Beyond Aesthetics: The Vital Role of Nails in Health

In an interview with Dermatology Times, Martin Zaiac, MD, discussed the importance of nail health and its relationship with systemic diseases.

Transcript:

Martin Zaiac, MD: My name is Dr. Martin Zaiac from Miami Beach, chairman of the department of dermatology at Herbert Wertheim School of Medicine at Florida International University.

Dermatology Times: Can you tell us about your session at the 2024 Society of Dermatology Physician Assistants (SDPA) Summer Conference?

Zaiac: Today, we're going to talk about nails, health, and disease.The concept of nails is something that is probably not taught enough in either residencies or in PA programs. I thought it was quite nice that they asked me to speak. Nails, as you know, are part of our body: skin, hair, and nails. Nails act similarly to hair; many things that affect the hair can also affect the nails. The nails can act as clues to systemic diseases, so it's important to always check your nails when you're getting an exam. They can show us signs that may be proceeding, during, or after some other medical condition that may be happening. It could be related to a particular disease; it could be related to a medication. It could be related to the patient self-manipulating their skin and self-manipulating their nails. There's a lot of different things that can happen with the nails, and obviously there's tumors that affect the nails. Basal cells are very rare, but squamous cells can affect the nails, especially if they're associated with HPV viruses. Melanoma, the worst of the skin cancers, can be found in the nail, so it's very important to talk about it.

DT: What advancements are we seeing in nail dermatology?

Zaiac: From a surgical point of view, we want to preserve the nail plate. In the older days, we used to avulse the nail completely; get the sample that we wanted to or try to treat the condition. But we know that the nail plate is very important. It acts as a template for the nail to grow out and it also gives protection. It takes away the pain, and also, from a cosmetic point of view, is better. If you remove a nail plate, you get what we call “nail bed regression,” where the nail bed turns into glabrous skin, so it will never attach. The relationship between the nail plate and the nail bed is very special. When people get onycholysis or separation, it's very difficult for that to reattach. When you remove the nail, if you lose the natural skin quality of the nail bed, those nails will never attach, and it's a problem.

DT: What are your perspectives on nail cosmetology?

Zaiac: I think that you have to be careful; over manipulation of nails is not a good thing. I always tell my patients, no matter what, when they go to get a manicure, do not allow them to take instruments to kind of scrape or clean underneath the nail. The safest thing to do is just to use a nail brush, because it's gentle, and whatever materials are underneath there can be removed gently with a nail brush, versus aggressively with some type of instrument. The aggressive instrument just causes that separation of that special relationship between the nail plate and the nail bed, and once that's separated, it's very, very hard for it to come back down. Don't over manipulate your nails, whether you're doing it yourself or the manicurist. Sometimes they remove the entire cuticle, which is somewhat bothersome, because the cuticle is a barrier that protects the proximal nail from intruding chemical irritants when you're cooking, washing dishes, or whatever. Maintaining that barrier is important, because if you lose that barrier, you can get problems like paronychiaor chronic inflammation around the nail. Then we go into the type of manicures that occur. We have gel manicures, which are very popular because, having 3 children and having sisters, I know that gel manicure lasts a long time. But, we know for a fact that gel manicures in certain patients can cause thinning of the matrix and creating more brittle nails. Gel manicures are not recommended if you're worried about your nails getting thin. Some of the processes require, usually, UV light to harden the products. We know UV light causes skin cancer. Any overexposure, the accumulation of more UV exposure, may lead to skin cancer problems around the nail. The acrylic nails are one of these things that women like, because, again, they last a long time, and they can give you long nails. However, acrylics are very commonly producing contact allergies, and when they do, they're very, very difficult to reverse. The same thing happens; you get destruction of the nail plate. You get onycholysis, which is the separation. Once that occurs, it's very hard to bring that back. We recommend that, yes, it's nice to keep your nails manicured, but gently, and don't use substances or procedures that may irritate or may cause changes in the natural skin that can lead to problems in the future.

DT: Do you have any tips to share regarding comprehensive nail care or factors to be mindful of?

Zaiac: A lot of times, I when I'm doing my exams on my patients, they come with nail polish on, and I say, “Is there anything underneath the nails? Do you have any pigmented bands or anything like that?” They go, “To be honest, I don't really look. I'm there getting a manicure,I'm on my phone, I'm reading, and I don't pay attention. ”It's very important that everybody pay attention to their nails. Like I said, you may develop a cancer there, and if you don't notice it, it may get to an advanced stage, which requires then a lot more serious procedures versus catching it early. Also, if you see any change in the nails, regardless of what you think, get checked by someone who is a specialist in nails. The other recommendationI have is for anyone who sees that they have opaque or yellowish nails. Right away people think it's fungus, sometimes the primary care doctor may think it's fungus, and even sometimes dermatologists may think it's fungus. We know that most of them are not truly fungi. A lot has to do with mechanical movements, especially in the feet. The way that we walk, the way our shoes fit, that can cause separation and that can cause that yellowing. Before you go on and spend a lot of money on lasers or medications make sure that what you have is really a fungus and not just discoloration of the nail.

[Transcript has been edited for clarity.]