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Nail Disorders
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The Nail Unit 
Introduction
Distorted, discoloured or otherwise unsightly 'abnormal' fingernails and toenails are very
common problems experienced by people of all ages in the community. Damage to the nail may be caused by an injury, fungal
disease, or other skin conditions such as psoriasis or eczema. As there are many potential conditions
which cause nail abnormalities it is important for patients to seek medical advice for correct diagnosis and the most effective
treatment. Role of Nails
The nail unit is made up of several components which form, support, protect and frame the nail
itself. These include the nail matrix, the nail plate, the cuticle, the nail bed and nail folds. The nail unit protects fingertips,
enhances fine touch and is important as a cosmetic structure. Some skin diseases affect all parts
of the nail unit and other conditions affect only one area. Some Conditions Causing Nail Abnormalities
Lifting of the
nail plate
A normal nail is translucent and its pink colour is provided by the nail bed. The end of the nail
appears white because of the air beneath it and if the nail becomes separated from the bed the white colour will extend down
the nail. This condition is often a result of repeated minor injury to the underside of the nail, (for example, excessive
cleaning under the free edge of the nail).
Lifting of the nail plate Ridging
of the nail
Ridging in nails can be either along (longitudinal) or across (transverse) the nail. Longitudinal
ridging normally becomes more prominent with age, but can also be associated with medical conditions such as rheumatoid arthritis,
lichen planus and injury to the nail. Transverse depressions often appear some weeks after an
illness or fever and grow out with the nail. Alternatively they may be caused by longstanding or severe eczema around the
nail fold and also trauma from pushing back the cuticle. Transverse layering or nail splitting
This is a frequent abnormality which involves splitting of the free end of the nail into layers. It is commonly seen in
people who frequently immerse their hands in water as part of their work or home duties. Thickening of the nail
Thickening of the nail can occur as a result of dermatological or
general medical disease, and is most frequently seen in the toenails of the elderly. It often results from the long term use
of ill-fitting footwear and neglect of the nails. When psoriasis and other skin conditions affect
the nail, they often lead to thickening of the nail. If a fungal infection is suspected to have caused the nail thickening
a sample of the thickened nail can be collected and analysed by a laboratory. If this confirms a fungal infection specific
treatments are available. Discolouration
Medications,
chemicals from hair dyes and nail varnish, nicotine and creams such as Dithranol can all cause discolouration of the nail.
Antibiotics can cause nail lifting an brownish discolouration of the nail plate. Antimalarial medications
and agents used in chemotherapy may also cause discolouration. Bleeding beneath the nail plate can also cause dark discolouration.
Melanoma is another important cause of nail discolouration and may involve the nail bed, nail and/or
cuticle. You should see your doctor is new or changing pigmentation of the nail or around the nail occurs.
Inflammation of the nail fold
Bacterial infection of the nail fold causes
redness, swelling, tenderness and pain usually around the proximal nail fold (see diagram), sometimes with pus formation. The most common cause is bacterial infection with Staphyloccus aureus. This condition is
often seen in nurses, hospitality workers and anyone involved in activities where nails are immersed in water for periods
of time. Damage to the cuticle, through immersion in water or over-zealous manicuring, also predisposes to this form of inflammation.
Nail disease of traumatic origin
Nail biting is associated
with infection around the nail folds and can cause deformity of the nail plate. Constant fiddling with the nails can produce
longitudinal depressions along the nail. Nail cosmetics, particularly nail hardeners containing formalin, can cause separation
of the nail plate from the nail bed. Adhesives used to attach artificial nails can be associated with nail and skin inflammation.
Skin with Nail Involvement
Many nail abnormalities stem from skin diseases which need to be treated to enable
the nails to return to normal. Some common examples are: Psoriasis
Psoriasis causes scaly red skin patches and visible abnormalities of the nail including pitting of the nails, with individual
pits about the size of a pinhead. Psoriasis can also lead to onycholysis (lifting of the nail plate) and thickening of the
nails. Eczema/Dermatitis
This superficial inflammation
of the skin causes itching, a red rash which may blister, weep and become crusted leaving the skin scaling, thickened or discoloured.
Often the fingertips and surrounding skin can be affected by eczema with swelling (and possibly infection) of the nail fold
tissues. This is often seen in infants who suck their thumbs. Fungal
skin and nail infections
Fungal infections of the skin ('tinea','ringworm') are contagious and
may appear as itchy and occasionally painful rashes of the skin. Once the skin is infected the problem moves to nails which
can be identified by thickening, a change in colour and sometimes crumbling of the nail. 'Jock
itch' and 'athletes foot' are common fungal infections which can spread to other areas of the body and nails.
Diagnosis is usually confirmed by taking a sample (scraping or clipping of the nail or a sample of the debris under the
nail). This sample is then examined and tested for fungal infection. Several topical and oral
treatments are available from your doctor to treat fungal nail infection. There have been significant advances in the treatment
of fungal infection, and cure rates, particularly for nail infections, are much improved. All medication however can cause
side effects, which are occasionally serious. Fungal infections can be caught in many situations,
but taking a few simple precautions will help avoid them. Some of these precautions are: - Wear thongs/sandals in communal showers
- Dry feet and body thoroughly
- Do
not share towels and clothing
- Wear loose fitting clothing, cotton underwear and socks
- Wear
cotton gloves under rubber gloves if hands are often in water
- Avoid harsh or irritating soaps/detergents
- Change shoes regularly. 'Air' them in the sun
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| Toenails with a fungal infection | Same nails after treatment
| Lumps
and bumps which may affect the nail
Viral warts may occur in, around, or under the nail plate and may result
in nail deformity. Cysts can occur towards the end of the finger and this can lead to a longitudinal depression in the nail.
Uncommonly, skin cancers (including melanoma and squamous cell carcinoma) can occur in the nail plate area and any non-healing,
growing bleeding or discoloured area should be shown to your doctor. What if You Have a Nail Problem If you have concerns about your nails and / or are looking for treatment, your
general practitioner should be consulted for correct diagnosis of the cause and advise on the most appropriate treatment.
Specialist help from a dermatologist may be required.
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Dear Friends Care. I personally see every new patient who visits our office. I am not just a physician, I am a Board Certified Dermatologist. This is the type of 5-star care and service that our patients expect, deserve and receive. I treat every patient the way I would want to be treated: with courtesy, dignity and respect. I carefully listen to their skin-care concerns and offer a variety of options including a treatment
plan that I believe will give them the best results. We also support our patients with a very fine medical staff . Please
take a moment to explore our top of the line winning website. My philosophy is simple…Experience Counts
and Quality Matters. Please allow me to solve your skin problems. After all, at NYC Dermatology , our
philosophy is if you look great you will feel great with gorgeous skin.” Best Regards, Dr.
Rothfeld
 How Acne starts
Acne affects almost everyone — more than 90% of all adolescents, nearly
50% of all adult women and 25% of all adults. Crossing gender lines as well as national borders, it's one of the most
widespread medical conditions in the world. Yet there's still no cure.
But there is hope. While acne is not curable, it
is treatable. We now know more about controlling this condition than ever before. The secret to managing acne is prevention
— stopping this condition before it exhibits visual symptoms. Once you have found an acne treatment that helps you
accomplish this, it's important to stick with it. Even after pimples disappear, you may need to continue treatment
to keep new blemishes at bay. It's also crucial to begin treatment as soon as the first signs appear; the
sooner you address your acne, the less likely you are to experience permanent damage to your skin. Of course, in order
to stop acne, we must first find out how it starts. What causes acne? One of the most important things
you can learn about acne is this: It's not your fault. Contrary to popular belief,
acne is not caused by anything you're doing — what you eat, how often you wash your
face or work out — but by a combination of factors at work far beneath the surface of your skin. A healthy follicle
 A blemish begins approximately 2–3 weeks before it appears on your skin's surface. It starts in your sebaceous hair
follicles — the tiny holes commonly called pores. Deep within each follicle, your sebaceous glands are working to produce
sebum, the oil that keeps your skin moist and pliable. As your skin renews itself, the old cells die, mix with your skin's
natural oils, and are sloughed off. Under normal circumstances, these cells are shed gradually, making room for fresh new
skin. But sloughing is different for everyone. Some people shed cells evenly; some don't.
Uneven shedding causes dead cells to become sticky, clumping together to form a plug — much like a cork in a bottle.
This plug, or comedo, traps oil and bacteria inside the follicle. A plugged follicle
 The plug traps oil and bacteria within the follicle, which begins to swell as your skin continues its normal oil production.
Your body then attacks the bacteria with a busy swarm of white blood cells. The whole process takes 2–3 weeks, culminating
in a pimple.
An inflamed acne lesion
 Why me? There is no one simple "cause" of acne — the condition is influenced
by many factors, many which are out of your control. The regularity with which you shed skin cells can change throughout your
life. The rate at which you produce sebum is affected by your hormone balance, which is often in flux — especially for
women. Research has also shown that genetics play a big part in the development and persistence of acne, so your family history
is a valuable prediction tool as well when considering the various causes of acne. One of the best weapons in the fight against
acne, however, is knowledge; if you know what causes acne, it's easier to formulate a good plan
of attack. There are five primary culprits contributing to this process. Each of these factors may vary dramatically between
individuals. While you don't have control over these factors, understanding them can help you in your search for the proper
acne treatment. Acne Causes - Culprit #1: Hormones.
For the majority of acne sufferers, the trouble begins at puberty, when the body begins to produce hormones called androgens.
These hormones cause the sebaceous glands to enlarge, which is a natural part of the body's development. In acne sufferers,
however, the sebaceous glands are overstimulated by androgens, sometimes well into adulthood. Androgens are also responsible
for acne flare-ups associated with the menstrual cycle and, on occasion, pregnancy. Acne Causes - Culprit #2: Extra
sebum. When the sebaceous gland is stimulated by androgens, it produces extra sebum. In its journey up the follicle
toward the surface, the sebum mixes with common skin bacteria and dead skin cells that have been shed from the lining
of the follicle. While this process is normal, the presence of extra sebum in the follicle increases the chances of clogging
— and can cause acne. Acne Causes - Culprit #3: Follicle fallout.
Normally, dead cells within the follicle shed gradually and are expelled onto the skin’s surface. But in patients with
overactive sebaceous glands — and in nearly everyone during puberty — these cells are shed more rapidly. Mixed
with a surplus of sebum, the dead skin cells form a plug in the follicle, preventing the skin from finishing its natural process
of renewal. Acne Causes - Culprit #4: Bacteria. The bacterium
Propionibacterium acnes, (P. acnes for short) is a regular resident of all skin types; it’s part of the skin’s
natural sebum maintenance system. Once a follicle is plugged, however, P. acnes bacteria multiply rapidly, creating the chemical
reaction we know as inflammation in the follicle and surrounding skin. Acne Causes - Culprit #5: Inflammation.
When your body encounters unwanted bacteria, it sends an army of white blood cells to attack the intruders. This process is
called chemotaxis; or, simply put, the inflammatory response. This is what causes pimples to become red, swollen and painful.
The inflammatory response is different for everyone, but studies have shown that it is especially strong in adult women.
What can I do?
Fortunately, you have options! There are many kinds of acne treatments available today. But first, you should
try to determine the type and severity of your condition. Acne, like a person, is highly individual — it can take
many forms, and have a highly variable response to treatment. The more you know about your specific form of acne,
the more likely you are to find a treatment that works for you.
Trained in Dermatology, NYC Dermatolgy by Board Certified Dermatologist NY Dermatology Dr. Gary Rothfeld
possesses the special knowledge, skills and professional capability that distinguishes him as an outstanding Dermatologist
in NYC , Manhattan , New York at NYC Dermatology by Board Certified Dermatologist. Top New York City Dermatologist,
Dr. Rothfeld in Manhattan treats the most difficult cases until the problem clears.- Do you peer in the mirror each morning and play little face
games?
- Do you find yourself raising your brows, smiling wider, stretching wrinkles, pursing your lips,
or lifting the droopy corners that weren’t there last month?
- Are you exhausted
from trying every TV promise out there to stop your acne and wonder “why me?”
Who doesn’t find something they don’t like about the face in
the mirror each morning? It’s human nature to want to look your best. Even royalty and celebrities find themselves sitting
across from Dr. Rothfeld seeking the fix for that blemish, that sag or that brown spot.
Dr. Rothfeld, having worked alongside several of the world's renowned dermatologists, has shaped a uniquely innovative approach in
treating any skin problem you may have. Through cosmetic and medical dermatology, laser surgery and powerful combination treatment
options, Dr. Rothfeld quickly and effectively helps you see dramatic improvements in the appearance and health of your skin.
Dr. Rothfeld is well known for his particular expertise is in designing
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conditions need specialized non-harsh therapies in order to be successful with minimal side effects. Over-treatment or overly
aggressive treatment can backfire. Dr. Rothfeld makes sure that doesn’t happen to his patients.
| Dr. Rothfeld has a main concern is that you receive an individualized
skin treatment program that eliminates your problems without unnecessary side effects. This is attained by having one-on-one
care with good old fashioned personal attention from Dr. Rothfeld himself." |
Dr. Rothfeld is featured as a Top Dermatologist in
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treatments for Acne, Aging and Rosacea as administered with good old-fashioned attention.. Dr.
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The most common
medical condition that Dr. Rothfeld treats is Acne. His comprehensive approach may include
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signs of acne. This treatment, which can consist of a combination of blue light and
laser, significantly diminishes your need for oral medications.
His cutting-edge technology at NYC Dermatology
has initiated his interest and involvement in Laser Dermatology. He has the latest proven lasers to treat Acne
& Acne Scars , Facial Blood Vessels Rosacea , Unwanted
Hair , Wrinkles , Age and Brown Spots & Sun
Damage , and Loose Facial Skin . These laser procedures provide tremendous results
with little downtime. All laser procedures are performed personally by Dr. Rothfeld.
One particularly
exciting use of Botox is the non-surgical Brow Lift. This procedure elevates the brow and can also elevate droopy eyelid skin.
He has helped countless patients avoid unnecessary plastic surgery with this procedure.
Another well-appreciated application of
Botox Cosmetic is in the treatment for excessive underarm sweating , which has been
recently FDA approved. The Botox Cosmetic is non-diluted and prepared in such a way as to be completely painless!
Rejuvenating Peels are excellent treatment for the prevention
of aging skin and acne. Light Peels and IPL Fotofacial offer quick treatments that
help improve skin texture and minimize fine lines. Cosmelan treats patchy brown hyperpigmentation.
Your Health is Vital; Start with your Skin. The American Academy of Dermatology recommends yearly
skin checks to examine moles and remove unusual ones that are often overlooked by patients. Since we live with a high risk
of skin cancer with its almost year-round exposure to the sun, skin checks are especially important. Dr. Rothfeld, a Board Certified Dermatologist
at NYC Dermatology in Manhattan, New York is caring, detailed, and meticulous and will never give up until the problem
is cleared. Dr. Rothfeld, a board certified dermatologist in nyc who practices Dermatology in Manhattan, New
York has treated many patients in the entertainment and music industry is caring, detailed and meticulous and will not give
up until the condition resolves. Dr. Rothfeld is recognized as one of the best Dermatologists in NYC by the entertainment
industry.NYC Dermatology is under
the medical supervision of Dr. Gary Rothfeld, a Board Certified Dermatologist.
To enhance every aspect of your skin
care, Dr. Rothfeld has personally created a superb line of cosmetic procedures.. NYC Dermatology
by Board Certified Dermatologist Dr. Gary Rothfeld is a board certified NYC Dermatologist
with a New York City office in Manhattan, New York providing expert skin care, dermatology, and
cosmetic dermatology services. A board certified dermatologist in NYC specializing
in dermatology and dermatologic surgery including state-of-the-art cosmetic surgical procedures, Dr. Gary Rothfeld is
known for his attention to body symmetry and his dedication to meeting patients’ personal goals. His specialties include
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As an expert in the field of dermatology and cosmetic dermatologic
surgery, Dr. Rothfeld is has appeared on national television shows. Dr. Rothfeld has also been quoted in many high
profile national magazines.
Our goal at the manhattan office of Board Certified Derrmatologist , Dr.
Gary Rothfeld is to create an atmosphere of professionalism, trust and complete patient satisfaction at the NYC Dermatology
and Cosmetic Surgery Center in Manhattan, New York. Dr. Rothfeld, Dermatology Director of NYC Dermatolgy is a Board
Certified Dermatologist at NYC Dermatology who has treated many patients in the entertainment industry. Schedule an appointment at
our office which provides top of the line expert skin care, dermatology, cosmetic dermatology services,
and advanced dermatology laser treatments for cosmetic needs and medical skin conditions. We offer a full range of services
including surgery for skin cancer, laser hair removal, Botox®, the Fractionated Resurfacing laser, Titan laser, and acne
photodynamic treatments. Our main goal is to provide you with the most effective and advanced treatment. Join the NYC Laser
Center NYC Dermatology Mailing List Our periodic newsletters include exclusive offers, educational articles, as well
as free treatment & product drawings! Email: nycdermatologist@aol.com in our Media office and including different offers and many more. We offer a variety of services from
Botox® to Liposuction . Please contact us with any questions you may have or schedule an appointment online or by phone for
a consultation. Beauty Is Forever! and Dr. Rothfeld
at NYC Dermatologist has over 20 years of experience with his beauty tips.
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During
your office consultation and examination you will be provided with a detailed plan of the treatments that will benefit
you most. NYC Laser Center NYC Dermatology top laser dermatology center offering skin care, dermatolgy,cosmetic
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hair transplants, and lasers in the country. Acne Photodynamic Treatment
- Botox® - Botox® for Hyperhidrosis - Cellulite - Cool Laser - Cosmelan Depigmentation Treatment - Glycolic
Acid Peel - Fat Transfer - Fotofacial / IPL Fractionated Resurfacing Laser - Hair Loss - Laser Hair Removal - Liposuction
- - Surgery - Minimal Scar Technique - Photodynamic Rejuvenation Radiance® - Restylane® - Sclerotherapy
- Sculptra - Smoothbeam - Stretch Marks - SunFX - TCA Peel - Tattoo Removal - Titan Laser Facelift - V-beam Laser Treatments
- Velasmooth Our cosmetic surgeon includes Dermatologist Dr. Gary Rothfeld Board Certified Dermatologist
at NYC Dermatology. Our NYC dermatologist offers advanced dermatology laser treatments for cosmetic needs and medical
skin conditions. We offer our services to Manhattan , Brooklyn, Bronx, Queens locations through our Manhattan
office in NYC
Open 7 Days A Week — Se Habla Español We accept all credit cards as well as debit cards for payment of services
NYC Dermatology - Manhattan Dermatology
- Skin Institute of New York - Skin Cancer Doctor- NYC Cosmetic Dermatology- Cosmetic Dermatological Surgery - New
York City - Board Certified Dermatologist
Manhattan Office Dr. Gary Rothfeld
NYC Dermatology - Board Certified Dermatologist -
New York, NY
30 E. 60th St. Ste. 805
Manhattan, New York 10022
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