Nail Infection

Nail / nail fold infections 

  Nail infections can be of sudden onset (acute) or develop over a  period of time (chronic) .They mostly start in the nail folds either at the base (proximal) or the sides (lateral folds). In acute scenarios it is often due to local injuries or following nail biting, causing pain, swelling and pus collection.It would also primarily be due to infections such as Herpes, Orf etc,. ( in those handling animals) Depending on the severity of the infection, the treatment requirements can be Soaking of nail in antiseptic solutions on a daily basis Topical and/or oral Antibiotics with or without drainage of the pus Or nail removal in certain scenarios.

Onychomycosis

‘Onycho’ is nail and the word ‘myco’ - is fungus .Therefore onychomycosis is a fungal  infection of the nail. Humidity, occlusive footwear, repeated nail trauma, genetic predisposition, and concurrent disease, such as diabetes, poor peripheral circulation, and HIV infection are all the common predisposers. It can present with color change (yellowish-white to brown), nail thickening, elevation of nail plate from bed. Treatment involves addressing the underlying issue. Medications will include topical ointments, nail lacquers and oral antifungals. The oral antifungals need to be taken for a longer period of time for the medications to reach the nail from circulation.

Chronic nail fold infections

occur commonly  in people with constant cold and wet hands.This will include those working with detergents, dyes, food handlers and other irritants. People who habitually push their cuticle proximally, or cut them during manicures are also prone to get this condition. As this causes a constant irritation to the nail folds causing swelling and subsequent nail abnormalities such as nail ridges and discoloration. Only in rare instances it is accompanied by infection. The infections can cause greenish discolouration of the nail which is fungal or there can be pus formation with bacteria as well.

Treatment 

Treatment will therefore include elimination of irritant contact be it water, food or other chemicals. Certain measures of prevention would be - Minimising water contact or Drying hands completely after , Cotton glove usage underneath plastic gloves, Avoiding manicure at the nail fold and other forms of injury to the cuticle. Treatment options will include - Topical steroids under antibiotic coverage will be the treatment of choice. Topical therapy has the greatest potential as primary therapy in mild infections. Oral antifungals are needed for chronic fungal involvement of the nail.