Directory of health resources for healthcare professionals.

If, as we insist, the skin is not a mere covering of the body, but is, in fact, one of the most important of the organs of the whole system, then we must realize its important relationship with the mind. As we know, all the important organs in the body are quickly responsive to the condition of the mind, and mental and emotional disturbances soon make themselves felt on bodily functions. For example, everybody knows how the stomach reacts to such upsets; the digestion is thrown out of gear, and it may take some time before order is restored. Worry, grief, anxiety, and emotional strain will produce great nerve tension and use up the nerve energy more quickly than any amount of overwork. In short, the quickest way to disturb the rhythm of the function of the alimentary tract is through the mind.Many people have been aware of this fact for a long time. They have seen various troubles develop which made it difficult to decide the starting point. Troubles like colitis, for example, are said to be of nervous origin because they seem to accompany a temperament that is overweighed in this way. The same is true of complaints like nervous dyspepsia, and there is a form of asthma that seems to be of nervous origin. We could go on listing other ailments which are of this nature, and in the last decade or so the term “psychosomatic” has crept into our language, showing that we tend more and more to think in terms of body and mind rather than to dissociate them in the way we did in the past. To a large extent the ordinary practice of medicine has been responsible for many of the misleading attitudes that “people have adopted towards illness. The idea prevailed for a long time that certain drugs had specific effects upon the various organs in the system, and therefore the text-books listed these agents as though the various diseases were confined to certain organs. For example, a medicine was said to be a diuretic, i.e. to have a special effect upon the kidneys and the bladder, and when people suffered from what was considered to be complaints affecting these organs the specific medicines were prescribed for the purpose of curing the disease. Following up this line of thought, intensive study was given to each particular organ, and the functions of the particular organs were described in detail with all the symptoms which manifested themselves. Later on, the idea of specialism developed, so that the medical profession itself was divided up into different categories, and there were specialists for each particular organ or set of organs: a heart specialist, a lung specialist, a skin specialist, and so on.This attitude has led people to think of disease not as a condition of the whole body but as separate conditions, all of them more or less unrelated to one another. So that now when we talk of a certain form of disease by the name which we have given to it we are inclined to regard it as an entity in itself. For instance, we talk about the common cold having attacked us, and we then go on to talk about finding a cure for it as though it bears no real relationship to our habits and our general way of life. We do exactly the same with all the diseases we have given a name; cancer attacks us as though it is something that exists apart from the body. We have been accustomed to think of skin complaints, perhaps more than other forms of disease, without trying to relate them to ourselves and our general way of life, and it has led to a great deal of treatment that has been very disappointing. When disease exists, it exists in all the parts of the body, because all the parts are related; and as the mind and the body are intimately related at all times we must never think of disease-causation without bearing this important point in view.
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There are a number of relatively minor disorders of the nails and the surrounding skin. These are fairly common in the community, and for this reason will be mentioned. Most of the more major disorders are fortunately less common, so only some of these will be discussed.

Fungal infections of the nail are also a reasonably common problem. Several fungi may be involved, including the common tinea fungus responsible for ‘athletes foot’. Initially the infected nail is merely discoloured at the end, but as the infection spreads, it may become softened, fragile, and later thickened.

Eventually the nails will separate and lift off, or become grossly distorted. Most commonly, the toenails are the ones affected.

Unfortunately surface applications are rarely sufficient to remedy the situation, nor is removing the affected nail. The most effective treatment is regular clipping of the nail, plus the taking of specific anti-fungal tablets. Because of a toenail’s slow rate of growth, and the necessity to take the medication for the entire growth period of the nail, this treatment may be required for anything between 6-18 months.

An ingrown toenail forms when the edge of the nail penetrates the adjoining soft tissue. The first symptoms are redness and pain, followed by swelling and a discharge. Secondary infection then frequently occurs. The most common causes of this problem are ill-fitting shoes, nails that have been cut too short, excessive curvature of the nail, and flat feet. The first three of these problems may be avoided by wearing adequately wide and long shoes, as well as by cutting the nails straight across and not too short. Mild cases may be treated with wet dressings and packing sterile cotton wool under the affected edge of the nail. Antibiotics may also be necessary. Severe cases may require an operation.

A corn is a cone-shaped overgrowth of hard skin with a central core. Corns usually occur over bony prominences, such as toe joints, or between the toes. They are a result of chronic pressure or rubbing for long periods. Poorly fitting shoes are the most common cause, but arthritis, improperly positioned toes or bony spurs may also be involved. Prevention requires shoes to fit properly and, occasionally, mechanical devices to position the toes correctly. Otherwise the corn may be padded over or gradually pared down. The latter may be done with either a salicylic acid paste or the help of a podiatrist. If there is an underlying bony spur, then an orthopaedic surgeon may have to deal with it.

Psoriasis frequently affects the nails, resulting in deformities which may precede all other manifestations of the disease. Although the nails may occasionally be the only part of the body affected, in most cases of psoriasis, the symptoms are much more widespread. Almost all patients with psoriasis find their nails are affected at some time during the course of their disease. This, however, may be quite transient. The character istic changes are fine thimble-like pitting, lifting, discolouration, and gross thickening of the nails. Treatment of nail psoriasis is most unsatisfactory. Some cases clear spontaneously, whereas others respond to rather painful cortisone injections into the nail-fold.

Eczema or dermatitis affecting the hands will often affect the nail as well. The usual symptoms are transverse ridging, coarse pitting, discolouration, and eventually marked deformity of the nail. This will all correct itself once the eczema or dermatitis is controlled.

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