Doctors Advice for Nail Care: cuticles, fingernails, hangnails and more

Cynthia Bailey, MD|June 6, 2011

Healthy fingernails Today I'm getting my first pedicure of the 'season' and I'm thrilled.  Neatly trimmed and polished nails are a beautiful thing - and a finishing touch to grooming that I love - BUT, improper nail care can be hazardous!  Knowing the important dos and don'ts for nail care will help you prevent some of the common problems like infections, yellow nail discoloration and white spots on the outside of your nail plate. As a dermatologist, patients, readers and journalists ask me for my nail care recommendations and advice.  Here's a list of questions and answers I usually cover when I'm teaching people about nail, cuticle and hand care. Should you cut your cuticles? No! You can push them back but don't cut them.  Your cuticles form an excellent and necessary seal to keep water and germs out of a fold between your nail and your skin.  When you break this fold water and germs enter and live happily on your warm body. Eventually these germs can enter your skin layers where they cause an infection called paronychia.  This infection can become quite severe and require antibiotics and surgical drainage.  It’s not worth the risk. Are dark polishes bad for your nails? No, it’s the formaldehyde type of ingredients that are bad for your nails.  Dark polish can cause a yellow staining to the nails that can be buffed off.  Buffing of course thins the nail plate, making them slightly more fragile. What causes the white flaky spots on the outer surface of the nails? Some polishes have ingredients that etch nails.  I learned years ago that it was the formaldehyde related ingredients in polishes (formalin, methylene glycol etc, and they are not always obviously labeled on products because of the complexities of chemistry reactions).  In doing the research for this article I could not confirm that fact, so I'll just have to say it's a consequence of some polish formulations.  If your polish is causing the white spots on your nails then what you'll see is a chalky white flaking on the outside of the nail when you take off your polish.  It will be on all your nails at exactly the line where your polish was.  It looks very much like a fungal infection and if you have any questions about it you should see your dermatologist.  You can buff this white etching off the nail plate, but again buffing thins the nail. Will Nail Hardener Polishes fix soft, splitting, brittle nails? Beware!  Nail hardeners have a lot of formaldehyde type ingredients.  It's these ingredients that causes the initially 'hardening' of the nails but then they cause nail splitting.  I see patients with brittle nails try to 'harden' their nails with these products and unfortunately end up with even worse splitting and fissures on the end of their nails. It's such a 'catch 22' because the softer and more brittle your nails are the more susceptible they are to damage with nail hardeners.  They are also more susceptible to developing dryness and fissures from nail polish removers used to take the hardeners off.  I never recommend nail hardeners.  Instead I recommend moisturizing nails and the nail care I outline below. Dermatologist's Tips For Dry, Cracked and Splitting Nails Nails benefit from the same care as skin when they're dry, which means moisturizing to trap water! Step 1 Moisturize your nails and add oils.  Use creams, oils and ointments on your nails everyday after they’ve been wet. My favorite is good old Bag Balm with it’s wool alcohol (aka lanolin).  Another lanolin containing cream is Cutemol.  Some of my other favorite hydrating ingredients for nails are Shea Butter, Jojoba oil, avocado oil, or other rich natural oils.  Glycerin and AHA's (alpha hydroxy acids like glycolic acid in Glytone Body Lotion or lactic acid in Am Lactin) are great ingredients too for holding water in your nails. The thicker the cream the better, and oils or ointments are best. The trick is to use something that stays put for awhile and doesn’t just rub off right away.  Plus, you always moisturize skin and nails immediately after water exposure; applying moisturizers to dry nails is a waste of time.  Put your moisturizer on within minutes after your bath or shower, or after washing your hands.  Do it as often as possible.  You can use a hand cream during the day (I love my Dry Skin Hand Cream, which is non-greasy), but use a thicker product like Bag Balm at bed time. If your nails are really bad, apply Bag Balm to them numerous times a day after washing your hands.

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Click here to see more about my non-greasy hand, nail and cuticle cream

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  Remember it takes 6 months or more to grow your nails from the cuticle to the end of your fingernail.  If you have damaged, dry, split nails you need to moisturize them for at least this long in order to see entirely new healthy nail plates. Step 2 Clip and file your nails when they’re wet. Clipping and filing dry nails makes the splits worse so always do it after water exposure.  Towel off the water and then use sharp nail clippers to trim your nails, followed by gently filing the edges.  You can also very gently buff the nail edges to keep the splitting layers from catching on things and progressing down the nail. Step 3 Wear gloves when you do rough work or get your hands into harsh chemicals. Obviously you want to protect your brittle and splitting nails from the things that make them worse. What should you do about hang nails? Hang nails are long splits of dry dead skin attached to the underlying living skin, which is why they hurt when they snag on things.  Clip them with sharp and clean cuticle scissors when they are wet, just as you would your fingernails.  Soak them in warm water for 5 minutes then towel off the excess water before clipping them.  Just clip off the small dry hang nail and be sure not to cut into your skin.  Always be sure your scissors are clean, and you may want to disinfect them first: you can wash them in soapy water then pour rubbing alcohol on them before use. Some final notes about nail and cuticle care: I've created a hand and nail care kit to provide you with the best-of-the-best for the type of products I recommend you use to keep your hands, cuticles and nails soft, hydrated and healthy.  Click here to see what I think are the hand and nail care essentials. dermatologist's dry skin hand and fingernail skincrare kit I have two blog posts that give you more information for good hand care and nail care.  There's info in them that people often ask me about like vitamin supplements for nails etc.  Click the titles to read these posts: Cracked, Dry, Brittle and Splitting Fingernails: Dermatologist's Tips Dermatologist's Tips for Dry, Chapped, Painful Hand Skin

I think I have chronic paronychia and some lifting on some of my fingernails.  After washing my hands is it better to dry my nails completely before applying ointment or moisturizing cream.  You stated applying moisturizer to dry nails doesn’t do anything yet if nails are not completely dry wouldn’t applying a moisturizer trap liquid under the nail making the infection worse?  Any advice would be much appreciated.  Thanks.
Hello Denise,
You are right, if paronychia is a chronic problem then drying under the nail fold in important. The nail unit is structurally complex and it is possible to have competing needs for the different nail unit structures. For nail fold yeast problems I have my patients drip lotrimin solution am and pm and drip rubbing alcohol under the distal nail fold after all water contact! If the nail plate is peeling and/or brittle (onychoschizia) I have them apply bag balm after washing and towel drying, but just apply that carefully to the outer surface of the plate. If the fingertip skin is fissured and cracked I need to decide if yeast is playing a role, if so, then I use lotrimin cream to that, trying not to occlude the fold with it. It can be a big job and sadly it can also take many many months to bring the skin and nail unit back to normal.

By Denise on 2016 10 14

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