By Oregon Dermatology & Research Center
November 12, 2018
Category: Nails

6 Nails Symptoms That Shouldn’t Be Ignored

Nails can tell you a lot about what’s going on inside your body. They can be markers for anything from cancer to anemia. Keeping an eye on your nails can be crucial to your well being. Here are six signs that you shouldn’t ignore when it comes to your nails.

A brown vertical line on the nail may be a sign of a melanoma. While most melanomas don’t occur in the nail, they are found in 1 percent of Caucasians and about 20 percent of African Americans. It's possible for certain medications to cause a darkening line on the nail, which appears very dark or brown in color and reaches from one end of the nail to the cuticle. If this is the case, it's important to have it checked out by your doctor.






Brittle nails can develop due to a nutrient deficiency in your diet or exposure to a chemical. Often times malnutrition plays a huge role in brittle nails, as well as iron-deficient anemia and thyroid disease. Nails grow from underneath the skin at what’s called the matrix and progress out towards the fingertip. Although some believe nails are made of calcium, they are actually made of a fibrous protein called keratin. People often take calcium suppliments to encourage their nails grow longer and stronger, but this won't actually do the trick. While calcium will make your bones stronger, eating a well balanced diet with lots of protein will promote strong, healthy nails. 

Brittle Nails
Brittle Nail Patient of Dr. Phoebe Rich's

Vertical ridges on the nails are common, especially as you get older. However, deep horizontal lines, known as Beau’s lines, and more concerning. Beau’s lines are indications that something has caused the nail to stop growing. This can include trauma, a blood transfusion, a car accident, chemotherapy or stress. If the vertical ridges are truly bothersome you can use a ridge filler to help cover them up. Just be sure to avoid using a nail buffer. If the horizontal lines continue to deepen and you're concerned, always reach out to your doctor.

White spots on a nail are referred to as punctate leukonychia. Many people think they are related to a vitamin deficiency, but they are actually caused by trauma that occurs while the nail is forming. On average, it takes nails about 6 months to fully grow out. As time goes on these white spots will grow out as well.

Excessive yellowing of the nails may be associated with lung disease. Known as yellow nail syndrome, this very rare disease results in chronic infection and inflammation of the main air passages. Yellow nails, especially on the feet, can be a result of fungus. Either way, have these symptoms checked out by your doctor.

Patient with Yellow Nail Syndrome

Infected, inflamed and reddened skin around the nail is called paronychia and is the result of the cuticle being pushed back. Although it is a common practice among nails salons, it's not good for nail health. When the cuticle gets pushed back it allows for bacteria, fungus, yeast and mold to get underneath the skin and cause an infection. If it does become inflamed and painful, you should soak it in hot water two to three times a day. If you don't notice improvement, contact your doctor who may prescribe a round of oral antibiotics. The best way to prevent paronychia is to use a sharp tool when trimming or cutting the cuticle. After showering, you can gently massage the cuticle with a towel to remove any dead cells.

While this is not a complete list of concerning nail symptoms, it does include symptoms that are very important to be aware of when deciding if you should consult your doctor.

As always, feel free to leave a comment below with any questions. We'd love to hear form you!

By Oregon Dermatology & Research Center
October 18, 2018
Category: Nails
Tags: Holiday Nails  

Tips for Healthy Holiday Nails
By Dr. Phoebe Rich

Painting your nails with festive colors is a fun way to share your holiday spirit. As we enter the season of orange pumpkins, red and yellow turkey feathers, and green Christmas trees, the creative nail options may seem endless. So how do you limit the damage done to your nails among the holiday hustle and bustle? Turns out, it's completely possible to have both festive and healthy nails! Here are some tips on how to keep your holiday nails protected:


1. Wear gloves while you're outdoors in the cold weather. This will minimize excessive exposure of the nails to the harsh elements of winter. The winter season is generally hard on nails because cold and dry climates tend to make nails more brittle, and therefore subject to breaking.

2. Moisturize your nails along with your hands. If you use a heavy moisturizer on your nails several times a day, this will help keep them protected. Try to keep the moisturizer on your skin by reapplying after washing your hands.

3. Limit polish changes to no less than 10 days. It can be tempting to change your polish frequently to match your holiday outfits. But removing and reapplying nail polish too often subjects your nails to dehydration and other associated problems. Using a light or translucent nail color allows for easy touch-ups as opposed to full removal, which extends the duration of your pretty and healthy nails.

4. While salon nail finishes are fine, try to avoid any filing or buffing of the surface of the nail plate. This removes a layer of nail cells and ultimately results in a thinned nail plate, which won't recover until the nail has grown out. It takes six months for a fingernail to grow from the cuticle to the free edge of the nail. 

5. Keep nails a bit shorter than usual in the winter in order to minimize breakage.  

6. People often believe that a hard nail plate is a sign of nail strength. But hard nails are actually brittle and fragile. Strong, flexible nails are more desirable because hydration allows nails to flex rather than break. Keeping nails moisturized will minimize the dryness and fragility that often occurs in winter. Overall, nails grow slower in the winter than in the summer, so it takes longer for nails to replace damages with healthy regrowth.

7. Eat healthy and include protein! Nails are made of keratin, a fibrous protein, which requires the amino acids that are derived from protein in your diet. During the holidays, it’s easy to indulge in sweet treats. Maintaining a balanced diet with adequate protein will help to keep your nails healthy and strong.

8. Make a New Year’s resolution to wear gloves for all your cleaning and household chores, especially those involving wet products. Hands can become chapped due to excessive hand-washing, cold and dry air, and overexposure to heat. Although nails do not become chapped, these same conditions that cause chapped hands in the winter will impact the overall health of your nails.

Follow these 8 tips for healthy nails this holiday season and you’ll be sure to dazzle your family, friends and guests at your next holiday party!

October 11, 2018
Category: Team Updates
Tags: dermatologist  

Meet Our New Provider: Dr. Anna Hare

We are very excited to announce that Dr. Anna Hare is joining Oregon Dermatology and Research Center and Phoebe Rich Dermatology as a provider. She will be involved with both the clinic and clinical trials. 

Dr. Hare will be joining our practice to assist Dr. Rich, Dr. Moore, and Amy Simpson, PA-C with expanding our patient base as well as helping with several clinical trials. Dr. Hare attended college and graduate school, studying Earth Systems and Human Biology at Stanford University where she played Division 1 soccer and later, Ultimate Frisbee. She attended medical school at Emory University School of Medicine in Atlanta, Georgia. She completed her internship in internal medicine at Providence Portland Medical Center and finished her 3-year Dermatology Residency at OHSU this past June.

Prior to medical school, Dr. Hare worked as a medical assistant with Dr. Rich, at an environmental non-profit in Washington D.C, and on HIV research in Boston at Brigham and Women's Hospital, an interest that she continued in medical school while working in Durban, South Africa at McCord Hospital. In her free time, Dr. Hare enjoys gardening, traveling, and being active outdoors. Depending on the season, you may find her skiing, biking, kiteboarding, or hiking with her rescue dog, Rue.

Dr. Hare is currently accepting patients!



By Oregon Dermatology & Research Center
September 27, 2018
Category: psoriasis

Psoriasis of the Nails

Content from presentations and scholarly articles by Dr. Phoebe Rich

Nail psoriasis occurs in up to 80% of patients with plaque psoriasis and is more prevalent in patients with psoriatic arthritis. Nail psoriasis is far more than just a cosmetic problem. Psoriasis of the fingernails is psychologically distressing and can cause pain and functional deficits in fine motor manipulation of small objects. When toenails are involved, it can cause difficulty with ambulation. Although nail psoriasis can be extensively destructive to the nail plate, it is a non-scarring process. If treated effectively, nails with psoriasis can return to a normal or close to normal condition. Nail psoriasis takes a vast toll on patients, but with treatment quality of life can greatly increase.

There are a few key factors by which the disease is characterized. Pitting is a common occurrence in which the keratin of the nail loses cells and forms pits in the fingernail or toenail. It can range anywhere from one pit to a dozen pits, varying from patient to patient. Oil drop discoloration is characterized by the appearance of a drop of oil under the nail-bed. It can range from yellow-red to yellow-brown in color. The nails turn white once crumbling begins to develop. If the nail starts to lift and separate from the nail bed on either the fingers or toes, this is referred to as onycholysis. Other characterizations include subungual hyperkeratosis and splinter hemorrhages.

Patient with Nail Psoriasis



"50% of people with Psoriasis have the disease on their nails, but only 5% have it limited to their nails."




Nail psoriasis can also be diagnosed along with toenail fungus, Reiter's syndrome, parakeratosis pustulosa, subungual hyperkeratosis, or fingertip eczema with subungual hyperkeratosis and onycholysis. Psoriasis can be accompanied by a secondary infection, such as yeast, fungus or dermatophytes. When fungus is involved, it can contribute to the Koebner phenomenon. Your doctor will do a KoH test or a culture on the nail and view it under the microscope for analysis.

There are many options for treating nail psoriasis. Possible options include topicals, injectable and oral medications, and physical modalities such as PUVA light therapy and Grenz Ray. Clinical features of psoriasis are isolated from the site of pathology. Challenges can arise if the nail plate prevents the delivery of medication to the the pathology. Medications are only effective when they get to where they need to go. If medications don't work, many patients may choose to simply conceal it.

When covering up nail psoriasis it's important to be cautious about potential Koebner reactions. If one does choose to go this route, avoid any potential allergies or irritants. While millions of women use nail cosmetics with no adverse effects to their psoriasis, cosmetic practices can cause problems in psoriatic nails just as well as non-psoriatic.



With any disease, it's important to have a support system. Optimism and encouragment can go a long way. Additonally, new research is being conducted at all times, as are possible trials to get involved with.

The Oregon Dermatology and Research Center is a proud supporter of the National Psoriasis Foundation. They are a great resource for individuals and families who are looking for support in the community, events, education for both adults and children alike, and ways to get involved.

By Oregon Dermatology & Research Center
June 09, 2014
Category: Welcome

All Things Derm, All the Time!

Whether you are an existing patient or searching for a dermatologist in the Portland, OR area, we’re excited you are here. With the dermatology industry advancing, we recognize the importance of keeping our patients and visitors up to date with all of the new and exciting things taking place in our practice.

We hope to promote skin health awareness as a vital part of your healthy lifestyle. Here you will find a variety of articles and topics including dermatology news, advancement in treatments, practical skin care advice, dermatological disease education and updates from our practice.

We hope you find All Things Derm, All the Time to be a helpful, engaging, and informational resource to ensure your best skin health. 

As always, feel free to contact Oregon Dermatology & Research Center with any questions or concerns.

Join us as we continuously share our knowledge of new treatments and skin care advice on our blog or on any of our
social media platforms: @PhoebeRichDerm

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