Many people have thickened, discolored toenails . About 50% of these abnormal nails are due to a fungal infection of the nail bed, matrix, or nail plate. The medical terms for this type of fungal infection are onychomycosis or tinea unguium. . Men are more often affected than women and usually later in life, after the age of 40.
Appearance There are actually 4 different types of fungal nail infections classified by the part of the nail involved. The most common infection involves the end of the nail . Initially, the nail plate splits from the nail bed. The end of the nail then turns yellow or white and keratin debris develops under the nail causing further separation. The fungus eats away at the nail itself causing it to become fragile and crumble. The fungal organism responsible for most fungal nail infections is Trichophyton rubrum. Risk Factors Tight footwear promoting crowding of the toes keeping the toes warm and moist is a perfect environment for fungi to grow. Exercise can cause repeated damage to the nail plate allowing fungi to invade. Communal showers can expose the feet to fungi. Diseases that influence the immune system like diabetes and medication that suppress the immune system can make it easier for a fungal infection to start.
Diagnosis of Fungal Nail Infections Not every thickened, discolored nail is a fungal infection. Other diseases that can cause thickened nails are psoriasis, eczema, and lichen planus. It is important that fungal nail infections are diagnosed properly because treatment is long-term and expensive. Fungal nail infections can be diagnosed by your chiropodist who may take a sample of the debris under the nail for culture . The active fungal elements are found under the nail and are closest to the skin, therefore the nail should be trimmed before a sample is taken.
Bacterial nail infections Paronychia is an infection of the skin that hangs over the side of the nail. It is the most common hand infection in the United States. Paronychia is seen frequently in children as a result of nail biting and finger-sucking. Paronychia is divided into acute paronychia and chronic paronychia depending on the amount of time the infection has been present. Causes Both acute and chronic infections start with a break in the skin. An acute infection is associated with trauma to the skin such as a hangnail, ingrown nail, pushing back the cuticle or nail-biting. The most common bacteria responsible is Staphylococcus aureus. Other bacteria that are less commonly involved are Streptococcus species and Pseudomonas species. A chronic infection is associated with repeated irritation such as exposure to detergents and water. Most chronic infections are caused by Candida albicans or other fungi. Appearance of Acute Paronychia Acute paronychia starts as a red, warm, painful swelling of the skin around the nail. This may progress to the formation of pus that separates the skin from the nail. Lymph nodes in the elbow and armpit may swell. Appearance of Chronic Paronychia In chronic paronychia, the redness and tenderness are less noticeable than the acute infection. . The nail may have a green discoloration due to Pseudomonas infection. Diagnosis Paronychia is diagnosed based on clinical symptoms. Sometimes if there is pus involved, a culture may be taken to determine the bacteria involved. This is not absolutely necessary since the bacteria can usually be assumed to be a Staphylococcus or Streptococcus species. Chronic paronychia is more difficult to diagnose. A smear from the nail fold can sometimes reveal a fungus. Treatment Soaking in saline solution can be used 3 or 4 times a day for acute paronychia to promote drainage and relieve some of the pain. Most cases of acute paronychia should be treated with antibiotics . Topical antibiotics or anti-bacterial ointments do not effectively treat paronychia. If there is pus or an abscess involved, the infection may need to be drained . Rarely, a portion of the nail may need to be removed. Chronic paronychia is treated with topical antifungal medication . A mild toical steriod likehydrocortisone may be added to the antifungal medication to help reduce inflammation. Steroids should never be used alone on a chronic paronychia.
Hitchin Chiropody and Podiatry Practice 13 Bearton Green Hitchin Hertfordshire Tel: 01462 456031
