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Nail Disorders and Treatments in the Aging Population

Nail Disorders and Treatments in the Aging Population. Generational Dermatology Summit New York, NY April 29, 2011 • Richard K. Scher, MD, FACP New York, NY. Nail Changes and Aging I . Yellow, gray, dull, opaque

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Nail Disorders and Treatments in the Aging Population

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  1. Nail Disorders and Treatments in the Aging Population Generational Dermatology Summit New York, NY April 29, 2011 • Richard K. Scher, MD, FACP New York, NY

  2. Nail Changes and Aging I • Yellow, gray, dull, opaque • Overcurved longitudinally and transversely • Markedly reduced growth rate Cohen and Scher, JAAD, 1992

  3. Nail Changes and Aging II • Brittle, ridged, peeling, splitting: (onychorrhexis, onychoschizia) • Lunulas may be absent • Thickened blood vessels and elastosis of nail matrix and bed

  4. Nail Changes and Aging III • Up to 40% decrease in nail plate growth rate in the elderly • A factor in 40-60% increase in onychomycosis prevalence • Slow growth rate contributes to nail thickening (onychauxis)

  5. Nail Changes and Aging IV • Longitudinal ridging (onychorrhexis) corresponds to skin wrinkling • Related to whorls of generative cells in the proximal nail matrix • Improves with light buffing

  6. Skin Disease in the Elderly – A Tunisian Study • All new skin diseases in patients over age 65 examined for 1 year • 1550 cases; mean age 72.6 years • 16.9% due to fungal infections, the largest group, of which onychomycosis predominated Souissi et al. Ann Dermatol Venereol 2006

  7. Brittle Nail Syndrome (BNS) • Normal water content = ~18% • Higher  soft; lower  brittle • Treat by re-hydrating, NH3 lactate, urea (5-20%), moisturizers, oral biotin (2.5mg daily for 3-6 months) • Check for hypothyroidism • Sanitizers, triclosan worsens

  8. Water content of brittle vs normal fingernails. • Found ~12% water content in brittle and non-brittle nails • Females 2:1 to males • BNS ↑ with age; water content ↓ with age • More common with frequent hand washing, exposure to chemicals, regular professional manicures Stern et al. JAAD, 2007.

  9. Could BNS be related to TOWL? • TOWL (transonychial water loss) of atopic, psoriatic, and mycotic nails is much lower than that of healthy nails Yet atopic nails are brittle! Less TOWL. Is this a contradiction? Psoriatic nails grow faster (younger). Less TOWL. Should also be less brittle! Is this also a contradiction? • [Our TOWL study did not work] Kronauer et al. Acta Derm Venerol, 2001.

  10. What else may help brittle nails? • Calcium, Zinc, Selenium, Iron, B12, Vitamin A may be helpful if there is a deficiency, but not likely otherwise • For patients with hypocalcemia due to hypoparathyroidism, calcium improves the associated brittle nails • Nail polish helps, French manicure; gelatin does not

  11. What else may help brittle nails? • Nail strengtheners with formaldehyde help, but caution: contact dermatitis and onycholysis may occur; may  brittleness • Nail polish helps, gelatin does not • Some women taking estrogens believe nails improve; also pregnancy [anecdotal] • Tried retinoic acid, minoxidil; did not work • Clinical trials on new emulsion current

  12. Faulty Biomechanics • Bony abnormalities: abnormal gait • Nails traumatized: permanent dystrophies, worsening of gait • Subungual hematomas may look like melanomas (trauma, aspirin, anticoagulants) • Pincer nails, subungual exostoses

  13. courtesy of Wendy Roberts, M.D.

  14. The elderly: fastest growing segment of the population WORLDWIDE • By 2030, 71 million Americans will be age 65 years or older; almost 20% of the population or 1 in 5 (now 12%) [10 million will be over 85 years] • 1950: 7 workers for each retiree… 2030: 3 workers for each retiree… • The retirement support system is under pressure!

  15. Only 11% of the NIH budget is devoted to elderly health concerns • Health needs of tens of millions of elderly will overwhelm hospitals and caregivers in the next 10 years • 7-10,000 baby boomers per day areentering medicare roles • Freudenheim. NY Times. 6/29/10.

  16. Genome investigators can now predict with 77% accuracy those individuals who have extended longevity to 100 years or more and are increasing • Are you interested in this test? Journal Science (AMA Bulletin, June 2010)

  17. Average American’s life expectancy is 75 years but many will live much longer • More leisure years, more spending years • Spending rate of elderly/retirees no lower than it was during their working years • Thus, more spending on appearance products for SKIN, HAIR, and NAILS • Today’s elderly care about how they look; are willing to spend more to look younger

  18. The Good (?) News • Sexually transmitted diseases rose 43% in American seniors during the five year period from 2005-2009 (Centers for Disease Control) • Seniors are moreaheadofthatcurve than non-seniors • Hooray! Seniors are having lots of sex.

  19. Conclusion Alas! Nails age along with everything else.

  20. Summary I • Do not abuse your nails • They are not screwdrivers, scrapers, or staple removers • Wear gloves for chores, gardening, etc • Avoid trauma, chemicals, detergents • Do not let nails grow too long – they will act like fulcrums and be injured

  21. Summary II • Nail cosmetics are OK: use acetone-free remover, formaldehyde- DBP-free polish • Avoid over-aggressive nail technicians; vigorous cuticle manipulation injures the matrix and damages the nail plate • Keep nails well moisturized and protected from excess sun exposure • Vitamins and minerals may help

  22. As a bright candle In a holy place So is the beauty Of an aging face - Joseph Campbell

  23. Grow old along with me The best is yet to be - Robert Browning

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