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What can I do about my abnormal looking Nail?
Nail deformities of the fingers and toes are a common source of functional and aesthetic deformities for many people. Most of these deformities are a result of traumatic finger or toe injuries. However, there are also cases where deformities result from prior biopsy or excision of nail lesions.
Parts of a nail-
The nail plate (hard part of the nail) is what most people refer to when they discuss their nails. The soft part of the nail below the nail plate is called the nailbed-this is where the nail grows from. The nailbed and plate are supported by the underlying bone of the finger or toe. The nail fold is where the nail plate goes under the skin closer to the hand.
Types of nail deformities.
There are several common nail problems patients present with. The first involves grooves or raised areas in the nail. This is often a result of a crush injury to the nail. These deformities can be a source of problems for patients as dirt and dust can become trapped under the grooved or raised areas. The abnormal part of the nail is usually a result of a scar within the nail bed. The treatment is based on the width of the groove/raised area. The simplest procedure is to remove the scar in the nailbed and repair the nailbed. This allows the nail to grow together with a uniform appearance.
A second common nail problem is a hook nail deformity-this is where the nail hooks downward at the end of the fingertip. This deformity is the result of a fingertip injury, resulting in the nailbed becoming longer than the underlying bone. Without proper support for nail growth, the nail hooks around the tip of the finger. The treatment for this type of deformity is to provide more support for the nailbed or to shorten the nailbed to the length of the bone.
A third type of nail deformity is where there is a scar from the surrounding skin to the nail. This unsightly deformity can be a source of great embarrassment for patients. This deformity can result from the crush injury or infection at the edge of the nail. These deformities can be corrected by excising the scar tissue and reconstructing the nail fold. This allows the nail plate to grow properly without adhering to the surrounding skin.
A fourth and most severe nail deformity is where the entire nail grows poorly, becoming an irregular, firm area without having any nail plate growth. This is usually the result of a severe crush injury. This type of severe deformity can only be corrected by excising the nailbed and transferring a thin piece of nailbed from one of the big toes. The nail on the big toe continues to grow normally. Many patients are nervous about this procedure, fearing that the toenail will be affected long term. However, taking a thin piece of nailbed from a toe does not affect growth of the toenail. In cases of severe nail deformities, this is the best option for obtaining a normal appearing and growing nail in a traumatized digit.
Conclusions: Nail deformities can be functional and aesthetic problems for many people. With proper planning and execution, the nail deformity can be corrected so patients can resume normal use and appearance of the finger or toe.