Biomedical Frontiers: Fall 1996, Vol.4, No.1
Nailing It!

For most of us, our nails are something we never give more than a passing thought to, other than to cut, file, or paint them. Yet nails actually serve several essential functions--protecting the fingers and toes and enhancing fine motor skills and the sense of touch. Nails that are injured or diseased can impair an individual's ability to do even the smallest tasks, such as picking up small objects, fastening buttons, wearing shoes, or walking.

Melanoma of the toenail.

At Columbia, the clinical research and clinical pharmacology section of the department of dermatology is actively involved in nail research. In fact, the division is one of the leading centers in the world for the study, diagnosis, and treatment of nail disorders, says Dr. Richard K. Scher, director of the pharmacology unit and professor of clinical dermatology. At any given time, clinical studies on nails, as well as on hair loss, psoriasis, eczema, skin infections, and seborrheic dermatitis, take place in the section.

Scraping the surface of a toenail to diagnose a fungal infection.

For instance, the division conducted pioneering clinical trials on the new systemic anti-fungal drugs itraconazole, terbinafine, and fluconazole, two of which were recently approved by the U.S. Food and Drug Administration. In addition, the division is testing topical antifungal preparations, some of which are added to a lacquer base for application similar to nail polish. Some 50 million Americans suffer from fungal infections of the fingernails and toenails. Approximately 40 percent of all elderly individuals have fungal infections of the toenails. Pharmacology unit researchers are also addressing the common problem of brittle nails: More than 20 percent of American women suffer from this condition. Researchers in the unit recently concluded clinical trials for a topically applied drug that treats the condition.

In addition to testing new compounds developed by pharmaceutical companies, the pharmacology unit is known for proposing new applications for available products, says Dr. Scher. For instance, researchers proposed treating brittle nails with alpha hydroxy acids, a study that is now under way. And in another study, researchers are testing the ability of minoxidil to stimulate nail growth.

Current Clinical Trials

Nail fungus: Oral medication; topical nail lacquer
Seborrheic dermatitis: Medicated shampoo
Severe psoriasis: Oral medication; phototherapy
Psoriasis of the nails: topical derivative of vitamin D
Sporotrichosis (a rare fungal infection often occurring from an injury from plant thorns) : oral medication
In addition, the unit is conducting studies of hirsutism and of latex glove allergy.