Our feet are more visible to the world at this time of year, whether it’s because we’re wearing sandals, going to the pool or walking on the beach. As a result, many people are more conscious about the health and appearance of their nails, particularly if their fingernails or toenails look odd because of thickening, lifting or color changes—all of which can be signs of infection.
“In the summer, people want to show off their nails,” says Amanda Zubek, MD, PhD, a Yale Medicine dermatologist. But that might be a problem if you’re an athlete with bruised or broken toenails as a result of repetitive activities like running—or if you have picked up a nail infection at a pool or salon.
“Nail fungal infections are more common in the warmer months,” says Dr. Zubek, who is the medical director of the Yale Medicine Dermatology Middlebury office. Prevention is key because fungal infections are hard to treat. Medications only work half of the time, according to the United States National Library of Medicine. Even when medication is effective, bear in mind that nails are slow growing, so it could take a year or longer to regrow them.
While patients tend to seek help for problems with their nails during open-toe-shoe season, it’s important to pay attention to nail health year round. To help, Dr. Zubek answers some commonly asked questions about keeping your fingernails and toenails in tip-top shape.
Can you really pick up infections or nail fungus at salons?
You can. Anytime your nails are getting wet, cut or filed—or your cuticles are being trimmed—it is an opportunity for bacteria and fungi to get in under the nail.
Both bacteria and fungi can cause nail infections and are very common in the environment. You can easily pick up a nail fungus, for example, at a swimming pool, from the gym floor, the dirt outside or even from a family member.
How would I know if I have a nail infection?
Fungus grows in warm, moist places such as under nails. When fungus has a chance to grow in the nail, it can turn into a fungal infection, which is a common problem. Typical signs of a fungal infection include new white or yellow patches and streaks, but nails can also turn brown or green. You’ll see lifting of the nail from the skin underneath, and sometimes you will see thickening of the nail. The nail will look bumpy or have ridges with crumbly debris underneath. It may even be so misshapen that it seems to be veering off to the side, or the nail may fall off completely.
If the infection is caused by bacteria instead of a fungus, you may notice redness, swelling, pain or pus in the skin surrounding the nail.
How are nail infections treated?
If you have any of these symptoms, make an appointment with a dermatologist. He or she will need to take a clipping of the nail to send out to the lab to be evaluated; so don’t trim the nail very short.
Once diagnosed with a fungal infection, you’ll need to apply a prescription-strength antifungal liquid, or take an oral antifungal pill. Topical over-the-counter antifungal creams usually don’t penetrate deeply enough into the nail. Patience is key because nails grow slowly. It can take months to clear up these infections. If you get a nail fungal infection, you may still be able to wear nail polish, but you should not wear artificial nails because it will be hard for your doctor to monitor your improvement. Artificial nails also can create an environment that allows fungi and bacteria to grow more easily.
If you’re treated for a toenail fungus, try not to wear shoes without socks. Also, buy an over-the-counter antifungal powder or spray at the drugstore to treat your shoes, so you don’t re-infect yourself.
For bacterial infections, your dermatologist may need to drain the infected area and might also recommend warm soaks and an antibiotic ointment.
How can a customer tell if a salon is clean and fungus-free?
You can’t tell just by looking! Nowadays, most salons meet stringent health regulations. There are regulations galore to be licensed, but there’s no way for customers to visually assess. You can, however, look at customer reviews online, ask to see the nail salon’s license or check to see if they’re accredited by the Better Business Bureau.
Is it smart to bring your own nail tools to an appointment?
It is recommended to bring your own manicure and pedicure tools. Be sure to clean them after every use with warm soapy water. Dry them, and then sterilize them with rubbing alcohol.
Is it okay for a nail technician to cut my cuticles?
They should not be cutting your cuticles or pushing them back. But you will have to ask them not to do this. Cutting the cuticle interrupts the protective barrier function it serves to keep the nail safe from infection.
Also, regularly pushing cuticles back causes permanent damage and can change the nail shape. Besides, it’s an unnecessary step—the cuticle stops growing naturally after a few millimeters.
I bite my nails sometimes—does it matter?
Biting nails and the skin around them is a bad habit. People who bite their nails don’t like to do it, but it’s hard to stop. You’re introducing bacteria from the nail into the mouth and creating an opening in the skin or under the nail that can introduce bacteria, fungus or yeast (a type of fungus) that can cause infection.
Do certain sports put your nails at risk for injury?
We definitely see a lot of nail problems with sports that require a lot of running, dancing or kicking. Chronic rubbing of the toe on the toe-box of shoes can cause lifting and bruising of the nail.
If you do a lot of running, keep nails short, and choose shoes with a wider toe box. And at the gym, be sure to wear flip-flops in the locker room and by the pool, so you don’t pick up a fungus.
How can I prevent ingrown nails?
Cut your nails straight across, and file into a square shape, not rounded. Cutting the corners off increases your risk of getting an ingrown nail.
How do I get rid of a hangnail?
Hangnails are a sign of dry skin. Don’t bite them. If they’re really painful, try to cut them with a clean clipper, and moisturize your fingers with petrolatum or cuticle oil.
What else can fingernails tell a dermatologist about your health?
Nails say a lot about your health. Your dermatologist can look for changes in the nail texture, brittleness, lunula (the half-moon at the base of your nails), overall shape and color of your nails.
Seeing changes in the shape and color of nails can mean chronic lung or heart diseases. Sometimes whitening might indicate kidney or heart disease. Brittleness alerts us to consider if the thyroid is working properly or if the person may have anemia. If there’s clubbing of the tip of the nail and texture changes, there could be an underlying lung problem. If I see concerning nail symptoms, I will look into it further. Often dermatologists are the first doctors to notice not-yet-diagnosed health problems.
Also, if you notice a new brown or black stripe, there’s a risk of melanoma under the nail—or it may just be a freckle or due to a nail infection or inflammation. It’s important to understand that most melanomas under the nail are not caused by sun damage, but by random mutations—if you have one, you just got unlucky.
New stripes going down the nail need to be checked out by a dermatologist. A red stripe or lifting of nail from the nail bed could indicate another type of skin cancer.
Yale Medicine is unique in that our staff includes highly trained dermatologists also trained in pathology, called dermatopathologists, who look under the microscope to confirm whether the problem is a nail fungus or another skin disease such as melanoma or another skin cancer. And if so, they help us make the right diagnosis.
Is it true that the ultraviolet (UV) lights used to dry gel nails can cause skin cancer?
UV light in general does cause skin cancer. Most salons use these UVA lamps to cure gel nails. If you use them weekly, it does slightly increase your risk of skin cancer as well as premature aging of the hands.
Use a broad spectrum sunscreen to protect against photoaging and skin cancer. These UVA lights aren’t as dangerous as going tanning in a tanning bed, but they’re not regulated, so we really don’t know how much radiation you’re getting at nail salons.
How can I keep my hands from looking old?
Prevention. Prevention. Prevention. Sunscreen is really essential. People often forget to put sunscreen on their hands every day. It’s also important to keep moisturizing the hands. Creams with ceramides are good because you naturally lose ceramides from your skin as you get older.
Hand creams also have glycerin and petrolatum that help trap in moisture. Some have alpha hydroxy acids (AHAs), which help get rid of dead skin cells. If you notice veins in your hands becoming more prominent, that’s caused by fat loss, which is a natural part of the aging process.
Can I take anything to help my nails grow?
Biotin supplements really help with the natural growth rate and strength of the nails. A well-balanced diet with enough protein also helps keep nails healthy.