ArTicle | AGEING NAILS | exist; nail avulsion does not improve the quality of a soft
or brittle nail. Rather, it can aggravate certain conditions and should therefore be avoided where possible. Nail care in the elderly consists of keeping the nails
dry, short and clean, and to use emollients or nail oil in order to retain elasticity and protect them from harmful exogenous influences. Even though they cannot substitute the integral lipids needed as cement substances, emollients can help to retain a greater amount of moisture. Patients should be advised to use them both before they embark on wet kitchen work or gardening, and after washing. Nail varnish may be applied, but wearing artificial nails, particularly when long, should be discouraged. Brittle nails, both onychorrhexis and onychoschizia,
are very stubborn. Systemic treatment of purported deficiency states usually remains unsuccessful. Even if it would be efficacious, it would take at least 6–9 months for the effect to become obvious at the distal margin of the nail. Small defects of the free nail edge can be corrected with nail repair kits available in cosmetic shops and pharmacies. Another option is to fortify the nail margin with a narrow border of artificial nail substance such as acrylic glue (Figure 10). Manicure must be performed gently without
Figure 10 Nail edge fortifying with a white acrylic by a 72-year-old female patient.
Note the grossly deformed and thickened big toenail due to congenital malalignment with consequent shrinkage of the nail bed
The brown manganese dioxide can be reduced to colourless manganese oxide with ascorbic acid. A gauze pad soaked with 10% ascorbic acid (e.g. from a vitamin C vial) is rubbed vigorously on the nail and clears the brown staining. Tar and other fat-soluble agents are best removed with another fat, such as an ointment and then soap. Again, it must be stressed that the use of soap is harmful and should therefore be limited to a minimum. The slow nail growth is thought to play a significant
nail care in the elderly
damaging important structures, such as the cuticle and hyponychium. Nails without sheen may be polished with nail buffers. This also helps to a certain degree to even out the characteristic ridging of the nails in people over 50 years of age. Cleaning of the nails with hard and sharp instruments must not be carried out; rather, an emulsion may be used instead of a soap to clean the fingernails from greasy dirt including tar. Scratching gently over the wet, soft surface of a soap bar and leaving the soap under the nail for some minutes before brushing the finger with a very soft brush will almost always remove all dirt and obviate the need for using a sharp instrument. Once onycholysis has developed, the most important therapeutic step is to counsel the patient about the most likely cause (such as aggressive manicure). This process should be completely stopped. The onycholytic nail has to be cut away to abolish the dead space where a variety of usually non-
pathogenic microorganisms can grow, which prevent nail reattachment. Water contact should be reduced to three times per day as a maximum; kitchen work with bare hands is forbidden. After washing and drying, the fingertips should be after-dried with a hairdryer and a mild disinfectant is sprayed on. Once every month the regrown but not yet attached nail has to be cut; this is approximately one half of the new nail. It takes a number of months to clear the condition, but the patient should be warned that recurrences may often occur. When onycholysis waxes and wanes, nail psoriasis has to be ruled out. In some regions, potassium permanganate is still used
as a disinfectant in baths. The permanganate has an oxidising property and is converted in manganese dioxide, turning the skin and nails a dirty brown colour.
64 ❚ May 2011 |
prime-journal.com consists of keeping the nails
dry, short and clean, and to use emollients or nail oil in order to retain elasticity and protect
them from harmful exogenous influences.
role in the untoward effects of ageing on the nails, so it would be ideal to be able to speed up this rate of growth. Physical activity, for example, is known to improve nail growth, while high altitudes, cold temperatures and nighttime are known to slow down the process. Biotin is sometimes termed the ‘hair and nail vitamin’, and is said to improve both nail growth and quality (15, 16). However, little is known about the daily need of biotin and how much the intestinal bacteria can produce. It appears that the usually
recommended dose of 2.5 mg daily is not enough, and that 5–10 mg per day are needed for a therapeutic effect (17). Whether zinc, iron, calcium, other vitamins, in particular vitamin E, and antioxidants can enhance the nail growth rate has not yet been proven in controlled studies. Antifungal azoles in high doses, in particular intraconazole 400 mg/d or fluconazole 150 mg/d, were observed to increase the nail growth. Even though this effect has been tried in the treatment of yellow nail syndrome (18, 19), it is not a generally accepted approach to deal with slow-growing nails of the elderly. There are also no reports on faster nail growth in persons taking drugs to improve blood circulation.
Diet and nutrition Hair and nails consist of 98% sulfur-rich proteins. A balanced diet is therefore assumed to be a prerequisite for good nail quality (20, 21). However, even those populations in the poorest parts of the world often have beautiful hair and excellent nails. As previously mentioned, the sulfur content of nails does not decrease with age. Malnutrition may be owing to a lack of adequate food intake, malabsorption, metabolic diseases or grossly abnormal eating behaviours, leading to sparse hair and nail growth disturbance (22–24), as seen in some severe malabsorption syndromes, serious malnutrition, kwashiorkor, after bariatric surgery, in anorexia nervosa
IMAGE HANEKE
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