A guide to nail health: breaking, biting and bleeding

Junior Sarah Janesko leans against the wall. Her hands are in her lap, immobile, while she talks about her nervous habit. As she explains how hard it is to stop, one hand slowly rises to her mouth. "Darn. I'm doing it right now," she jokes, realizing what she was about to do. However, what Janesko, a nail-biter, doesn't realize is that her habit is far from trivial.

Nails are essential to human health and function. They protect the sensitive skin on the fingers and toes. Without them, it would be difficult and painful to pick up small objects, untie knots, hold onto and manipulate objects, dial telephone numbers and type. Unfortunately, many people do not take proper care of their nails, and nail disorders comprise 10 percent of all skin conditions, according to the Center for Disease Control and Prevention (CDC), and lead to infections, deformities and other problems.

Nail biting

Nail biting, or onychophagia, can lead to many problems, including bacterial infections, permanently deformed nails and dental problems. On top of that, you touch thousands of germs every day, and by biting your nails, they all go straight into your mouth.

Reasons for biting vary from person to person, but the habit is prevalent in today's society. According to Clinical Pediatrics magazine, 45 percent of teenagers gnaw on their nails. "It's a nervous habit," explains Janesko, "but it's also just for passing the time. If I'm stuck in class and there's nothing to do, I just bite my nails, or when I'm at a swim meet, waiting to dive, I can't do anything, so I bite." She also bites them when they look bad, admitting that her biting is part of what makes them look bad and keeps her trapped in a "vicious cycle."Junior Debbie Cheng, another biter, sympathizes with Janesko. "I usually bite when I'm nervous," she says. "It calms my nerves." She also feels like she is a part of the vicious cycle and bites because her nails are, as she proclaims, "ugly."

Janesko started biting in middle school, when she watched her brother nibbling and wondered what it felt like. She's been hooked ever since and admits she wants to stop. "I've had minor success with it, but not too much." Cheng has never made a serious effort to stop.

Benson recognizes the hardship of quitting nail biting and occasionally bites her own nails. However, she has lots of advice for her patients on how to avoid or quit nail biting. "You tell people to do another type of hand activity when they're anxious," Benson said. "If you can get people do something else with their hands, they won't bite." Benson had one patient who took up knitting and now constantly makes knitted objects instead of biting. Benson suggests manicures, both to keep skin and nails in good condition and to deter those who bite because their nails look bad.

The Palo Alto Medical Foundation has additional advice for nail biters, including painting nails with a bitter-tasting polish and rewarding yourself for resisting the urge to bite. They also advise wearing gloves, band-aids or colorful stickers on your hands as a reminder not to bite.

Disease

Nails, especially when taken care of improperly, are prone to various diseases. "Probably the most common thing is paronychia infections around the edge of nails and fungal infections in the nails," said Linda Benson, a Montgomery County family physician.

Paronychia is a bacterial infection that causes pain, redness and swelling around the cuticle. If it gets bad enough, the infection can cause a discharge of yellow or green pus. Acute cases can be treated with antibiotics, but the nail may become distorted and discolored, and skin around it may lift away. Paronychia can also spread from one nail to another. According to Benson, the infection is commonly caused by people cutting or biting their nails too short or tearing away hangnails.

Fungal infections constitute about half of all nail disorders, according to the CDC. "It's not really known why some people get it and others don't," Benson says, but she advises that keeping fingernails and toenails dry can help prevent fungal infections. This can be done by wearing absorbent socks, wearing sandals in public shower rooms and avoiding non-porous closed shoes. Anti-fungal preparations may also help prevent the infections, which can cause the end of the nail to separate from the nail bed as well as cause discoloration due to debris building up under the nail. The infections usually require months of oral medication to cure.

Ingrown nails

Ingrown nails are one of the most common problems treated by podiatrists. Occurring when the nail begins to grow into the skin along the sides of the nail, ingrown nails are painful and can cause infection. The nail on the big toe is the most common ingrown nail, but it can occur on all nails, including fingernails. The skin around an ingrown toenail will first be swollen and tender and may later turn red and infected. If left untreated, skin may start to grow over the ingrown toenail.

Freshman Olivia Bozik vividly recalls her ingrown toenail. She says that having one "hurts a lot, especially in the summer when you're barefoot. It's like something trying to break through your skin, trying to get to freedom, but it's stuck."

Ingrown nails are mainly caused by improper cutting of the nail. Most people tend to taper the sides of the nail when cutting, but this encourages the sides to grow down into the skin. Instead, nails should be cut straight across with minimal curving. Ingrown nails can also be caused from wearing shoes that are too tight, so if your feet feel cramped, you may want to buy new shoes before your feet get infected.

Bozik attributes her healed nail to both a change in shoes and to the close attention paid to the injury. "I just tried to be careful with it and not touch it or anything, just keep it out of harm's way." Benson advises soaking the infected foot in warm water mixed with antibacterial soap. However, if the nail doesn't get better or there is an infection, go to a doctor immediately so that you can receive the proper medical care. Never try to cut away your own ingrown toenail, this can just lead to worse problems.

Subungual hematoma

Benson said that another common nail injury is a subungual hematoma, caused by slamming the nail into doors or similar trauma. A subungual hematoma is when blood gathers and gets trapped behind the nail, turning it dark red. Pressure builds up behind the nail, causing extreme pain.

The treatment for a hematoma is relatively simple, but it should be performed by a doctor. "They have a disposable instrument where the tip heats up. You put a tiny hole in the nail, and the blood drains out," says Benson.

Sometimes, instead of a hematoma, trauma to the nails will cause the nail to fall off. Junior Tommy Dugan vividly remembers his experience with his big toe a few years ago. "I was playing in soccer cleats that were a few sizes too small, and my nail starting peeling off. It just kind of went away," he says. He cringes. "Oooh. It hurt."

CDC research found that nails that have fallen off usually take around four months to grow back entirely. While it is growing back, the finger or toe should be covered in order to prevent dirt from getting into the wound.

Nail care

While nail problems can occur even if you take all precautions, there are several things you can do to try to eliminate most issues. By keeping nails clean and dry, you can prevent infections. Nails should also be shaped straight across and not to a point. Pointed nails are weaker, break easier and can become ingrown. You should also try to avoid biting and picking at nails, as this can cause infections in addition to several other problems.

In case you have a hangnail, do not tear at it. Benson advises that if you have hangnails, you should "soak them to keep them soft, then trim them with cuticle scissors," but make sure you don't cut them down so much that they bleed.

While its unlikely that any nail disease or disorder will kill you, they are not something that can or should be ignored. Proper nail case is essential to good health and hygiene and is necessary in order to keep your nails and fingertips functional. Just a few simple steps are all that is needed in order to protect this important part of the hands and feet and prevent the pain of infection, biting and hematomas.