Paronychia. Onychomycosis. Surely, these are the names of six-armed Greek monsters that might attack Jason and the Argonauts.

In fact, they're microscopic monsters that will gladly attack your nails and may do damage if you don't do something about them.

Rarely do people hold forth about the condition of their nails while co-workers are gathered around the office coffee pot. But nail problems do cause considerable pain and embarrassment.

"As many as one in five older people can expect to suffer from a fungal infection of the toenails, a common source of nail problems," says Dr. Philip Fleckman, Associate Professor of Medicine in the Division of Dermatology at the University of Washington. He practices at UW Medical Centre.

About half of the people with nail problems have fungal infections, and they may be helped by new anti-fungal medications. But those medications may have side effects, and they are not appropriate for everyone. So it is important before considering treatment to confirm that the nail problem is, in fact, caused by fungal infection. People with any doubt about their nails should consult with a dermatologist. Another good reason to do so is that sometimes nail problems are signs of serious illnesses in other parts of the body.

Acute paronychia is a swelling and redness of skin around the nail, seen more often in fingernails than toenails. It may be caused by an injury to the skin around the nail, by pulling on or chewing the cuticle, or it can also be caused by hangnails. Paronychia's underlying cause is bacteria. So a doctor may suggest an antibacterial ointment or other medicine.

Recurrences of acute paronychia can develop into chronic paronychia, which is more serious. You can avoid paronychia by wearing waterproof gloves over cotton gloves while doing housework, or when you are exposed to chemicals. Also, avoid pulling at or chewing on the cuticles or skin around your nails. Don't pick or chew hangnails; trim them with nail clippers.

Onycholysis is when the nail plate separates from the tissue beneath it, usually at the tip of the nail. It's more commonly seen in fingernails than toenails. You'll notice that the normal white tip of the nail begins to extend toward the cuticle.

The separation between nail plate and nail bed gives dirt a nice place to hide, and provides a fertile home for fungus and bacteria. The most common causes of onycholysis are continuous exposure to water and contact with chemicals. It can also be caused if someone, perhaps playing a sport, accidentally tears the nail plate from the bed. And it can be caused when someone cleans too aggressively beneath the free edge of the nail. In some cases, it may reflect systemic or skin disease.

One tip to avoid problems: clip your nails short to reduce the chance of tearing.

Onychomycosis is when fungus attacks your nails. It usually occurs with athlete's foot. The nail plate and bed separate. In many cases, the nail plate thickens. The border of the nail may crumble. The nail's colour may vary from yellow to brown.

Among the causes of onychomycosis: injury to the nails, repeated stress on nails because of athletic activities, mechanical stresses created by bone changes in the feet as they age, and nerve and circulatory changes caused by ageing.

There are new medicines available to treat the disease. Again, it's important to discuss all circumstances with your doctor. It's certainly a good idea to try to prevent the infection. Dry between your toes after bathing. Don't walk barefoot around public pools, showers or locker rooms. And change your socks frequently, perhaps even several times a day, if you sweat a lot.

Health Beat, University of Washington

Date reviewed: 07 December 1999