Your nails can be affected by trauma, irritation, or certain infections. These conditions can involve your fingernails as well your toenails. Nail infections can be caused either by bacteria or a fungus. Paronychia is a condition of the nails which develops when bacteria enter damaged skin near the cuticle and nail fold, causing an infection. It is usually treated with antibiotics to kill the infection, but sometimes drainage of pus is required if any collection occurs. When the nails are infected with fungus, it is called onychomycosis. It can make your nails look yellow, hard, and crumble. It can be mild, non-bothering, and may not need medicine. Some may need to be treated, but it can return.
Paronychia is usually caused by Staphylococcus aureus bacteria. Other bacteria like Streptococcus pyogenes can also cause nail infections. Bacteria penetrate the skin through cuts, broken or damaged skin, or hangnails. Certain medications can be the cause of paronychia as well. They include retinoids (used for skin treatments), HIV medications, cancer treatment medications, and specific antibiotics.
Several fungal organisms can cause Onymychosis. The most common type of fungus involved is dermatophyte. Others include yeast and molds. Dry nail cracks, reduced blood circulation, warm moist areas are predisposing factors for fungal infections.
Some common risk factors include:
Paronychia is more common in females than males because of prolonged water use during washing dishes or clothes. Onychomycosis is more common in males and affects around 10% of the general population, of which 20% of the people are older than 60 years.
Paronychia signs symptoms include:
Onychomycosis signs and symptoms include;
· Thickening of the nails
· Yellowish or brown discoloration
· Ragging or crumbling of the nails
· Nails might smell bad
Taking history and general physical examination help in diagnosis as other tests or investigations are not required for acute mild cases. Sometimes, a tissue sample like nail clippings or debris under nails is required and sent to a laboratory to test for particular infections like bacteria or fungi. If the infection is severe and aggressively growing, imaging such as an X-ray may be required to check for the involvement of the bone tissue.
Several nail conditions can look like infections that may need to be excluded for efficient management.
· Irritant Contact Dermatitis
· Nail Psoriasis
· Lichen Planus
· Traumatic onycholysis
· Drug reaction
· Thyroid disease
· Yellow nail syndrome
· Cutaneous Melanoma
If your symptoms are bothersome, you must consider consulting your healthcare provider for treatment. Nail infections caused by bacteria are treated with warm soaks and topical antibiotics, including Amoxicillin/clavulanate or fluoroquinolones. Topical steroids may or may not be required. Fungal nail infections may sometimes be difficult to treat. Treatment depends on the severity and the type of fungus responsible for the infection. It may take a prolonged time to treat the condition. If the nail condition improves, then recurrent infections are also common, which must be seen.
Medications: Some therapies for treating fungal infections include:
· Oral antifungal medicines: These drugs are frequently the first choice because they clear the infection more abruptly than topical drugs. Some of them are terbinafine (Lamisil) and itraconazole (Sporanox) taken for 6 to 12 weeks.These drugs help grow new nails free of infection, slowly replacing the part of the infected nail. But the results of treatment will be evident after the nail grows entirely. It may take more than four months to cut off infection. The success of treatment with these drugs is lower in the elderly, over the age of 65 years.
Surgery: In cases of abscess formation, you may need incision and drainage. For chronic fungal infections, surgeons might suggest temporary removal of the nail so that they can apply the antifungal drug directly into the infected area under the nail. Some fungal nail infections are resistant to medications, so the doctor might suggest permanent nail excision if the infection is spreading, severe, or intensively painful.
Paronychia is easily cured with treatment. Some may get multiple infections or recurrent infections (chronic paronychia). The untreated infections can extensively damage the nail. Some untreated paronychia can spread deeper into the finger or toe's deep tissues and bones, resulting in a serious infection. People with diabetes or people with underlying medical issues get chronic paronychia. If proper care and medication regimen are taken, fungal infections can be cured. Otherwise, there are more chances of resistance or relapse of the infection.
To prevent a nail infection, certain measures are useful
Our clinical experts continually monitor the health and medical content posted on CURA4U, and we update our blogs and articles when new information becomes available. Last reviewed by Dr.Saad Zia on May 04, 2023.