ArTicle | AGEING NAILS |
implicaTions for TreaTmenT
of The nails: aeTiology and
The ageing
Eckart Haneke investigates the reasons why the human nail may change with the ageing process, the conditions this may cause, and the range of treatments available
ABSTRACT
Ageing of the nails, a relatively inconspicuous process, is the result of a general slow-down of the metabolism in older persons, impaired vascular supply and decreased physical activity. The fingernails become thinner, more friable, develop longitudinal ridging and lose part of their shine, whereas the toenails tend to become thick, yellowish and hard. Onychogryposis is typically seen in the debilitated elderly. Over-curvature of the toenails often develops from the age of 30 years onwards, and is mainly owing to genetic factors, but foot deformities also cause pincer nails. Degenerative osteoarthritis of the distal interphalangeal joints is the reason for finger nail over-curvature. Onychomycoses increase in frequency with age, reaching up to 50–60% in the over-60s, and are the more resistant to treatment the older the patient is. Psoriasis of the nails is also more frequent in older individuals and often recalcitrant to therapy. Myxoid pseudocysts are the most frequent tumour-like lesions seen in persons over 40 years. Melanoma of the nails makes up for roughly 1.5–2.5% of all melanomas in the fair-skinned individual. Its peak incidence is between 50 and 65 years of age. Bowen’s disease and invasive squamous cell carcinoma also mainly occur in the second half of life. The treatment of choice for these malignant nail tumours is microscopically-controlled surgery.
A ❚
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geing is A universAl biologic phenomenon that nobody can escape. however, the visible changes of ageing are very obvious in some bodily regions, such as the musculoskeletal and cardiovascular systems, and barely noticeable in others. While the damaging effects of sunlight and other potential
ultraviolet sources, as well as a variety of different harsh exogenous influences can be avoided, the ageing process is mainly genetically influenced. however, marked changes in sun-exposed areas are often referred to as ‘photoageing’, although they should be termed ‘photodamage’ as this is a more accurate description of what these areas entail.
Background The nail is a gently curved plate of keratin solely produced by the nail matrix (Figure 1). In contrast to hair, which is biochemically identical but anatomically different, the nail grows continuously throughout one’s
May 2011 |
prime-journal.com
KEYWORDS nails, ageing of nails, nail alterations, onychomycosis, nail tumours
ECKART HANEKE is Dermatologist, Dermatologic Practice Dermaticum, Freiburg, Germany; and consultant professor at Dept Dermatol, Inselspital, Univ Bern, Switzerland, Centro Dermatol, Inst CUF, Porto, Portugal; Dept Dermatol Acad Hosp, Univ Gent, Belgium
email:
haneke@gmx.net
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