Though she might have been able to guess at the name, it took a visit to her dermatologist to discover she had Green Nail Syndrome, a relatively unusual infection of the nail involving Pseudomonas bacteria, which manifests in a green/black discoloration. Common in moist, warm environments, Pseudomonas likes to inhabit tennis shoes, according to her doctor, Matthew H. Mahoney, MD, a board-certified dermatologist at Mahoney Dermatology Specialists. “The bacteria can be treated topically with anti-bacterial drops,” he says, “but it’s also a matter of keeping the area dry and treating any other nail problems.”
In Karen’s case, the bacterial infection was secondary to a nail fungus, which also gave her toenail a thickened appearance. Unlike Green Nail Syndrome, nail fungus, known as onychomycosis, is extremely common, Dr. Mahoney adds. “It’s actually quite prevalent when you look at a nursing home age population. There are probably more people with nail fungus than without.”
Unexpected treatment
For Karen, however, the trip to the dermatologist wasn’t originally motivated by questions about her toenail. Acquainted with Dr. Mahoney through their church, Karen says she originally visited his office to have some moles assessed. “He made an announcement to the congregation about mole screening and I decided to go in and see him.”
As part of his evaluation, Dr. Mahoney routinely checks fingers and toes. “If I’m doing a complete examination,” he says, “I always look at the nails.” Far more clues are waiting to be found than the average person would imagine. “There are actually a hundred or so terms for various, unique nail changes.”
In general, the doctor notes, nail changes can reflect reactions to medications, reveal systemic disease, manifest due to infection or injury and even be a sign of a genetic syndrome or nutritional issues. Spoon nails, as an example, can be associated with an iron deficiency. “That’s a common one – often seen as a normal finding in children and babies – in which the nail is curved upward instead of downward, making it look like a spoon.”
Another example, splinter hemorrhages, presents as thin, dark red to purple lines in the nail, according to Dr. Mahoney. “These can be associated with endocarditis, a bacterial infection related to the heart valves.”
Nail changes can even be related to breathing problems, he adds. Both asthma and chronic obstructive pulmonary disease can cause clubbing of the nails.
Ask the expert
Though he has all of this information at his disposal, Dr. Mahoney finds that a lot of people don’t know they can go to a dermatologist for a nail problem. “Patients don’t realize that dermatologists are specialists in the skin, hair, nails and even the oral mucosa, such as the mouth and lips.” He adds that the typical experience is not unlike what happened with Karen. “Someone will be here for a rash on their arm and they’ll say, ‘I have this nail thing. I didn’t know who to go to for that.’”
And, just like health clues wait to be discovered in the fingernails and toenails, the doctor says that he can learn similar things with regard to hair. Patients can have hair changes from systemic or dermatological disease, as well as trauma, surgery or infection.
“There are a lot of parallels because both hair and nails have a matrix, and they grow slowly, so the effects take a while to present. If you have a high fever, you don’t lose your hair the next day, you lose it four to six months later.”
Dr. Mahoney does stress that it’s important to ask questions about these seemingly small things. “There is a risk of more serious problems presenting as a simple nail problem in the first place.”
Keeping it personal
Just as he takes the time to check fingers and toes in his examinations, Dr. Mahoney strives to provide one-on-one attention by maintaining a solo practice without non-physicians seeing patients on his behalf. “I would never see seventy or eighty people a day and sacrifice that time spent talking and getting to know the patient a bit.”
A real family business, Dr. Mahoney’s wife supervises the office as well, and they both strive to provide a positive experience starting from a patient's very first phone call. From Karen’s perspective as a registered nurse who knows how patients should be treated, they succeed beautifully. “Their office is so new and clean, with the latest in technical equipment. The whole staff is excellent.”
“We try to spend the time people need to get better,” the doctor emphasizes. “I’ve had a lot of patients thank me for that.”