Q. Nails appear to be unfixed in the skin. Can this issue be treated?
Hello doctor,
My friend's daughter is suffering from nail problem in both hands and legs. She is a 14-year-old girl now. The problem started when she was a 2-year-old baby. The nails appear to be unfixed in the skin because they would easily be pulled out when they are stuck in clothes' fabric, for example. Then a new nail will appear in the place of the removed one in a month or two. She is otherwise a normal girl with no unusual symptoms. Her father has not consulted a doctor because nobody knows what disease it is and which doctor they should consult. When I saw the patient I thought it would be a fungal infection and I decided to consult you. Would you please look at the pics in the attachment and tell us about your impression and views about the case. Can such an issue be treated? What is the treatment plan?
Hello,
Welcome to icliniq.com.
I saw the clinical picture (attachment removed to protect the patient's identity). It looks like twenty nail dystrophy. This is a clinical diagnosis. Some cases are genetic and some are acquired. The cause for the nail dystrophy is not very well known. Some of the systemic diseases like anemia, IgA deficiency, primary biliary cirrhosis are the mentioned causes. Some of the skin diseases like atopic dermatitis, alopecia areata, vitiligo, eczema are also known to cause this type of nail changes. This is not a fungal infection. Because all the finger and toenails are involved equally. Usually, fungal nail infection starts in one fingernail then spreads to few other nails, but never all nails. This is a difficult condition to treat, there are case reports saying spontaneous correction of nails with age.Other treatment modalities include:
- Nail supplements, Biotin oral pills, at night.
- Topical corticosteroids would help in the early stages.
- Topical 5 FU has shown some promising results.
- Topical Psoralen UVA (PUVA) therapy for nails.
A protein-rich diet consisting of eggs, chicken, milk, dal (lentil), and curd would help because nail is made up of protein. Dietary protein is very important. She can start taking nail nutrient pills, that has biotin, calcium, zinc, iron, etc.
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