Herts Podiatry
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FUNGAL NAILS

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.
 


 Herts Podiatry   13 Bearton Green Hitchin  Hertfordshire
Tel: 01462 456031

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