The State of Nail Health Research and Remedies

Author(s): Scott Douglas Jacobsen

Publication (Outlet/Website): The Good Men Project

Publication Date (yyyy/mm/dd): 2025/08/02

 Dr. Viktoryia Kazlouskaya, MD, PhD, is a dermatologist with 20 years of skincare, cosmetic procedures, and dermatological research expertise. She specializes in evidence-based treatments, including sunscreen, retinol, and antioxidants, while addressing conditions of acne, rosacea, and aging skin. Passionate about patient education, she emphasizes the importance of lifestyle, diet, and personalized care. Dr. Kazlouskaya is also experienced in advanced therapies such as exosomes, microneedling, and lasers, making her a trusted authority in modern dermatology. She addresses common concerns such as nail biting, trauma, fungal infections, and tumours, including melanomas that are often misdiagnosed. She explains that diet, chronic conditions, and seasonal changes can impact nail growth. Advances in dermatology, such as injectable treatments for psoriasis, improve nail health. Ethical considerations in cosmetic procedures, including plastic surgery trends like Brazilian butt lifts, are explored. The conversation concludes with plans for a future discussion on skin rejuvenation, Botox, and ethical concerns surrounding aesthetic treatments and psychological motivations.

Scott Douglas Jacobsen: Today, we’re with Dr. Viktoryia Kazlouskaya. We previously discussed hair, and now we will discuss nails. So, overall, how can you differentiate between healthy and unhealthy nails?

Dr. Viktoryia Kazlouskaya: That’s a good starting point. It’s quite simple—just by looking at the nails. Healthy nails are not brittle; they are pink, smooth, relatively thick, and strong. That’s the general appearance of a healthy nail.

Jacobsen: What about people who bite their nails? They have unhealthy habits. What issues arise in terms of those behaviours? These aren’t just lifestyle habits; they seem more like behavioural tics.

Kazlouskaya: Yes, it’s quite common to see. There are a few specific changes associated with habitual trauma. One example is nail biting, where patients typically develop uneven ridges and thinner edges on the nails. Another habit is when individuals constantly traumatize one nail with another finger.

In such cases, you may see a midline deformity in the nail. This well-known condition, “habit-tic deformity,” is quite common. Sometimes, patients don’t even realize they are doing it. However, during an examination, you might observe them engaging in repetitive movements, continuously traumatizing their nails without noticing.

Jacobsen: What health risks are associated with nail-biting, picking, or repeated nail surface or root trauma?

Kazlouskaya: The first thing that comes to mind is infection. While the overall health risks aren’t usually severe, these habits can impact one’s self-presentation. For example, constantly biting your nails in a professional setting may create a negative impression. Additionally, there is a risk of bacterial infections. Although rare, bacteria can enter through damaged nail beds, leading to potential infections.

Jacobsen: Let’s say you want to help someone stop this behaviour. How can you help them break the habit?

Kazlouskaya: It isn’t easy. It can be quite challenging if a person is consciously willing to change the habit. Psychological conditions like depression or anxiety don’t always cause nail-biting; it can simply be a habitual behaviour. Changing this habit requires effort and awareness. Interestingly, there are even devices designed to help. For example, some bracelets detect movement and send signals to alert people when they start engaging in the behaviour.

You can program this device for different behaviors—pulling your hair, biting your nails, touching your face, or squeezing pimples. When it detects these actions, it gives you a small vibration, allowing you to redirect your behaviour consciously. It’s like a prisoner’s ankle bracelet, but instead of a shock, it helps deter bad habits.

Jacobsen: What about, for instance, dental technology, braces now can be pretty sleek, and you have to look a little harder to notice them. They can be more invisible and subtle when done well. Back in the day, people wore headgear. So, what are some of the gimmicky treatments that have been used in the past, which have had questionable efficacy in preventing these behaviors or supposedly improving nail health?

Kazlouskaya: I don’t know if I’m familiar with those gimmicky things. Nails don’t get as much attention as skin and hair. I don’t know of any weird treatments for nails from the past. 

Jacobsen: Something that comes to mind is the longest-standing method as a type of coating you apply to the nails. It hardens and has a bad taste, discouraging biting. But that’s not a gimmick—it probably works for some people.

Kazlouskaya: It’s more like an old-fashioned remedy. If you ask grandmothers, they might suggest applying something sour to help someone break the habit of biting their nails. However, that would not work for an adult. This habit is so common that I’ve even seen it among my colleagues—physicians who constantly bite their nails.

Jacobsen: Are physicians usually anxious because of their long hours?

Kazlouskaya: I looked into this habit thoroughly, and it’s not necessarily connected to anxiety or depression, as I mentioned before. It can be purely habitual—people do it unconsciously without it being driven by stress. For example, picking behaviour can be driven by anxiety. There’s an urge and then relief after picking. But nail-biting is more of a routine behaviour.

No, no deep underlying psychological mechanism causes it—it simply becomes a habit. The key to stopping is recognizing and then consciously working to overcome it.

Jacobsen: Now, what about dietary habits? How do good and bad dietary choices affect nail health?

Kazlouskaya: Well, nails are made of keratin, so protein intake is the number one dietary factor to consider. You can track aspects of your health by looking at your nails. For example, nails can show signs of chronic anemia—low iron. Some nail changes can also indicate liver or kidney disease, so nutrition is definitely important. Protein is the most important nutrient for nail health, followed by iron.

Jacobsen: How do people maintain healthier nails in terms of stimulating growth? Pop culture often says that filing or trimming your nails stimulates growth and helps keep them even and rounded. Is that true?

Kazlouskaya: No, I don’t think filing or cutting nails makes them grow faster. Nail growth depends on whether your body is in balance. Younger people tend to grow nails faster, and fingernails grow more quickly than toenails. Growth can also be affected by factors like the season and diet. Many elements determine how fast nails grow.

Jacobsen: Why does the season affect nail growth? I’ve never heard that before.

Kazlouskaya: Generally, we have more vitamins and healthier habits during certain seasons. But in the summer, you can sometimes see slightly faster nail plate growth. I’d have to look up the exact scientific explanation for that.

Jacobsen: Outside of keratin, are there specific vitamin imbalances that you can notice in the nails? You mentioned kidney and liver disease as potential indicators.

Kazlouskaya: Yes, there are certain signs. One example is the little white spots on the nails as they grow. These don’t go away until the nail grows out, which suggests the issue originates at the nail matrix.

When examining the nail, you must look at different parts, including the cuticle, because it provides important clues about overall health. Changes in the cuticle can sometimes indicate serious conditions, such as autoimmune diseases like lupus. For example, under a microscope, you might see pronounced blood vessels in the cuticle, a telltale sign of an autoimmune condition.

Vitamin and nutrient deficiencies don’t always have distinct signs on the nails, but brittle, dull, or rough nails could indicate a deficiency. We typically conduct a range of tests to evaluate these possibilities.

Jacobsen: What things are catastrophic to nail health? I’m sure certain genetic conditions exist where people don’t grow nails. Still, I’m thinking more about lifestyle-related damage—situations where someone has harmed their nails so severely that they stop growing altogether.

Kazlouskaya: Yes, trauma can cause permanent nail damage. If someone experiences a severe injury—like a fall, a deep cut, or having something heavy fall on their finger or toe—they can damage the nail matrix, where the nail grows from. If the nail matrix is permanently damaged, the nail might never grow back normally. Unfortunately, in these cases, not much can be done.

In most cases of trauma, the nail might separate completely from the nail bed but will eventually grow back to normal. The outcome depends on the severity of the injury.

Jacobsen: Let’s say someone drops a hammer on their toe, causing blood vessels to burst and creating a lot of pressure and pain. What’s the appropriate response?

Kazlouskaya: That’s painful and sometimes requires medical attention. If there’s a hematoma (a collection of blood) under the nail, it may need to be drained to relieve the pressure.

A dark discoloration under the nail can look alarming, and some people even mistake it for melanoma, a type of skin cancer that can occur under the nail. Because of this, I often see patients who come in to check if their darkened nails are serious.

KIn most cases, the dark discoloration under the nail is just blood. You wait for the nail to grow out. On the toes, this can take up to a year because, as we discussed earlier, nails do not grow as quickly as you might want—especially toenails, which take many months to regenerate fully.

Jacobsen: What do people come to your office for the most when it comes to nails? What is the most common concern?

Kazlouskaya: The most common issue is fungal infections, which are very prevalent. After age 50, about one in three or four people will have a fungal infection on their toenails. It can be not easy to treat, especially if it is advanced, which is always challenging.

Another common issue is trauma or changes in the nails due to chronic conditions or deficiencies. Many people misdiagnose themselves with a fungal infection when, in reality, the changes are caused by another underlying issue. Beyond that, there are also tumours under the nails.

Many malignant and benign tumours can grow under the nail, and this is a whole subspecialty in dermatology. Some dermatologists focus exclusively on treating nails because diagnosing and treating nail-related conditions can be complex. Surgery on the nail is especially challenging because it can lead to permanent trauma to the nail plate.

Last year, I had about five relatively young patients with malignant tumours under their nails. Their nail deformities had been misdiagnosed as fungal infections for a long time, but multiple tests kept coming back negative. Eventually, I had to remove the nail plate and biopsy the tumour underneath. In some cases, it turned out to be malignant.

These are the major concerns: blunt trauma, deformities, unhealthy habits, poor overall health, fungal infections, and cancer. Melanoma and tumours in the nails are significant issues, and one thing that many people are not aware of is how unusual the location seems for skin cancer.

Jacobsen: That’s something I wasn’t aware of either. It is such an unusual spot for melanoma.

Kazlouskaya: Yes, but acral melanomas—melanomas that appear on the hands, feet, and nails—are more common in African American patients. A well-known example is Bob Marley, who died from melanoma that started on his toe.

The problem is that these melanomas are often misdiagnosed for a long time. People assume it is just trauma, a darkened nail, or a fungal infection. In general, African American populations are underserved in healthcare, meaning they don’t always see a physician as early as they should, which leads to worse outcomes.

Additionally, surgery on these melanomas is quite difficult, presenting another challenge. However, apart from melanomas, we also see squamous cell cancers on the nails. One factor that may contribute to an increased risk of these cancers is UV exposure from gel manicures.

We are not yet 100% certain about how significant this risk is, but it is a concern. If you go for a manicure every two or three weeks, you are exposing yourself to higher levels of UV light, which is known to cause cancer. This could be a contributing factor.

Another issue is HPV-related warts. Chronic warts around the nails can sometimes lead to certain types of cancer. So, major concerns, such as warts, fungal infections, and tumours, are among the most significant problems we deal with regarding nails.

Jacobsen: What new technologies might be available for special cases or are already in limited use? So, for instance, with hair, once rare technologies—like hair plugs—are now common. We also have a better understanding of the causes of hair loss. What about nails? Are there certain treatments or technologies that are rarely used now but show promise and could become more widely adopted?

Hypothetically, let’s say someone has uneven nail beds because they constantly pick at their nails. Could there be a technology that smooths out the surface they’ve deformed over time?

Kazlouskaya: Well, in the nail industry, there are a lot of new techniques for manicures, but that’s a question for a nail technician rather than a dermatologist.

However, in terms of medical treatments and new technologies, treating nail conditions has historically been challenging—especially when nails are affected by chronic conditions like psoriasis or eczema. In the past, we had very limited options to address nail changes caused by these conditions.

Fortunately, we have many medications that, while they may not completely cure these diseases, can significantly improve the appearance of the nails. For example, new injectable medications for psoriasis can help restore normal nail appearance, a major advancement in dermatology. We can now offer patients treatments that allow them to be free of these nail-related changes, which is a big step forward.

Jacobsen: Thank you for your time, Dr. Kazlouskaya.

Kazlouskaya: Bye.

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