People tend to attribute all nail changes to fungal infections when in fact nail disorders may be due to variable causes.

Fungal infections account for only about 50% of nail problems. Many dermatologic diseases as well as benign and malignant tumors can affect the nails. Exposure to exogenous chemicals and, less commonly, systemic illnesses may also induce nail changes.

Fungal infections
Fungal infection of the nail is known as onychomycosis. It is most commonly caused by dermatophytes, a group of fungi that are ubiquitous in the environment. Dermatophytes and other fungi are more likely to invade dystrophic rather than intact nails, and nails of older individuals which have a slower growth rate.

Dermatologic diseases
A well-known skin condition that may affect the nails is psoriasis. The changes due to psoriasis may range from mild onycholysis (separation of the nail from the skin below it) to total dystrophy (complete destruction of the nail), but are always reversible. Lichen planus of the nail on the other hand leads to scarring and irreversible changes if not treated prompltly.

Lumps or bumps under or around the nails should be taken seriously. As should any brown-black discoloration of the nail or of the surrounding skin. Of course these may be due to benign processes such as a simple verruca (wart) or a lentigo (brown spot) affecting the nail, but they may also be due to a malignant and potentially life threatening process such as a melanoma. Your doctor will be able to tell the difference or may refer you to a specialist.

Systemic diseases
Nail changes can offer valuable clues to a discerning clinician and help in establishing or supporting a diagnosis as many diseases or chronic illnesses affecting various organs (liver, kidneys, heart, lungs..) may manifest themselves in the nails.

Exogenous causes
Repeated exposure to harsh chemicals such as detergents or acetone can lead to brittle nails, one of the most common nail problems encountered in women. Brittle nails split and crack easily and fail to grow, and are one of the main reasons women resort to the use of artificial nails.


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