. Fungal paronychia is also common among diabetics and those who frequently get their hands wet for long periods of time (e.g., swimmers). Biting the nails, hangnails, or pushing back the cuticles also increases the risk of an infection. In addition, nail polish, nail wax, and artificial nails may trap fungi, increasing the risk of infection.

• Patients respond well to treatment with medications called antifungals. However, it may take several months for the infection to be completely cured.

• Bacterial infections: Although paronychia can be caused by fungus, most cases are caused by bacteria. The bacteria can enter skin around the nail that has been damaged by trauma, such as nail biting, finger sucking, or chemical irritants or solvents.

• Symptoms of bacterial paronychia are generally the same as those of fungal paronychia. However, bacterial paronychia is generally much easier to treat. Antibiotics are not usually necessary for bacterial nail infections. Instead, patients soak the infected nails in warm water and bacterial soap 3-4 times daily until symptoms subside.

• Vertical ridges: Vertical ridges, which are tiny lines or ridges that run from the cuticle to the tip of the nail, may occur in some people. Vertical ridges are relatively common, and they tend to become more noticeable with age. Although these ridges occur for unknown reasons, they are not considered a health concern. However, patients should visit their healthcare providers immediately if the nails start to change in color or develop horizontal ridges. These may be signs of serious health problems, such as lung disease, poor nutrition, or heart attack. This is because some illnesses affect many parts of the body, including the nails.

• Ingrown toenails: An ingrown toenail is a common condition that occurs when part of the toenail starts to grow into the skin of the toe. Ingrown toenails occur most often on the big toe. As a result, individuals typically experience pain, swelling, and redness.

• Ingrown toenails may occur if the toenails are trimmed too short, if the toenails are unusually curved, if shoes are worn that crowd the toes, or if the toenail becomes injured.

• Ingrown toenails are most common among older adults. This is because the nails naturally thicken with age, which changes the curvature of the nails.

• Ingrown toenails can often be treated at home. However, if quick action is not taken, an infection may develop. If the infection is not treated, it may spread into the bone and cause a serious bone infection. Bone infections are usually difficult to treat and require the use of intravenous antibiotics. Diabetics are most likely to experience serious complications of ingrown toenails, because they have poor circulation and decreased sensations in the feet. Therefore, an ingrown toenail is more likely to go unnoticed and develop an infection in someone who has diabetes.

• Individuals should visit a doctor if they experience severe pain or inflammation near the ingrown nail or if the symptoms start to worsen. These may be signs of an infection.

• Weak or brittle nails: Even though the nails typically thicken with age, the nails are generally not as strong in older individuals. The nails are usually weaker, more brittle, and prone to breakage in older adults. However, if symptoms develop suddenly and are accompanied by discoloration of the nail or other symptoms, individuals should visit a healthcare provider. These may be signs of an underlying condition.

• Signs of underlying health problems: Unhealthy nails that are discolored, weak, brittle, or inconsistent in shape may be symptoms of underlying medical conditions. For instance, weak and brittle nails in combination with weight loss, pale skin, and hair loss may indicate poor nutrition.

• Nails may also become yellow or green as a result of swelling in the hands caused by lymphedema (an accumulation of lymph fluid) or a lung condition such as bronchitis.

• Small indentations across the nails, called Beau's lines, occur when nail growth beneath the cuticle is interrupted. This may occur after an injury or severe illness such as a heart attack. It may also indicate poor nutrition.

• Spoon nails, also called koilonychias, occur when the nails become soft and curve upwards around the sides (like a spoon). This condition may indicate iron deficiency anemia.

• Drug-induced nail problems: Nail-related problems may occur as a result of drug therapy, specifically cancer treatments, including both chemotherapy and radiation. These nail changes do not happen with every type of cancer treatment, but nail changes are a fairly common result of chemotherapy and radiation. Some of these nail problems include hyperpigmentation (color changes), Beau's lines, Mee's lines, half-and-half nails, or onycholysis (nail detachment). Mee's lines are single or multiple white lines that extend across the nail. Medications that have produced Mee's lines include doxorubicin, cyclophosphamide, and vincristine. With half-and-half nails, nails appear reddish brown at the base and are abnormally white toward the tip of the nail. In some cases, nails may completely fall off (this is called onychomadesis). These nail changes can occur with both fingernails and toenails and may involve one or multiple nails. Many of these changes occur with multiple drugs and cancer treatments. However, some specific agents may cause nails to change certain colors. Patients may have nails change to blue in color after administration of bleomycin or 5-fluorouracil. Adriamycin, bleomycin, doxorubicin, doxorubicin, mitoxantrone, and idarubicin have all been known to cause nails to become brown in color. These changes often resolve once drug treatment is complete and the damaged nail grows out.

Treatment

• Oral antifungals: Patients with fungal nail infections typically take antifungals by mouth. These medications, such as terbinafine (Lamisil®), fluconazole (Diflucan®), or itraconazole (Sporanox®), kill the fungus and allow a new nail to grow that is not infected with the fungus. Treatment generally lasts about 6-12 weeks. However, results will not be apparent until the new nail has completely replaced the old, infected nail. Treatment does not cause the infected toenail to fall off. This may take anywhere from 4-6 months. Once treatment is over, individuals should try not to expose the nails to warm, moist environments, because this may cause the infection to return.

• Some antifungal medications that are taken by mouth may cause liver damage. This is because they are strong medications that must be broken down by liver before they can be absorbed into the body. Ketoconazole (Nizoral®) and amphotericin B (Fungizone®, Abelcet®, AmBisome®, or Amphotec®) are the most likely to cause liver damage. Therefore, blood tests should be performed regularly during treatment to monitor liver function. Patients who experience nausea, vomiting, weakness, fatigue, abdominal pain (especially near the liver), dark urine, or jaundice (yellowing of the skin and eyes) should consult their healthcare providers immediately. These are all signs of liver damage.

• According to the U.S. Food and Drug Administration (FDA), two oral antifungals, called itraconazole (Sporanox®) and terbinafine (Lamisil tablets®), have been associated with rare cases of liver failure and death. Itraconazole that is taken by mouth may weaken the heart and should not be prescribed for long-term use if a patient has a history of heart disease or heart failure.

• Antifungal lacquer: Rather than taking oral antifungals, some individuals who have mild-to-moderate fungal nail infections may be treated with an antifungal lacquer, such as ciclopirox (Penlac®). Once daily, the lacquer is painted onto the nails like nail polish. After seven days, all of the lacquer is wiped off with alcohol. The treatment is then repeated. However, this treatment may be less effective than oral antifungals. According to human studies, daily use of Penlac® cured fungal nail infections in 10-30% of patients. Therefore, some doctors may prescribe an antifungal lacquer in combination with an oral antifungal.

• Topical antifungals: Topical antifungals may be used in combination with oral antifungals. Unlike antifungal lacquers, topical antifungals are applied to the surrounding skin as well as the nails. Topical antifungals usually do not cure fungal nail infections on their own, which is why they are usually used in combination with oral antifungals. Patients may be asked to use topical antifungals in combination with other creams that contain urea. The urea-containing creams may help speed up the absorption of the medication.

• Soaking the foot: Individuals who have minor ingrown toenails are encouraged to soak the foot in warm water for 15-20 minutes. Then, a dry cotton ball should be placed under the ingrown corner of the nail. This may help the nail start to grow above the skin. Signs that an ingrown toenail is not healing include increased pain, swelling, and drainage of pus or blood from the affected area.

• Individuals who have bacterial paronychia should soak the infected nails in warm water and antibacterial soup 3-4 times daily for 15 minutes. This should be continued until signs and symptoms are gone. If the condition does not improve in a few days, patients should visit their healthcare providers.

• Nonsteroidal anti-inflammatory drugs (NSAIDs): Patients with mild ingrown toenails may also take over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Motrin® or Advil®) or naproxen (Aleve®), to help reduce pain and inflammation. If pain is severe or worsens, patients should visit a healthcare provider, because this may be a sign of an infection.

• The frequency and severity of side effects vary. The most common side effects include nausea, vomiting, diarrhea, constipation, decreased appetite, rash, dizziness, headache, and drowsiness. The most serious side effects include kidney failure, liver failure, ulcers, heart-related problems, and prolonged bleeding after an injury or surgery. About 15% of patients who receive long-term NSAID treatment develop ulcers in the stomach or duodenum.

• Minor surgery: If an ingrown toenail does not improve with the treatment mentioned above, minor surgery may be necessary. A doctor first numbs the affected toe with an anesthetic. Next, the toenail that is growing into the skin is cut and pulled out of the skin.

• In some cases, a liquid solution or small electrical charge may be applied to the nail bed. This nonpermanent procedure, called ablation, helps prevent the nail from growing back into the skin. A permanent procedure, called nail matrix ablation, can be performed to prevent the nail from growing back at all. This procedure is usually only performed in patients who experience frequent ingrown toenail or in individuals who have a high risk of experiencing complications (such as diabetics).

• After surgery, patients are typically advised to soak the foot in warm water each day. An antibiotic ointment may be prescribed to help prevent an infection. Nail treatments, including painting the nail with nail polish, are not recommended during the healing process.

• Patients who experience frequent ingrown toenails may have part of the toenail and nail bed removed in order to prevent that part of the nail from growing back.

• Individuals who have fungal or bacterial paronychia may have to have abscesses drained. In serious cases, the entire nail may need to be removed.

• Antibiotics: If an ingrown toenail causes an infection, antibiotics are prescribed. These medications kill the bacteria that are causing the infection.

• Most cases of bacterial paronychia do not require antibiotics. These medications are used when there is extreme swelling and pain that does not respond to other treatments.

• Nail hardeners: Nail hardeners may be applied to nails in patients who have weak or brittle nails that are caused by nail dehydration. Nail hardeners typically contain acetates, toluene, nitrocellulose, acrylic, and polyamide resins. Some products, called fibered nail hardeners, contain 1% nylon fibers. Other additives may include glycerin, hydrolyzed proteins, modified vegetable extracts, propylene glycol, and metal salts.

• Patients should avoid products that are made with formaldehyde or sulfonamide because they may irritate the skin. Nail hardeners should not be used if a nail infection is suspected.

• Limit use of nail polish remover: Individuals who have naturally weak or brittle nails should limit their use of nail polish remover. In general, individuals should not use nail polish remover more than twice per month. Many nail polish removers contain harsh solvents, such as acetone, alcohol, ethyl acetate, or butyl acetate. Individuals should avoid nail polish removers that contain acetone, because this product dries up nails, making them even weaker and more brittle. Individuals can purchase acetone-free nail polish at local drug stores.

• Cryotherapy: Some patients receiving certain cancer mediations such as docetaxel may have reduced nail toxicity by receiving cryotherapy while medication is administered. Patients wear frozen gloves or socks prior to, during, and for a short period of time after the administration of chemotherapy. Secondary sources suggest that placing the hands or feet in ice water during chemotherapy may also help delay or prevent nail changes.

Integrative Therapies

• Unclear or conflicting scientific evidence:

• Biotin: Biotin is an essential water-soluble B vitamin. Biotin has been suggested as a treatment for brittle fingernails, particularly in women. There is not sufficient scientific evidence to form a clear conclusion.

• Avoid if hypersensitive to constituents of biotin supplements.

• Bitter orange: Limited available human research has found promising results using the oil of bitter orange for treatment of fungal infections. However, due to the methodological weakness of this research, further evidence is needed to confirm these results.

• Avoid if allergic or hypersensitive to bitter orange or any members of the Rutaceae family. Avoid with heart disease, narrow-angle glaucoma, intestinal colic, or long QT interval syndrome. Avoid if taking antiadrenergic agents, beta-blockers, QT interval-prolonging drugs, monoamine oxidase inhibitors (MAOIs), stimulants, or honey. Use cautiously with headache or hyperthyroidism (overactive thyroid), or if fair-skinned. Avoid if pregnant or breastfeeding.

• Garlic: Garlic is used both medicinally and as a food spice. Several studies describe the use of garlic as a topical antifungal to treat fungal infections of the skin, including yeast infections. More research is needed in this area.

• Use cautiously, as garlic can cause severe burns and rash when applied to the skin of sensitive individuals. Avoid if allergic or hypersensitive to garlic or other members of the Liliaceae(lily) family (e.g., hyacinth, tulip, onion, leek, or chive). Avoid with a history of bleeding problems, asthma, diabetes, low blood pressure, or thyroid disorders. Stop using supplemental garlic two weeks before and immediately after dental, surgical, or diagnostic procedures with bleeding risks. Avoid in supplemental doses if pregnant or breastfeeding.

• Lavender: Early laboratory studies suggest that lavender oils may have topical antibiotic activity. However, this has not been well tested in human studies.

• Avoid if allergic or hypersensitive to lavender. Avoid with a history of seizures, bleeding disorders, eating disorders (such as anorexia or bulimia), or anemia (low levels of iron). Avoid if pregnant or breastfeeding.

• Propolis: Propolis is a natural resin created by bees to make their hives. Propolis is made from the buds of conifer and poplar trees and combined with beeswax and other bee secretions. Animal and laboratory studies suggest that propolis may be a beneficial treatment for various types of bacterial infections. Additional research is needed to confirm these findings.

• Avoid if allergic or hypersensitive to propolis, black poplar (Populus nigra), poplar bud, bee stings, bee products, honey, or balsam of Peru. Severe allergic reactions have been reported. There has been one report of kidney failure with the ingestion of propolis that improved upon discontinuing therapy and deteriorated with re-exposure. Avoid if pregnant or breastfeeding, because of the high alcohol content in some products.

• Seaweed, kelp, bladderwrack: Bladderwrack (Fucus vesiculosus) is a brown seaweed found along the northern coasts of the Atlantic and Pacific Oceans and North and Baltic Seas. Another seaweed that grows alongside bladderwrack is Ascophyllum nodosum, and it is often combined with bladderwrack in kelp preparations. Laboratory research suggests that bladderwrack may have antifungal activity. However, reliable human studies to support this use are currently lacking in the available literature.

• Avoid if allergic or hypersensitive to Fucus vesiculosus or iodine. Avoid with a history of thyroid disease, bleeding, acne, kidney disease, blood clots, nerve disorders, high blood pressure, stroke, or diabetes. Avoid if pregnant or breastfeeding.

• Tea tree oil: Although tea tree oil has been found to have antifungal activity against several fungus species in laboratory research, there is currently insufficient human evidence to determine if it is an effective topical treatment for this indication. It has been proposed as a potential topical therapy for onychomycosis (fungal infection of the nails). However, the available research is limited. More high-quality studies are needed in this area.

• Tea tree oil may be toxic when taken by mouth and therefore should not be swallowed. Avoid if allergic to tea tree oil or plants of the Myrtaceae (myrtle) family, balsam of Peru, or benzoin. Use cautiously with a history of eczema. Avoid if pregnant or breastfeeding.

• Traditional or theoretical uses lacking sufficient evidence:

• Apple cider vinegar: Apple cider vinegar (ACV) is prepared by pulverizing apples into a slurry (watery mixture) of juice and pulp then adding yeast and sugars. Apple cider vinegar has been suggested as a possible treatment for various nail problems. However, scientific evidence is currently lacking to determine if this is a safe and effective treatment for any type of nail disorder. Research is warranted in this area.

• Apple cider vinegar is likely safe when taken by mouth as a food flavoring. Avoid sipping or drinking undiluted apple cider vinegar. Use cautiously if allergic to apple cider vinegar or any of its ingredients (such as apples and pectin). Use cautiously with a history of low potassium levels, diabetes, or osteoporosis. Avoid if pregnant or breastfeeding, due to a lack of safety evidence.

• Brewer's yeast: Due to high vitamin B content, it has been suggested that brewer's yeast may help improve the condition of nails.

• Brewer's yeast is likely safe when taken by mouth for up to four months. Use cautiously in patients with a history of headaches or diabetes, or in those using hypoglycemic agents, patients using antihypertensives, and patients using antifungal agents (theoretically). Use cautiously in patients taking lithium, as some brewer's yeast products contain nutritional amounts of lithium. Avoid in patients with an allergy to brewer's yeast or possibly other yeasts. Avoid in patients with Crohn's disease, as brewer's yeast has been shown to exacerbate the disease. Avoid in patients taking monoamine oxidase inhibitors (MAOIs), due to the potential for hypertensive crisis, as brewer's yeast contains high levels of tyramine.

• Gelatin: Secondary sources suggest that eating gelatin, taking gelatin capsules, or soaking nails in gelatin may increase nail growth and make nails stronger. Information regarding the effectiveness of this treatment is lacking.

• Hypnotherapy, hypnosis: Hypnosis is a trance-like state in which a person becomes more aware and focused and is more open to suggestion. Hypnotherapy has been used to treat health conditions and to change behaviors. Hypnotherapy has been suggested as a possible treatment for nail biting. Theoretically, this therapy may help individuals break this habit. However, this theory has not been tested in scientific studies. Until research is performed in this area, a firm conclusion cannot be made.

• Use cautiously with mental illnesses (e.g., psychosis, schizophrenia, manic depression, multiple personality disorder, or dissociative disorders) or seizure disorders.

• Thyme: Thyme has been used medicinally for thousands of years. Beyond its common culinary application, it has been recommended for many indications based on its proposed antimicrobial, antitussive, spasmolytic, and antioxidant activities. Thyme essential oil and thymol have been shown to have antifungal effects. Topical thymol has been used traditionally to treat paronychia (skin infection around a finger or toenail) and onycholysis (fungal nail infection causing nail detachment). Currently, there is insufficient reliable human evidence to recommend for or against the use of thyme or thymol as a treatment for fungal infections.

• Avoid if allergic or hypersensitive to thyme, members of the Lamiaceae (mint) family, any component of thyme, or rosemary (Rosmarinus officinalis). Avoid oral ingestion or nondiluted topical application of thyme oil, due to potential toxicity. Avoid topical preparations in areas of skin breakdown or injury or in atopic patients, due to multiple reports of contact dermatitis. Use cautiously with gastrointestinal irritation or peptic ulcer disease, due to anecdotal reports of gastrointestinal irritation. Use cautiously with thyroid disorders, due to observed antithyrotropic effects in animal research of the related species Thymus serpyllum. Avoid if pregnant or breastfeeding.

Prevention

• In order to maintain healthy nails, it is recommended that individuals keep the nails clean, trimmed, and moisturized.

• Trim fingernails and toenails regularly. Do not cut the nails, especially the toenails, too short. This may cause the nail to grow into the tissue.

• Most experts do not recommend cutting or pushing back the cuticles, because it may damage the nail beds and increase the risk of infection.

• Diabetics or individuals who have poor circulation should visit their podiatrist regularly in order to prevent complications, such as infected ingrown toenails, from developing. These individuals should also consider having their nails professionally trimmed.

• Individuals should wear shoes that fit properly. If there is too much pressure on the toes, the nails may end up growing into the skin.

• Individuals should wear protective footwear, such as steel-toed boots, if they are at risk of injuring their toes at work.

• Wear gloves when performing activities that may damage nails, such as gardening. It is also recommended that individuals wear cotton-lined rubber gloves when handling harsh chemicals or soaps for extended periods of times. This is because soaps and chemicals may weaken the nails, making them susceptible to breakage.

• Avoid application of polish or other nail treatments to nails suspected of infection. Such areas may appear red, discolored, or swollen.

• Individuals should not use nail polish remover more than twice per month. Avoid nail polish removers that contain acetone. This product dries up nails, making them even weaker and more brittle. Individuals can purchase acetone-free nail polish at local drugstores.

• In patients receiving cancer chemotherapy, cryotherapy may help to prevent certain nail abnormalities caused by certain agents. Secondary sources also suggest that applying nail polish may help prevent nail damage caused by cancer treatments.

Author Information

• This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography

Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

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8. National Institutes of Health (NIH). www.nih.gov.

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12. Piraccini BM, Iorizzo M, Tosti A. Drug induced nail abnormalities. Am J Clin Dermatol. 2003;4(1):31-7. View Abstract

13. Scher RK. Toenail disorders. Clin Dermatol. 1983 Jul-Sep;1(1):114-24. View Abstract