What They Are

two hands positioned to show all fingernailsNails are made of keratin, a hardened protein that is also in hair and skin. Their role is to protect the delicate tissues at the ends of fingers and toes. Nails grow from the base toward the tips of fingers, so the tips are the oldest part of your nails. The appearance of your nails depends on a number of things including nutrition, health, as well as contact with various substances (e.g. soap, chemicals).

Are your nails healthy?

You can usually tell by simply looking at them. Healthy nails are smooth and free of spots and unusual shapes and colour. Signs of nail problems and diseases, on the other hand, can include pitting, ridges, streaks, yellowing, and other forms of discolouration. In people with skin of colour, it is completely normal for multiple nails to have brown longitudinal bands of pigment (physiologic melanonychia).

Healthy nails can be a sign of overall good health, whereas nail troubles can betray a systemic disease, such as diabetes, anemia, thyroid disease and infections like Hand-Foot-Mouth Disease. Some skin diseases can present with nail and cuticle findings, such as psoriasis, lupus, and hand eczema. Nail problems can result from various medications used to treat diseases, such as antibiotics and chemotherapy. You can also develop benign and cancerous growths of the nail (See Subungual Melanoma).

Nail Care

Keeping your hands, nails, and cuticles well moisturized goes a long way towards maintaining healthy nails. This helps prevent hangnails from developing. Hangnails are simply dry, dead bits of skin. You may be tempted to bite or pull them off, but this can result in removing more than just the hangnail and injuring the surrounding skin, causing swelling, redness, pain, and possibly even infection. The safest way to get rid of a hangnail is to snip it off carefully with clean, sterilized scissors or a nail clipper.

It’s also important to leave your cuticles alone – cutting your cuticles or pushing them back can expose the nail to infection, irritants, and allergens or injure the surrounding skin.

There are several environmental exposures that can damage your nails:

  • Water – repetitive water immersion can weaken the nail, sometimes causing it to lift off from the underlying skin (onycholysis). It also makes nails and surrounding skin more susceptible to damage from irritants and allergens.
  • Irritants – these can include but are not limited to soaps and detergents, chemicals, soluble oils and metalworking fluids, exposure to plants, and mechanical friction
  • Allergens – commonly includes resins in nail polish, acrylates in the glues for acrylic and gel nails, and solvents used for removal.

Manicures and pedicures with acrylic and gel nails can cause many types of traumatic nail injury such as brittleness, riding, pitting, nail detachment and infection around the cuticle (paronychia). They can also cause irritant and allergic contact dermatitis.

When doing any type of manual or wet work around your home, such as housework, yard work or repairs, it is important to protect your hands and nails. The best way is to wear vinyl or nitrile gloves when performing these tasks.

Did you know?

Nails grow at a rate of 2.5 mm on fingers and 1 mm per month on toes.

Nails grow faster in summer than winter.

It takes six months for fingernails, and one year for toenails, to grow back if you lose one.

Nails absorb more water than skin.

Nails will not grow any faster if you eat or apply gelatin.


You can help to keep fungal infections at bay by observing these practices:

  • Keep skin clean and dry
  • Do not share tools such as nail files
  • Trim your nails straight across
  • Use an antifungal spray or powder daily
  • Give feet a break from shoes
  • Do not go barefoot in locker rooms or public showers, and wear flip flops
  • Examine toenails regularly

The only way to accurately tell whether you have a fungal infection is for your doctor to take a sample (by clipping or scraping under the nail) and send it to a lab, where it will be examined under a microscope and cultured (grown in a Petri dish).

Treating fungal infections generally requires prescription-strength topical and/or oral medication. Topical lacquers can require close to 1 year of treatment with a complete cure rate of up to 20%. Oral medications for toenail infections are pills taken daily for 3 months with a success rate of about 40% complete cure rate.

Even when a fungal infection does go away, there is a good chance, about 25%, that it will return.

Not all nail infections need to be treated. It is important to have a discussion with your doctor whether treatment is needed and whether a topical lacquer or an oral medication is the best treatment for you. There are far fewer side effects with topical medications than oral medications. Topical medications are often used when only a few nails are involved, and oral medications (pills) are used when many nails are involved.