Nailing the problem

HEALTH/ Your fingers and toes may be harbouring dirty secrets

Humans make and use more tools than any other creature on the planet. Yet we come factory-fitted with plenty of tools of our own. Among the most obvious are our nails, which are convenient for prying, scraping, twisting, pinching, scratching, enticing and playing music.

With all this hands-on work, nails are at the cutting edge of our encounter with the world. Because they face unusual stress, they need special care. The warm, wet environment of dishwashing and of close-fitting shoes, for instance, causes the commonest nail problem: fungal infection.

It isn't a pretty subject, but as many as one in 10 people (UK) have fungus-infected nails. In less-developed countries where people wear open sandals, the incidence is as low as one percent (Zambia). The better shod one is, the greater the likelihood of nail problems. And once the fungus takes root, it can slowly spread by contact to other toenails and fingernails.

Nail fungus infection, or onychomycosis, causes unsightly thickening, darkening, splitting and deformation. Infected nails may crumble slightly, or separate from the nail beds. If you are over 60 and suffer from diabetes, circulation problems or diminished immunity, you are most at risk.

To avoid ugly, infected nails, doctors and podiatrists advise the following steps. Keep your nails short, neatly cut, dry and clean. Don't share nailcutters or files; take your own along even to a professional manicurist. Don't use the same cutter/file for infected and healthy nails. Wear rubber gloves for wet and cotton gloves for dry work.

Don't wear varnish long, because your nails need to breathe. Wear cotton socks, changing them regularly, and shoes with a wide toe area made of breathable canvas, leather or mesh. If you have sweaty feet, use talcum powder. Don't walk barefoot in public areas like locker rooms. (This last will be tricky if you are a regular at the temple, mosque, gurdwara, other place of worship.)

Once diagnosed, most reliably by testing nail scrapings, several treatments are available. They do take time "" several months "" because nails grow so slowly and the fungus resides deep within.

The most effective treatments involve both oral antibiotics and topical ointments. Perhaps the most widely prescribed medicine is terbinafine (marketed as Lamisil or Terbisil); but all have side-effects, especially on the liver and skin, so talk to a doctor first.