Show 1487: Hair Loss and Nail Problems: A Dermatologist's Guide to What Actually Works

Do you worry that your hair is thinning? You may wonder what treatments could make a real difference. After all, you wouldn’t want to spend money on something that has no chance of helping. Many people also have concerns about their nails. Perhaps they are ridged, or loose, or too thick. Could that be due to nail fungus, or might it have another cause? Most importantly, what could you do about it? In this episode, you’ll get a dermatologist’s guide to what actually works.

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What Actually Works for Hair and Nail Problems

Dr. Chris Adigun practices both general and cosmetic dermatology. We wanted to ask her about nail problems in particular because they are very common and she maintains a specialty in treating them.

We asked her about the most common nail problems she sees, and she named simple onycholysis (pronounced Oh-nick-oh-LYE-sis). In this condition, the nail begins to lift away from the nail bed. You can identify it because the white area at the fingertip becomes much more extensive than usual. Usually, this is due to exposure to acids such as citrus juices or cleaning solutions. Having your hands in and out of irritants or even water (with or without soap) could lead to onycholysis. An overactive thyroid gland could also lead to onycholysis. To prevent it, try to avoid putting your hands into that sort of liquid. If you must do so, use gloves. And of course, a good hand cream to bolster the skin barrier is a very good idea. If these approaches don’t do the trick, especially if there are other symptoms, the doctor may want to test for thyroid function.

Another common problem is allergic contact dermatitis. This could be caused by some of the same irritating substances responsible for onycholysis, but cosmetics are common culprits here. Nail polish and remover, especially nail polish remover, can cause nail problems for some people. If you are one of them, what actually works best might mean finding a less irritating product or, even better, leaving the nails unadorned.

White Spots on Nails

Many people have noticed white spots on their nails. We asked Dr. Adigun what causes these, and she replied that usually they are not worrisome. If you bang your fingertip, as you might if you slammed it in a door or a drawer, the trauma may show up several weeks later as a white spot. (More serious trauma could show up as a dark spot due to blood pooling under the nail; we discussed that with podiatrist Jane Anderson here,  but not with Dr. Adigun.)

What About Ridges on the Nails?

Nail ridges are very common, and the ones that run lengthwise along the same axis as the finger are due to aging. Just as our skin develops wrinkles, so do our nails. Consequently, there are no effective treatments.

Nail ridges in children are a different story. They might show up as nails having the texture of sandpaper, or they could be horizontal ridges. Such nails should be seen by a physician, as they could signal an inflammatory condition called lichen planus or even an early sign of psoriasis. While we don’t have cures for these conditions, there are effective medications to manage them.

Hangnails and Cuticle Problems

Are you surprised that dermatologists have a fancy term to describe cuticle problems and other trouble affecting the skin around the nail? They call it paronychia (PEAR-oh-nick-ee-ya). If it is caused by an infection, it might be treated with an antimicrobial compound. The best preventative is not to pull, bite or clip off hangnails or rough spots in the cuticles, the skin near the nails. Instead, moisturize and possibly cover the spot with a bandage to remove the temptation while it softens and heals. Instant glue is another simple remedy that really works for hangnails.

Treating Nail Fungus

When the nails are thick, ugly and hard to trim, often people blame nail fungus. But surprisingly, it isn’t always the culprit. Mechanical trauma can also create thick nails that are hard to cut. If the nail is thick because it is on a hammer toe so it bumps against the insole of the shoe, antifungal treatment won’t help. If a healthcare professional addresses it when it first appears, it may be treatable, but once the body has grown accustomed to producing that thick nail, there may be no effective treatment.

Some nail infections are bacterial as well as fungal. Both may show up together, or the infection may be one or the other. A dermatologist has techniques for diagnosing whether the problem is due to a fungus or to bacteria such as Corynebacterium. Different types of antimicrobial medicines are effective for these infections. Athlete’s foot also needs a real diagnosis, since it too might be bacterial rather than fungal in nature. OTC athlete’s foot medicines target fungal infections.

Handling Hair Loss

Both men and women experience hair thinning, and no one is pleased about it. The patterns differ, with men noticing a receding hairline and less hair on their temples. Women’s hair loss tends to form a Christmas-tree pattern, with the tip of the tree right behind the hairline and the base spreading out over the crown of the head. Women are also prone to hair loss after giving birth to a baby. However, while that may be alarming in the moment, it often corrects itself without treatment over the following months.

Hormonal Treatments for Hair Loss

With men, scientists have identified testosterone metabolites as contributing factors. Drugs such as finasteride (Propecia) or dutasteride block those metabolites and help men regrow hair. Dr. Adigun has begun using these compounds in women who are beyond childbearing. (They are off limits for a person who might become pregnant because they could interfere with the normal development of genitals in a fetus.)

A different hormonal treatment for hair loss is spironolactone. Dermatologists have long used it to treat female pattern hair loss. A review found that spironolactone is an effective and safe treatment option for hair loss” (Cureus, Aug. 16, 2023). Besides boosting scalp hair growth, however, it can also cause itchy scalp, facial hair growth and menstrual problems.

Another approach that actually works for hair loss is minoxidil (Rogaine). Most people are familiar with this as a topical product to be applied twice daily. That might get old after a while. Also, some people react to the product with contact dermatitis, irritation or itching. Low-dose oral minoxidil seems to work as well as topical minoxidil without the irritation. Another possible option which is better than placebo but not as potent as full strength topical minoxidil is rosemary oil. It is less likely to cause itching, however.

This Week's Guest

Chris G. Adigun, MD, FAAD, is a board-certified dermatologist and the President and Medical Director of the Dermatology & Laser Center of Chapel Hill, which she founded in 2016. Dr. Adigun practices both general and cosmetic dermatology, with a strong emphasis on minimally invasive treatments that deliver natural, impactful results. She has devoted much of her career to increasing public awareness of skin cancer and the harmful effects of UV exposure—both medical and cosmetic—and maintains an academic specialty in nail disorders.

[caption id="attachment_141515" align="alignnone" width="768"] Chris G. Adigun, MD, FAAD, Dermatology & Laser Center of Chapel Hill[/caption]