Eczema, a common inflammatory skin condition, can affect fingernails. This can lead to various changes in nail appearance and structure. Understanding these changes and their causes is important for proper management.
How Eczema Impacts Fingernails
Eczema can cause visible symptoms on and around the fingernails. One common sign is nail pitting, where small, round indentations appear on the nail surface. This occurs when eczema affects the nail matrix, the area under the cuticle where nail growth originates.
Nails may also develop ridges, either horizontal (Beau’s lines) or vertical. Horizontal ridges suggest a temporary interruption in nail growth, while vertical ridges can indicate dry skin or eczema. Discoloration, such as yellowing or browning, and thickening of the nail plate are common. Nails might become brittle, break easily, or even separate from the nail bed (onycholysis). Inflammation of the nail folds, called paronychia, can also cause swelling and tenderness around the nail.
Common Eczema Types Affecting Nails
Several types of eczema are associated with nail changes. Atopic dermatitis, a chronic form, can lead to nail abnormalities like pitting, ridging, and thickening. This is often seen in individuals who also have atopic dermatitis on their hands. About 10% of people with eczema experience nail changes.
Dyshidrotic eczema (pompholyx) primarily affects the hands and feet and commonly causes nail involvement. This type can cause tiny, fluid-filled blisters on the palms, soles, and sides of the fingers. Repeated flare-ups can result in thickened, discolored nails with pits and ridges. Contact dermatitis, triggered by irritants or allergens, can also impact the nails. Chemical exposure, such as from nail products, can cause redness, itching, and swelling around the nails, leading to nail changes.
Differentiating from Other Nail Conditions
Distinguishing eczema-related nail changes from other conditions is important for accurate diagnosis and treatment. Fungal infections of the nail (onychomycosis) also cause thickening, discoloration, and crumbling. However, fungal infections present with a distinct ring-shaped rash elsewhere and are confirmed with lab tests. Eczema, in contrast, causes intense itching and can affect multiple body areas, though localized changes are possible.
Nail psoriasis, another inflammatory condition, shares similarities with eczema, such as nail pitting. Psoriasis causes additional signs like lifting of the nail from the nail bed and white discoloration. It presents with well-defined, thick, red plaques with silvery scales, differing from eczema’s less distinct borders. Trauma to the nail can also cause deformities, including cracking or excessive curvature, by damaging the nail matrix. Consulting a healthcare professional is recommended for a precise diagnosis, as self-diagnosis can be misleading.
Treatment and Management Strategies
Treatment for eczema affecting fingernails involves medical therapies and diligent home care. Topical corticosteroids reduce inflammation around the nail area. Calcineurin inhibitors are another class of topical medications used. In severe cases, systemic medications or phototherapy are considered.
Beyond medical interventions, general care tips manage nail eczema. Regularly moisturize hands and nails with fragrance-free, hypoallergenic creams to alleviate dryness and irritation, and protect hands from irritants and excessive water exposure by wearing cotton-lined gloves, especially during household chores or wet work. Keeping nails trimmed short and filed smooth prevents further damage from scratching and reduces secondary infections. Avoid harsh nail products, like those containing acetone, and opt for non-toxic, hypoallergenic nail polishes for nail health. If symptoms worsen or do not improve, seek further medical advice from a dermatologist.