In this episode of Topical Conversations, Dr Jasmine Rana, Clinical Assistant Professor and Director of the Nail Disorders Clinic at Stanford Dermatology, discusses her recent publication, “Nails as Dynamic, Not Static, Entities—Rethinking the Approach to Nail Disorders,” reviewing the practice gaps that exist for nail diseases and offering a few practical takeaways to improve nail disease management. 

Nail disorders are dynamic 

Dr Rana emphasizes that nail disorders are not static entities. Instead, they are dynamic, influenced by various coexisting factors that affect nail health. She notes that it is the responsibility of the health care provider to piece these factors together. A key example is diagnosing nail fungus, or onychomycosis. While fungus may be present, it is also crucial to identify other structural influences such as bunions, hammer toes, arthritis, nerve dysfunction, and nail psoriasis, since these factors influence treatment approaches and patient counseling. 

Recognizing cognitive biases 

Dr Rana also notes the importance of health care providers recognizing cognitive biases. Many dermatologists are not trained to recognize or treat podiatric disorders; similarly, podiatrists may not be trained to recognize nail psoriasis or conditions like nail lichen planus. Recognizing and addressing these biases can improve diagnosis and treatment. 

Improving nail disease management 

Dr Rana emphasizes that nails do not belong neatly to one medical specialty, making interdisciplinary approaches essential for optimal care. She suggests considering interdisciplinary nail clinics staffed by dermatologists, podiatrists, radiologists, vascular doctors, and orthopedic surgeons to provide an opportunity to offer holistic, high-value care. 

Practical takeaways 

Acknowledging that establishing interdisciplinary clinics is challenging, Dr Rana proposes a few practical strategies to improve nail disease management: 

• Separate visits for nail concerns: Scheduling separate visits for nail concerns can reduce the stress of addressing multiple issues in one visit, leading to better diagnosis and recognition of nail conditions. 
• Championing nail disease in large practices: In large group practices, identifying a specialist with an interest in nail disease can help champion educational initiatives and facilitate referral pathways, promoting cross-specialty collaboration. 

By implementing these strategies, health care providers can enhance the diagnosis and treatment of nail disorders, ultimately leading to improved patient outcomes.