Fingernails and toenails protect the tissues beneath your toes and fingers. The term “nail disease” refers to various conditions affecting the nails and the skin surrounding them. Such problems may indicate anemia, lung disease, heart disease, diabetes or other medical conditions. Symptoms of nail disease include sudden changes in growth rate, discoloration, thinning or thickening, pain, bleeding, discharge, and pain. Patients experiencing nail problems should go to a dermatologist to receive proper treatment and minimize the occurrence of complications.
Common Nail Condition
Fungal nail infections (onychomycosis) accounts for roughly 50 percent of all nail disease cases, typically affecting the toenails. The toenails may get infected in showers, locker rooms, swimming pools and other damp places in which people walk around barefoot. Symptoms of a fungal infection include discoloring and thickening of the affected toenails. If left untreated, fungal infections can spread to other toenails, the fingernails, and elsewhere throughout the skin. This can lead to walking difficulties, as infected toenails are difficult to trim and hurt when wearing shoes.
Treatment for a fungal infection varies depending on each patient’s individual condition. Mild infections may be successfully treated with over-the-counter products and daily cleansing of the affected area. Oral antifungal medications may be prescribed in certain cases. Severe fungal infections may require removal of the infected nail. Only a qualified physician can properly diagnose and treat fungal infections after a physical examination and review of the patient’s medical history.
An ingrown toenail occurs when the side of a toenail grows into the soft tissue of that toe. This condition usually affects the big toe, although it can occur on any toe. Ingrown toenails may occur as a result of wearing cramped shoes, trauma to the feet, hereditary factors, or improperly trimming toenails. Symptoms of an ingrown toenail may include redness around the affected toenail, infection of the tissue surrounding the toenail, and swelling of the affected toe. Ingrown toenails that are left untreated may spread infection to the surrounding bone.
Ingrown toenails can usually be treated by regularly soaking the foot in warm water and applying antibiotic creams. More severe cases may require lifting the nail from the skin or removing part or all of the affected nail and its surrounding tissue. The exact course of treatment will vary based on each patent’s individual condition and medical history.
Paronychia is a common infection of the skin just next to a nail. Treatment usually involves antibiotic medicines for germ (bacterial) infections. Occasionally antifungal medicines for infection caused by a yeast (candida) or a fungus are used. In some cases steroid creams may be needed for the skin around the nail. Occasionally a small operation is needed to drain out any pus which has collected.
What is paronychia?
Paronychia is an infection of the skin just next to a nail (the nail fold). The infected nail fold looks swollen, inflamed and may be tender. There may also be a small collection of pus in the swelling. The nail itself may become infected or damaged if a nail-fold infection is left untreated. Paronychia is also sometimes called ‘whitlow’.
- Germs (bacteria). These tend to cause sudden-onset (acute) nail-fold infections which are painful. A bacterium called Staphylococcus aureus, which often lives harmlessly on our skin, is most often the cause.
- Candida. This is a yeast (a type of fungus) and is another common cause. Nail-fold infections with candida tend to develop slowly and cause persistent (chronic) infection. They do not cause pus to appear.
- Other germs (microbes). These include viruses and other fungi. They are less common causes.
Many nail-fold infections occur for no apparent reason. However, the following can increase the risk of germs (bacteria) and other germs getting into the nail-fold skin and causing infection.
You are more likely to develop a nail-fold infection if your hands are in water for long periods, particularly with detergents. Some jobs involve having wet hands for long periods of time. Constant washing may damage the nail fold and allow infection to develop. The following are examples of people who might be more prone to nail-fold infections due to their job:
- People who wash dishes frequently.
- Dairy farmers.
A break in the skin allows the germs on the skin to get inside. Examples which make you more prone to infection around the nails include:
- Nail biting.
- Poor manicure technique – for example, pushing the cuticles back too far with a hard instrument.
- Damaged or diseased nails or nail folds – for example, from skin conditions such as eczema or contact dermatitis.
- In-growing toe nails – the nail grows into the skin, breaking it.
If you use gloves for long periods, or use artificial nails, it can cause a moist, airless condition around your fingernails. This is good for some germs to thrive and cause infection.
If your infection is caused by bacteria then an antibiotic may be prescribed. Antibiotics commonly used for this type of infection include flucloxacillin or erythromycin. In a minor infection an antibiotic cream may be all that is needed – for example, supirocin cream or fucidic acid cream
If the antibiotic prescribed is not improving your infection after you have been taking it for a few days, you should see your doctor. Your doctor may take a sample (swab) of the infected area (to determine the actual bacteria causing your symptoms). He or she may also change the antibiotic to a different one.
Draining the pus out
If a lot of pus has collected, and your finger or toe is very swollen, the pus may need to be drained. A small cut is made to allow the pus to come out.
Warm bathing and painkillers
It may also help to soak the affected finger in warm salted water four times a day. Pain medicines such as Paracetamol or diclofenac, often work well to ease any pain.
Treatment for paronychia which lasts more than six weeks
If the problem has dragged on for six weeks or more, it is called chronic paronychia. Chronic means persisting. If this is the case there may be an underlying skin condition. In other cases there can be infection with a yeast or fungus. This is particularly common in those people mentioned above who have their hands in water a lot.
Treatment options include:
- Keeping the hands warm and dry.
- Avoiding anything which might irritate the skin, such as soaps and detergents. Also avoiding injury, eg avoid manicures, finger sucking, nail biting etc.
- Wearing very comfortable shoes if the affected nail is a toenail, to avoid any pressure on it.
- Treating any underlying skin condition.
- Steroid creams, such ashydrocortisone or betamethasone.
- Antifungal creams such as clotrimazole, miconazole or terbinafine
- Antifungal tablets such as itraconazole.
- An operation to open up the infected area, and keep it open and let it drain and heal over time.
The following may help:
- Do not bite your nails or pick at the skin next to nails.
- Keep your hands and feet dry as much as possible. Dry well after washing.
- Wear rubber gloves (preferably cotton-lined) if you work a lot with water.
- Do not wear gloves or artificial nails for long periods.
To know more about your condition
There are a variety of factors which can cause nail disease. To learn more about your nail condition or to schedule an appointment, contact our offices today.
ADVANCED SKIN CLINIC
Ground Floor, Susie House, Plot 1001 Ggaba Road, Nsambya Central, Kampala. P.O Box 612, Kampala.
Tel: 0755-562430 (Office Line) or 0778-389002