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Dr. Zain, Heather, and Courtney break down why nails matter in dermatology, covering basic nail anatomy, slow toenail growth, and how trauma can change nails. They review common nail findings (ridges, Beau’s lines, pitting, thickened nails, habit-tic damage), brittle/splitting nails, and color changes including yellowing, white spots, green nail (Pseudomonas), and brown streaks (melanonychia) with red flags for melanoma and when biopsy may be needed. The episode also covers nail infections (fungal, bacterial paronychia, HPV warts), treatment options and timelines, nail salon safety (tool cleaning, UV lamp sunscreen, avoiding over-trimming cuticles), common myths, and when to see a dermatologist—especially for new or changing pigment or symptoms like pain, bleeding, or lifting.
00:00 Gross Toenail Talk: Socks Off = Crime Scene
00:55 Welcome to Skin Side Out: Why Dermatologists Care About Nails
02:10 Nail 101: Anatomy, Matrix Biopsies & Why Nails Change Slowly
03:18 Growth Rates & Trauma Clues (Toenails Take Forever)
04:34 Texture Changes: Ridges, Beau’s Lines, Pitting & Inflammation
08:34 Thick, Curved “Ram’s Horn” Nails vs Fungus Myths
09:34 Habit-Tic Deformity: Nail Picking, Biting & Permanent Damage
12:52 Brittle & Splitting Nails: Onycholysis, Peeling, Lichen Planus + Causes
15:06 Supplements & Medical Causes: Water, Acetone, Thyroid + Biotin
16:40 Nail Color Changes: Yellow, White Spots & When to Worry
17:48 Brown Streaks (Melanonychia) vs Bruising: Hutchinson Sign & Biopsy Decisions
21:19 Green Nail Syndrome: Pseudomonas from Nail Enhancements
22:07 Green Nail Syndrome & Where Pseudomonas Hides
23:09 Fungal Toenail Infections: Causes, Contagion & Why OTC Fails
24:39 Treating Nail Fungus: Orals, Rx Topicals, Home Remedies & Lasers
26:12 When Fungus Gets Gross: Thick Nails, Spreading & Podiatry Help
28:17 Bacterial Nail Infections: Paronychia, Triggers & Painful Drainage
30:07 Viral Nail Problems: HPV Warts Around (and Under) the Nail
31:39 Nail Salon Safety 101: Tools, UV Lamps, Breaks & Cuticle Care
35:29 Rapid-Fire Nail Myths (Biotin, “Breathing,” White Spots & More)
37:53 When to See a Dermatologist + Final Nail Care Tips
Creators and Guests
Host
Host
What is Skinside Out?
Welcome to Skinside Out, where science meets beauty, the ultimate dermatology podcast! Dive deep into the fascinating world of skin health with expert insights, evidence-based discussions, and myth-busting truths. Each episode explores the medical, cosmetic, and surgical aspects of dermatology, while keeping you informed about trending skincare topics. Whether you’re a skincare enthusiast, medical professional, or just curious about how to achieve your best skin, Skinside Out is your go-to resource for staying informed and inspired.
44 - Skinside Out - Nails
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[00:00:00]
Dr. Zane: You know what else you can get?
So basically when they're, when, especially guys, when they're putting their underwear now, they're putting on their underwear. They're transferring from their, from their toenails up into their groin area, and then you got a whole other mess going on.
Courtney: I'm not gonna lie, I don't miss the, like medical assisting days when like you walk in and like, I love my old men, but not with their shoes and socks off.
'cause they take it off and their nails are growing like, like every which way. And it's like. Straight yellow, and you're like,
Heather: oh, they, and they take their sock off and they just mm-hmm. Pull their sock and you're like, mm-hmm. Please don't. It's a crime scene. Like it's gonna like fling at me and then all the dust is gonna go everywhere.
Yeah. I dust like
Courtney: a mask. I feel like I'm gonna inhale the, I get no, yeah. I get anxious. Yeah. I'm like, put that thing back on.
Dr. Zane: Welcome to Skin Side Out. I'm your host, Dr. Zane, with Heather and Courtney. So [00:01:00] today we're talking all about nails and the inside out. So let's get right to it. Why are nails important in dermatology?
Heather: Um, I think nails are really important because we don't really think about that as being part of our skin, but there's a lot of.
Different anatomical things about a nail that make up a nail. And so it depends on if you're having nail issues, where on the nail, what does it look like? It could be, even though it's a small little area, it could be a number of things.
Dr. Zane: I'm always surprised when patients are asking, wow, so you guys take care of nails?
Mm-hmm. As a dermatologist, I'm like, yeah, we are the experts in skin. Hair and nails and it just baffles 'em and it baffles me like they don't think that that's part of your skin. Um, so it is something that we evaluate not only just the nails themselves, but they can give us signs of other systemic diseases.
So certain connected tissue diseases can also give us insights into other. You know, [00:02:00] pulmonary issues, um, you know, things that are, you know, up with our nutrition. So it is a very valuable tool when we're examining patients. So I find it very helpful. So let's get into the basics of nails. Let's talk about nail anatomy, um, and what parts make up the nail unit.
Heather: Um, so you have the nail plate, um, that's what's the, the hard piece sitting on top. Then you have the cuticle, which is kind of like at the base. Um, you have the matrix underneath, which is really important. We won't go into like full details of anatomy, but if you're gonna have a biopsy. Of the nail, typically.
Typically it's of the nail matrix. So we actually have to remove the nail plate, take the biopsy at the nail matrix underneath the nail, and then put the nail plate back,
Dr. Zane: and that's where the nail originates from. That's why it's so important.
Heather: There's also the nail bed, which, um, is kind of the foundation of the nail itself. Um, but the biggest thing that we see [00:03:00] with nails is they're slow to grow, but they're slow to change also. So sometimes you can.
Notice a spot on your nail that just kind of grows out on its own and then it's gone and you cut it off and there's no problems. But if it continues to linger, then that becomes a different issue.
Dr. Zane: Yeah. And fingernails and toenails have differences in the growth rate. Can you comment about the growth rate between the two?
Heather: Um, the toenails typically grow slower. Um, I don't know why though.
Courtney: Further away from the heart. That's my,
Heather: yeah.
Courtney: Slower to heal. Slower to grow, yeah.
Dr. Zane: Yeah. Not sure. Um, but it does take about, I think three times as long for the toenails to grow compared to the fingernails.
Courtney: I know, and I think that's why a lot of patients sometimes get frustrated when they are treating the toenails.
They feel like things are not working, but they just don't realize that it truly can take up to a year to see some of those, um, true effects of the, the results.
Heather: Mm-hmm. Especially if we're treating some sort of [00:04:00] like fungal infection mm-hmm. Or anything. Mm-hmm. It definitely takes close to a year.
Dr. Zane: Yeah. And trauma does play a role in a lot of what we see in the dermatology office.
A lot of patients come in, um, with abnormalities of their nail and just eliciting a history, um, of some recent trauma can often explain many of the changes that we see. Like we see sometimes bleeding under the nail called the subungual hematoma. Sometimes we see some nail dystrophy, oh, I dropped something on my foot.
Mm-hmm. Um, you know, and that can lead to changes in the nail. All right, so let's talk about texture and growth disorders and nails. So, you know, when we look at a healthy nail, it looks smooth, it grows in a uniform way. Um, we typically see, um, we don't see pigment in it. So these are things that we normally see with, you know, healthy nails, but.
When we start seeing changes in the texture, what does that give us, um, information about? So let's talk about vertical ridges first. So Heather, what do you see with vertical [00:05:00] ridges?
Heather: Um, vertical ridges are very, very common and it's something that unfortunately comes with aging. So it could be just a normal part of your aging process, but it could also, um, be.
Attributed to dehydration. If you're not really getting your water intake, sometimes you can get that sort of like, um, vertical bridging and, um, there's typically not much that we do about it unless it really bothers you. There are some like smoothing techniques that we can do.
Dr. Zane: Yeah. Um, let's talk about Bose lines.
So those are those horizontal lines that we see on the nails, and we have a photo of that that we can show on the screen.. So Courtney, these horizontal ridges are important because they signify certain aspects of her health. So what can it show?
Courtney: It can show different signs of stress, um, illness. Sometimes in pregnancy we see these exacerbated, um, surgery. [00:06:00] So anything that kind of has that traumatic impact on your body your nails can, can show it through the bow lines.
Dr. Zane: Yeah, I kind of see this sometimes in concert with like losing hair from like telogen effluvium too, because that's also stress-induced hair loss. So it's interesting when we talk about nails, I always also talk about the hair and see what's going on there.
Heather: Mm-hmm. Which also I think a lot of people don't expect a dermatology office to treat hair too.
Mm-hmm.
Dr. Zane: Mm-hmm. Um, so pitting, so these are these small depressions in the nail look like tiny little pits, and we see these in a variety of different conditions. Usually there's some type of we see this often in inflammatory skin disorders.
We see it often in psoriasis. Sometimes we do see it in severe atopic dermatitis or eczema. Mm-hmm. Um, so that is also a clue. And we sometimes see another autoimmune condition, such as the alopecia areata, where we have, you know, a hair loss. So that's another [00:07:00] sign that we can see. What about Rekia?
Heather: So trache.
What
Dr. Zane: is traia?
Heather: , It kind of looks like nail pitting, but it's more like a. It kind of looks like your nail has been sandpapered, um, or like you've almost like you've taken a hammer to brass.
It kind of has those like little indentations. Um, we can see this with alopecia areata as well. Um, but I think nail pitting is also common with alopecia areata.
Dr. Zane: Yeah. Um, and then eczema also see it with lichen plan is sometimes also host those changes as well. Okay. What about Aniko Phos? One of my favorites.
Heather: The brown one. Nasty. So, um, Ani Chaus and Aniko Phos, these are thickened nails and so you can either just have the thickened nail, which is ani chaus. [00:08:00] I don't know if I'm pronouncing that right, but, um. Rifs, this bottom second one, it is where you get that thickening of the entire nail, but then it kind of looks like a Ram's horn.
Mm-hmm. And it has that kind of like curve to it,
Courtney: like a witch's fingernail.
Heather: Yeah. These are most common with, um, aging, but also like if you're having pressure on your footwear or your shoes, um, it can definitely help kind of like thicken the nail. In its entirety.
Dr. Zane: Yeah. These are pretty gnarly looking.
Heather: Yeah.
Dr. Zane: Um, but it is a fun diagnosis and like explaining to the patient what's going on. They all think it's fungus.
Heather: Yeah.
Dr. Zane: It's not. Um, so let's talk about something that we do see, um, sometimes in our patients with. Anxiety or OCD habit, tick deformity is on the nail. Um, so you know, we do see patients who tend to tap or pick at their nails at the nail [00:09:00] folds and it leads to, um, deformity, especially in the middle of the nail.
So that's a habit. Tick deformity. Also known as Median canal formm dystrophy. And you know, it's traumatic changes to the nail and unfortunately, most of the time it's not reversible.
Heather: Mm-hmm.
Dr. Zane: So I always tell my patients with early signs to avoid doing that. So you don't get permanent, you know, dystrophy of your nail.
But we do see it a lot and a lot of people are just, you know, tapping away not even knowing that they're doing it. Mm-hmm. Mm-hmm. And they come in and they're like, oh, I don't know why this is happening to my nail. It's always been like that. I'm like, do you tap your nails? Do you, you know, bite your nails?
Mm-hmm. Those, um, those physical trauma can actually lead to these changes.
Heather: Do you have a way of determining whether it's the habit tick or, 'cause sometimes I feel like they look like Bose lines and I feel like they're also. Very different, especially if the patient's not aware that they're doing it.
Dr. Zane: Yeah, I mean, [00:10:00] I feel like when I see these habit deformities, it's definitely more centrally located.
Heather: Mm-hmm.
Dr. Zane: Um, it's usually, you know, surrounded by normal nail, like on the, um, you know, outer edges. Outer edges. Um, whereas where I see bow eyes, it's more of a, you know, horizontal line and it's kind of throughout. I mean, it's unusual for someone to kind of traumatize the entire width of the nail.
Heather: Mm-hmm.
Dr. Zane: And I think that with a habit tick deformity, you kind of see just like a focal area in the center.
That's what I've seen clinically.
Heather: Is it usually too, like the habit tick is more commonly on the thumbs, whereas the Bose lines could, is usually most of the nails?
Dr. Zane: Yeah, I typically do see that.
Heather: Okay.
Dr. Zane: Mm-hmm.
Courtney: I used to be a nail biter. Bad habit.
Heather: That why you get your nails
Courtney: done. That's why I get these pretty babies on.
And you know, it also helped me stop biting my nails when I, 'cause I take breaks obviously, um, from my nails, but I read, um, you can get pinworms [00:11:00] because they sit underneath your nails. And so there are, I went on a whole Reddit thread of people getting pin pinworms by biting their nails and oh my God, that stopped me.
Like I had been biting my nails for. 21 years of my life, and then when I read that, I instantly
Dr. Zane: new nightmare activated.
Courtney: Yeah. Yeah. Well, just don't bite your nails.
Dr. Zane: I don't, yeah. And you know, babies, um, they often like, you know, suck on their fingers, their thumbs. Mm-hmm. Um, and they bite their nails. Mm-hmm.
So my daughter, um, Maryam, she, she was a big nail biter and we could not get her to stop. You know what stopped it?
Heather: Spray?
Dr. Zane: Nope.
Heather: Oh. You
Dr. Zane: on dog. Perfect case of hand, foot of mouth. Oh. Literally like blisters all over her fingers. Oh, her nails fell off and that's what stopped
Courtney: it. Yeah. I thought you were gonna say like spraying some sour spray or something
Dr. Zane: like Oh yeah, we tried that.
It didn't work. Yeah, it was a, it was a really bad case of hand, foot and mouth. But after that, not real good.
Heather: Wow. Last thing
Courtney: gonna occur. Yeah. [00:12:00]
Dr. Zane: Um, so let's talk about brittle and splitting nails. A common complaint we hear about regarding nails. So let's talk about Oncolysis. What is that? Heather
Heather: Oncolysis is where your nail is kind of lifting off of the nail bed.
So up on the top, the fourth one that's oncolysis. It's kind of hard to see, but you can notice that the top, um, portion of the nail is lifted, so it kind of looks more yellow. Mm-hmm. And that's because it's not kind of stuck down anymore. Um,
Dr. Zane: I had that happen to me in soccer. Oh,
Heather: really?
Dr. Zane: Many times. Oh, on my toenails.
Heather: A lot of people also think this is fungus too. Mm-hmm. Yeah.
Dr. Zane: Yeah. I, I was in medical school where you're playing soccer and like my, like toenail was like ready to fall off. And then all my fellow med students, um, they were saying, oh, you have like fungus? I'm like, no, it's not. It's from trauma lecture. Yeah.
So Annika Ski, that's a fun one.
Courtney: Mm-hmm.
Dr. Zane: Um, so what is that?
Courtney: It is peeling nails. I was trying to see if it is on. [00:13:00] Yeah. So, um, on the bottom left you can kind of see it's where that split happens. Um, or the peeling of the nails. I feel like we don't see that one as common as we see some of the Annika lys. I feel like we see a lot of Annika lysis.
Mm-hmm. Yeah. Um,
Dr. Zane: with the, an askia, often they complain about these little nicks at the, um, end of the nail.
Courtney: Mm-hmm. Mm-hmm.
Dr. Zane: So, you know, we. Typically see that these patients, oh, like whenever I grow up my nails, it just breaks in the same spot.
Heather: Mm-hmm.
Dr. Zane: Um, so that's usually ongo, Rexi,
Heather: rexi is kind of similar. Um, so it's like a splitting or a cracking at the end of your nail.
And we can see this with, um, just brittle nails in general, but it can also be associated with lichen planus. Lichen planus, I think. Unfortunately, very commonly affects the nails, but in a lot of different ways. Like you could have like reddish blue nails that are kind of like swollen underneath. You could have like, all of your nails could just kind of fall off.
Mm-hmm. It's called 20 nail [00:14:00] syndrome. Um, that could be a bunch of different things, but um, yeah, I think one of the skin conditions that we. Don't typically expect to affect the nail. Um, it's like in planus.
Dr. Zane: Yeah. Um, so there are physical, um, agents that can also, um, make nails brittle or cause them to split.
So we're looking at water exposure, so prolonged water exposure. We definitely see that affecting nails. I see that in swimmers sometimes. Um, acetone, um, and gel overuse. So in the nail salons we definitely see that a lot. So we had to be careful about what you do to your nails because prolonged and repeated exposures to these can cause a lot of damage to the nails, right Courtney?
Courtney: Right now, we'll get into that later. How, how to keep your nails cute and healthy.
Dr. Zane: Um, and in terms of. Thyroid [00:15:00] disease, that's another common medical condition that affects the nails. Mm-hmm. And I do see a lot of brittle nails, um, associated with hypothyroidism.
Courtney: Mm-hmm. Yeah.
Dr. Zane: Um, and then people talk about supplements, how they can improve their nails, um, with that.
And, you know, we hear a lot about biotin. So what are your thoughts on biotin for nails?
Heather: I think if you're gonna take biotin. It's probably a little bit better for your nails than it is for your hair.
Dr. Zane: I agree. I feel like it does nothing for hair growth.
Heather: Mm-hmm. It causes acne though.
Dr. Zane: Mm-hmm. But I do, I mean, anecdotally I've had patients say that, oh, you know, like, I think my nails are stronger.
They're not breaking as much. So I do hear that feedback, um, whereas I never hear anyone say like, oh, buy it and help me regrow my hair.
Heather: Mm-hmm. Yeah.
Dr. Zane: Um, okay, so let's go to nail color changes. So what's normal versus what's suspicious? So what are common color changes that we see in nails? [00:16:00]
Courtney: So yellow nails, we definitely see a lot that, again, can be indicative of the Annika lysis with the lifting or, um, the, you know, nail fungus.
That's a very classic sign of nail fungus. Um, smokers, we see that a lot and all of that carcinogens from the actual smoke itself is. Coloring that nail. Um, we see it with psoriasis. Mm-hmm. So I think yellow is probably one of the most common nail color changes we see.
Dr. Zane: Yeah. We see those oil staining.
Mm-hmm. Appearance on the nails with psoriasis especially.
Courtney: Mm-hmm.
Dr. Zane: Um, white spots, you know, similar to what we had talked about before, um, with some of those, you know, horizontal. Changes of the nail, they're often white. It's called Leia, meaning white nail. And many times it's due to trauma.
Heather: Mm-hmm.
Dr. Zane: So we see that a lot
Heather: fallen on my thumb, but it's growing out.
Dr. Zane: Alright, and then let's talk about. Pigment and nails. Mm-hmm. Because I feel like this one is the [00:17:00] one that causes the most concern in patients.
Courtney: It's scarious. Yeah. You have, you, you know, everyone is nervous about, I think having melanoma when you see that brown pigment, especially if you have not always had that pigment.
Um, but there are differences between. Pigment and what we see very commonly, you know, the blood, blood from trauma. So the hematomas where, you know, someone maybe shut their finger in a door and it caused that blood stain, or sometimes even runners that compression on the, the toenail can cause that.
Mm-hmm. Um, but the difference, um. With that is that should be growing out and it shouldn't be getting bigger than what the actual size is. Um, versus when you are looking for things like melanoma, um, your dermatologist might measure that, you know, the length and the width of that line. You obviously don't want it to get larger.
Heather: Yeah, so Melano Nickia, um, is that term for like the brown streak? I think we have a good photo of that as well. But um, that is where you, [00:18:00] yeah, you can be concerned for melanoma, but it can also be a. Normal variant. I think we do see that a lot, especially in our darker skin types. They tend to have multiple nails involved.
And one of the biggest signs that we look for is called the Hutchinson sign, which is where you can have like pigment that goes past the cuticle. And that kind of gives us an idea that, um, it might not be. A benign form of longitudinal Melania and then further warrant a biopsy.
Dr. Zane: Yeah, so with benign, Melania, very common in ethnic, um, patients and skin of color.
We also see that happening with certain medications as well, and pregnancy with hormone changes too. So it all has to be taken into context as well, because you don't wanna just go straight to a nail matrix biopsy, believe me, it's not fun. Mm-hmm. I do them. Um, it's not pretty. Mm-hmm. [00:19:00] Um, you know, so we really want to get a good history.
We wanna know what's going on with their health, if they've noticed changes. Um, if. If they've noticed it and their symptoms, like, I have low threshold to biopsy, but you know, if you have multiple nails affected, you know, it's very unlikely that you have melanomas going on all on nature. Mm-hmm. In your nails.
Um, and then also like with pregnancy, recently pregnant, like changes, we do see those changes. So, um, it always has to be taken in the context of a good history. Um, and then along with Hutchinson sign, I think that's really important to distinguish, you know, if it's under the cuticle or if it's going into the nail bed.
That's really important because, you know, benign Nevis, I've seen Hutchinson sign. With a benign mole, um, you know, causing the Melania. So, you know, it's not always 100% reliable.
Heather: Yeah. And the reason why it presents as a streak, even though it's a mole, is it, it because the mole is underneath the nail. And so it's kind of growing out in that [00:20:00] matrix with the nail.
And so. Like Courtney mentioned, yeah. We want to especially measure the width because we wanna make sure it's not growing and involving more area of the nail itself.
Dr. Zane: Yeah. Um, I know that a lot of patients come in for routine monitoring of their Melania, so I think measurements are like our best option along with photography.
Mm-hmm. And just kind of looking at those nuances with Oscopy. Mm-hmm. All right. Green nails. Pretty, huh?
Heather: This one's kind of common. Yeah. Green Nail
Dr. Zane: syndrome, P or Nickia.
Heather: Mm-hmm.
Dr. Zane: So what does that usually attribute it to?
Heather: Pseudomonas. Um, which is a bacteria. Um, we see it a lot with people who often get their nails done.
Mm-hmm. Um, corn, have you ever had. Green
Courtney: nail? No, because, and we'll get into this when we're going into do's and don'ts, but you find one place, you stick with it for 15 years and you don't run into these problems. Yeah. That you go nail [00:21:00] shopping around. Yeah. I've never,
Heather: so
Courtney: never. And I don't even need to knock on wood 'cause that's how much I trust my girl.
Heather: So pseudomonas, um, I think it, it creates this
Dr. Zane: green,
Heather: green pigment. There's a name for it and I'm
Courtney: blanking. There's a nice, isn't it like grape? Odor. It doesn't pseudomonas smell. Mm-hmm. But it smells kind of sweet.
Heather: Yeah, I think so.
Dr. Zane: And it likes water.
Heather: Yeah.
Dr. Zane: So that's where you get water trapped underneath.
Exactly. And then also, like in sketchy nail places, like, you know, who knows what they're sketching out.
Courtney: I always heard, um, like gardeners too, like if they don't wear gloves and I don't know if it's like the water content in the soil or something like that, but, oh. I've heard that can be like a commonplace too.
Heather: Yeah,
Courtney: if people are, I mean, I, that's where you get pinworms too, so I'd be wearing your gloves. Gardening.
Dr. Zane: Courtney has me nail,
Heather: I have a hole in my gloves, so I should probably change them
Courtney: just in case.
Dr. Zane: All right, so let's talk about some more [00:22:00] inflammatory and autoimmune nail conditions. So let's start off with psoriasis and how that presents.
Courtney: I was gonna say, if you wanted to skip these portions and go into nail infections, we kind of already kind Oh, we already talked about, okay. Yeah, so maybe just go back and say, so let's go to, to nail infections.
Dr. Zane: All right. So let's go right into the most common chief complaint regarding nails. Nail infections. So let's talk about fungal nail infections. So let's talk with Courtney.
Courtney: Yeah. The fungus expert.
Dr. Zane: There's a fungus among us.
Courtney: No, you know what? I do think I have fungus on my left big toe. It's been there for a really long time and I just need to treat it, but,
Heather: but you don't wanna get your liver function
Dr. Zane: tested.
Courtney: No. Yeah. So what. So nail fungus, it's so common, right? But, um, majority of people, you know, as we talked about kind of within our Subter episode, but fungus loves moisture environments. So, you know, you think about places like water parks or [00:23:00] the gym or things that are kind of that hot, sweaty environment and you know, even.
Couples can pass it in the shower. Um, if you're, you know, taking a shower and your spouse has fungus on their foot, and then you get that, you know, you're not really clean. They're playing footy, they're playing footy, you're getting that fungus and that fungus on the, on the foot can actually get into the nail.
So, you know, that's why it's so important to, to monitor that. But, um, a lot of times people will start with the over the counter. So you have your, you know, Lail, um. I can't even remember some of those over the counters. 'cause none of them ever worked.
Dr. Zane: Enact,
Courtney: enact. Yeah. You know, none of them ever really worked.
That's why we see people in the office so frequently.
Dr. Zane: Yeah. There's a less than 10% success rate with these topicals. Like it is low.
Courtney: Yeah.
Dr. Zane: That's why nobody ever seems to get rid of it.
Courtney: No, and I do think the orals do work so much better. So, you know, there are oral medications like Turine. Um. And, um, Fluconazol.
Mm-hmm. Fluconazole that, you know, your provider might check your [00:24:00] liver. Um, but they do, I think a much better job. There are topicals that are prescription. Some newer ones like you might have heard of, ju, where it's a topical, um, polish that you're putting on the toenail. But again, as we said earlier, your toenails do take almost a year to fully grow out.
So patients. A virtue in this condition. Um, you just have to keep treating and hopefully as your nail grows out, you'll see that healthy nail coming through, but it's something you kind of have to stay on top of. Mm-hmm.
Heather: Yeah. Yeah. You have to do it for like 48 weeks.
Courtney: Mm-hmm.
Dr. Zane: Yeah. It's a long time.
Heather: Mm-hmm.
Dr. Zane: I mean, there are some home remedies that.
Patients sometimes swear by like the vix. Mm-hmm. Um, vapor rub, which
Courtney: I think there's studies on the vix
Dr. Zane: There are, it it does work. Yeah. But I mean, I don't think it's nearly as high of a success rate as the oral antifungals. Yeah. Um, some people do like the vinegar soaks. Mm-hmm. Um, that can be helpful.
Mm-hmm.
Courtney: Heard Listerine? Mm-hmm. Well use the brown one specifically.
Dr. Zane: The brown one.
Courtney: Yeah.
Dr. Zane: Courtney's tried it. [00:25:00]
Courtney: Not success.
Dr. Zane: Um. And then there's some, um, you know, patients who ask for laser treatments. Mm-hmm. So apparently the heat
Heather: mm-hmm.
Dr. Zane: Um, certain lasers can help to, you know, kill the fungus.
Heather: Mm-hmm.
Dr. Zane: And I'm sure it's a very painful and expensive process.
Heather: Mm-hmm.
Courtney: Yeah.
Heather: You had mentioned that, um, you know, it can, you can have it on the foot and it goes to the nail. I do have a lot of patients who seem to say, well, it's on my nail, like. What would happen if I don't do anything? Mm-hmm. And it's definitely something where you can get like athletes' foot, so like Tinia, Pettus can be related and people tend to have both very commonly.
Dr. Zane: You know what else you can get?
So basically when they're, when, especially guys, when they're putting their underwear now, they're putting on their underwear. They're transferring from their, from their toenails up into their groin area, and then you got a [00:26:00] whole other mess going on.
Courtney: I'm not gonna lie, I don't miss the, like medical assisting days when like you walk in and like, I love my old men, but not with their shoes and socks off.
'cause they take it off and their nails are growing like, like every which way. And it's like. Straight yellow, and you're like,
Heather: oh, they, and they take their sock off and they just mm-hmm. Pull their sock and you're like, mm-hmm. Please don't. It's a crime scene. Like it's gonna like fling at me and then all the dust is gonna go everywhere.
Yeah. I dust like
Courtney: a mask. I feel like I'm gonna inhale the, I get no, yeah. I get anxious. Yeah. I'm like, put that thing back on. You know, some
Heather: of them just aren't. Aren't very considerate with like how they take their sock off. No,
Courtney: they fling it off.
Heather: Yeah. And it's like, poof.
Courtney: I know. Well, and it makes me wonder, when's the last time you clipped your nails? Mm-hmm. Which obviously it's been months, if not years. Um, that is not your. Job. Ah, I would go see po dietary for, that's where we draw the line. [00:27:00] Sometimes they're like doing a bio, so sometimes to test for the fungus because it can't, again, it can be difficult to determine sometimes what's just distro versus fungus.
But sometimes it's. You know, funny when we do the nail clipping and mm-hmm. You can't even get the clippers to, I had that
Heather: yesterday. It was so thick.
Courtney: So thick.
Dr. Zane: Yeah. So your podiatrist will be your best friend.
Courtney: Yeah. Yeah. Yeah. They'll clip them.
Dr. Zane: Um, yeah. So let's go on to bacterial infections.
Heather: Mm-hmm.
Dr. Zane: So we talked about the pseudomonas infection leading to the green nails.
Mm-hmm. What else can we see?
Heather: Um, Paraia is very commonly bacterial, so paraia is where you get this inflammation around the nail, um, and it can get very swollen. Mm-hmm. Like on the side. Mm-hmm. Or at the base, um, red, painful and. I see this a lot for people who get their nails done, but I also see it for a lot of people who are on Accutane.
Mm-hmm. Um, and I think it just has to do with like [00:28:00] that dryness aspect. And I think your nails are changing a little bit when you're on Accutane too. So, um, typically it responds really well to antibiotics. Um, sometimes it has to be drained, but. Not super common.
Dr. Zane: Hmm. Certain chemotherapy agents also can lead to paraia.
I've had a paraia before and it's like one of the worst things in the world. It is. It's awful.
Courtney: Yeah.
Heather: I'm sure.
Dr. Zane: Um, it's very painful. Um, you know, drops it like, has its heartbeat. Yeah. And it has to like get drain at that point. Mm-hmm. And that's very painful. Mm-hmm. I remember when. I think I was a new attending.
Um, I got one 'cause I pick up my hangnails. I know I shouldn't. Um, but yeah, I mean, I had one of my medical assistants and numb my finger. That was one of the worst. One of the worst experience I ever had in my life. Yeah. It was so painful. 'cause think about it, like nails and like fingers are very sensitive.
Mm-hmm. You have an infection, so it's not really that effective 'cause acidic [00:29:00] and it's, it was awful.
Heather: Yeah.
Courtney: I think pe I was gonna say, I think people who pick at their hangnails and cuticles are also like very, I noticed that as a trend, um, being susceptible to that. Mm-hmm. And it just, I think creates that like opening and environment for.
Or the parata in.
Heather: Mm-hmm.
Courtney: Yeah.
Dr. Zane: Another common thing we see in the office are warts, right? Mm-hmm. And those are caused by viruses. So which virus specifically?
Heather: Um, HPV.
Dr. Zane: Mm-hmm.
Heather: So there's a lot of different strains of HPV. Some of them more commonly cause genital warts. Some of them more commonly caused warts on the feet, more commonly some on the hands.
But, um, we do also see this unfortunately, with a lot of, um, people who get their nails done too, and. Unfortunately, I think a lot of people don't. Know that it's a wart and they think it's just like an overgrown cuticle or something like that, and then they're like traumatized. Mm-hmm. To find out that it's likely from your nail salon.
Mm-hmm.
Courtney: I'd be [00:30:00] traumatized.
Heather: Yeah.
Courtney: I,
Heather: and they're so stubborn to treat. They are. They're very hard to get rid of. They are. Yeah. And sometimes they can get on the nail too.
Dr. Zane: Yeah. And they're pretty common, especially in the pediatric population. Mm-hmm. Kids have a ton of warts. They pass 'em to each other. So, you know, we see a lot of pediatric patients and it's sometimes very difficult to treat them.
'cause many of the treatment options are pretty painful.
Heather: Yeah.
Dr. Zane: So they don't tolerate very well. Um, so we do liquid nitrogen, we do some topicals that can help reduce the growth. Um, topical, um, immuno stimulating agents. Um, we have also some sensitizing agents. So a lot of different things that can be used to treat warts.
Courtney: Especially we get into the manicures, the pedicures.
Dr. Zane: All right, you guys take this from here.
Courtney: You know what, men should get manicures though. I, there, there a lot of men get pedicures and manicures and, but it is, you know, I'm not gonna lie, there's a lot of nail salons out there. Not all of [00:31:00] them have good practice.
Mm-hmm. I've been very fortunate, but again, I am a very loyal customer to my, my one woman, like it's me and her, and I've been going since I was 15. Wow. Um, so yeah, there, you know, there's the gel, the acrylics. There's, um, the different, different kinds I think. Yes. You wanna be aware of a salon that is definitely cleaning in between.
So normally they'll have like the barber side or Steri side or something like that. If they're reusing any tools, obviously that's a red flag. If they're, um, you know, not cleaning things in between. Um, I don't think one is safer than the other. Like a gel over acrylic. I mean, the acrylic, you're. I guess the acrylic you're putting on a fake nail.
And so technically that kind of acts as almost like a barrier between your nail and then whatever polish they're using. Um, but again, you can get fungus or bacterial infections from. You know, from a lot of things at the [00:32:00] nail salon. Um, the UV nail lamps, I know that's like a hot topic too. I always put on sunscreen before I get my nails done.
So I don't have that problem, but I keep my little, like sample size and I just pop it on on my hands before they set 'cause they do set on the nail. And some of that can even cause um, you know, that hardening around the nail and that that trauma. So. I recommend people taking breaks. Like I'll normally have my nails done maybe for like, I don't know, three to six months, and then I'll take 'em off for a couple months till they're fully grown out and fully healed before I put them back on.
I think that's helpful.
Heather: Mm-hmm. And I think it's also important to check your nails mm-hmm. While you're getting your nails redone because you can have some sort of. Nail change. Mm-hmm. Like the melano nickia and not know it if you're getting your nails done every single time and not paying attention.
Courtney: Exactly.
Dr. Zane: Yeah. So public service announcement, when you're getting your skin check, make sure that your nail polishes off. Mm-hmm. And don't have like acrylics or gels on, I wanna be able to see your nail so I can properly assess it.
Heather: A lot of people [00:33:00] apologize that their toes are not painted and I'm like, trust me, I'd rather you have your toes not painted so I can see them.
Um, I think another big thing with. Manicures and pedicures is cuticle. Mm-hmm. Trimming. Mm-hmm. I think a lot of places over trim. Mm-hmm. And it can really traumatize, um, that area and lead to more infections or just irritation.
Courtney: Yeah.
Dr. Zane: Guys, the cuticles is there to protect the nail. Mm-hmm. Um, from infection, environmental irritants.
Heather: Mm-hmm.
Dr. Zane: Um, it's. There for a reason. Mm-hmm. You don't want to get rid of it because that makes you more prone to, you know, these infections and irritations that can cause a lot of problems down the road.
Heather: Yeah. And you can gently push it back. Mm-hmm. Um, you don't want to overdo it, but you also, um, some of that cuticle as it's growing out is dead skin too.
So you wanna get that off. I mean, you don't want to trim it, but you can like lightly kind of scrape it off. [00:34:00] Um. But that's something like you could easily do with just your other fingernail, like I said, very, very gently. It's easier to do like after the shower when your skin is a little bit more, um, malleable.
But I wouldn't recommend cutting it.
Courtney: And that's one thing I've noticed with my son is they never, like, I've seen that tool where they push the cuticle back with that like little metal tool and ooh, that sends shims up my spine. Like it looks painful and I don't think it's needed really. I think sometimes they do that to try to um, get your nails to last as long as possible.
They're getting right to the bed, but I think that's also where some of that trauma can come into. Mm-hmm.
Dr. Zane: Yeah. So let's get into some fun rapid fire nail myths. So. There are a few things that we commonly see. Um, patients, you know, coming up with these statements that they've heard on social media, um, from other, um, you know, information sources.
So biotin fixes everything. True. False.
Courtney: False. I wish it did false.
Dr. Zane: Yeah, right. [00:35:00]
Courtney: A cheap solution. Yeah.
Dr. Zane: Nails need to breathe.
Courtney: True. I would say. True.
Dr. Zane: Mm-hmm.
Courtney: Yeah.
Dr. Zane: Um, white nails equals calcium deficiency.
Heather: Um, some people say calcium or zinc. I don't know if it's like a guarantee.
Courtney: I would say no. 'cause Well, are we talking the whole nail or are we talking, you know, spotty
Heather: like the Leia?
Courtney: Mm-hmm.
Heather: That could just
Courtney: be trauma.
Dr. Zane: Yeah.
Heather: I think if it's repetitive or like it's all the time and it's like all of your fingernails, then it might be worth checking, but.
Dr. Zane: Fungus only lives in the locker room.
Heather: False.
Courtney: False fungus lives in your bathroom thanks to your husband. Tell him to wash his feet in the shower feeling men do not do that.
Heather: Yeah,
Courtney: just let the water and say, put soap. And then they're like, okay, I am good. No. Wash your heels. Wash your, wash your toes.
Heather: Do you wash your ears, your belly [00:36:00] button and your feet? I feel like those are the three
Courtney: my ears. Yes. I definitely, my belly button I get, I'm not like getting in there. Yeah. You know?
Heather: Yeah. I feel like a lot of people forget to, I don't really wash my ears
Courtney: Really? I do do a little low puns. I do. I do
Dr. Zane: it behind the ears.
Courtney: Yeah, I do behind too. Just 'cause I'm afraid my conditioner and stuff's gonna build up there.
Heather: Yeah.
Courtney: Um,
Heather: I do My feet.
Courtney: Yeah, my feet. I definitely do. Yeah. Oh, you know, I go one leg at a time.
I stand one legged, but I feel like I, I don't know, I don't know men, I feel like I hear sometimes they're like, oh, I put the soap on my body and it just
Dr. Zane: gets,
Courtney: it runs down. I'm like, no, that's not watching, that's not the same thing.
Dr. Zane: Um, dark Polish Ruins nails.
Heather: I haven't heard that one.
Courtney: I don't think it ruins, but I think it can stain.
Dr. Zane: Yeah,
Courtney: I've definitely
Heather: Stain or stain.
Courtney: Stain.
Heather: Yeah.
Courtney: I've definitely had my nail stained before.
Heather: Yeah.
Dr. Zane: So I think any nail polish can, you know, damage the nail.
Courtney: Mm-hmm. Mm-hmm.
Dr. Zane: So dark [00:37:00] or light.
Courtney: True.
Dr. Zane: Yeah. All right, so let's wrap up this episode on nails. So when do you need to see a dermatologist for a nail condition?
So I think the biggest one that we see is. A change, especially in a pigmented streak in the nail. I do think that that's worth investigating because you know, the consequences are pretty dire. Mm-hmm. If it is melanoma. So if you notice any changes like that, um, definitely call your dermatologist and we'll be happy to see you.
Um, if you notice any symptoms like pain, bleeding, lifting, pigment changes, I think that definitely warrants an examination. Um, nail changes lasting over six months. And it does pay to actually get your nails examined because it can be a, you know, a sign of other systemic issues going on and other, other, um, you know, issues that may be at place.
So I do think that it is important to get your nails evaluated, make sure that your nail polish is off, um, your gels are off, [00:38:00] and so that we can kind of take a good look at it. Um, so any other tips, tricks for nails?
Heather: Mm.
Courtney: Derma nail. You have Weekend Nails. I love Derma Nail. It's over the counter, like a little polish you put on.
It just helps strengthen them.
Heather: Yeah, I do recommend that a lot.
Dr. Zane: Well, I think we nailed it.
Heather: Aha.
Dr. Zane: Until next time. Skin side, [00:39:00]