Over the last two years, my fingernails and toenails seem to be getting rough, with uneven grooves and strange lines. The colour is also changing. I was put on an anti-fungal medication. What should I do?

It’s extremely unusual to see all 20 nails getting affected with fungal infection, except in severely immunocompromised patients. Long-term oral anti-fungal treatment should only be prescribed after being justified and supported with a positive fungal growth in a laboratory culture done for the nail clippings of the affected nails. There are potential adverse effects of a long-term anti-fungal treatment, including liver function disturbances. Therefore, before, during and after the treatment, liver function tests are a mandatory part of the monitoring protocol for such treatment. We strongly suspect lichen planus of the nails to be the likely diagnosis. However, nail psoriasis and the nail changes produced by certain rare systemic metabolic disorders cannot be excluded. A close clinical examination usually would be sufficient, but in more complex cases, a nail biopsy may be required. You should also stop getting manicures and pedicures done, whether at nail salons or by yourself, as it can cause further damage to the nail folds and sometime to the nail matrix as well, resulting in further distortion of the newly formed parts of the nail plate.

I am a 33-year-old hairstylist. I have developed severely itchy inflamed scaly patches on both my hands, wrists and lower forearms. Please help!

I suspect you could be having allergic contact dermatitis (ACD). A vast majority of cosmetics and haircare products, including hair dyes, contain many of such ingredients that have the potential to cause ACD. It seems quite obvious that during your professional work you must be getting exposed to these ingredients. Most of the hair colouring products contain Para-Phenylenediamine (PPD) as an integral component – PPD is a common cause of ACD reactions/rashes seen on the skin of hair dye users and stylists. Usually ACD lesions are seen confined to the area of application of the so-called culprit (allergen-containing chemical); however in many cases it can spread to distant body areas as well through an exaggerated immunosensitivity, as such causing widespread skin rashes. In your case, our advice is to switch your profession if possible. Even mild contact or exposures can continue to ignite the ongoing immunosensitivity and activation of pre-existing skin lesions. As a compromise, start wearing elbow-length plastic gloves with cotton inner lining during your working hours. For now, frequent applications of thick emollients will help you to find some temporary relief.