Nail infections

You are at a higher risk of developing a nail infection if:

• You are over the age of 60.
• You live with or share personal items (e.g., towels, nail clippers) with someone who has a nail infection.
• You have underlying health conditions, such as diabetes, HIV, or cancer, or are undergoing chemotherapy.

Frequent exposure to moisture or trauma increases the risk, such as:

• Wearing tight shoes or damp, dirty socks that restrict airflow.
• Prolonged exposure to water (e.g., swimmers, dishwashers).
• Wearing plastic gloves for long periods.
• Walking barefoot in hot, humid public areas (e.g., showers, pools).
• Sustaining an injury to the nail or nearby skin.

Doctors typically diagnose nail infections by examining the symptoms and taking the patient's medical history. Signs of a nail infection may include discoloration, brittleness, flaky nails, pus discharge, swelling, and changes in the nail shape. To confirm the specific cause, the doctor may recommend the following tests:

When a bacterial nail infection is suspected:

• Complete Blood Count (CBC) and Erythrocyte Sedimentation Rate (ESR) are conducted if fever accompanies an acute bacterial infection.
• Pus culture to identify the bacterial strain present in the infection.
• Nail clipping analysis for culture and direct microscopic examination.

When a fungal nail infection is suspected:

• Nail clipping examination for culture and direct microscopy to detect fungal pathogens.
• Fungal susceptibility testing to determine the effectiveness of antifungal medications.
• Potassium Hydroxide (KOH) Test, used to identify fungal infections in nails, hair, and skin.
• Polymerase Chain Reaction (PCR) Testing, which offers a more sensitive detection method for identifying fungi in nail samples from individuals suspected of having onychomycosis.

Certain habits and age-related factors can increase the risk of nail infections. To reduce the likelihood of developing an infection, consider the following preventive measures:

• Maintain proper hand and foot hygiene by washing them daily with soap and water. Ensure thorough cleaning of the areas between fingers and under the nails.
• Wear well-fitted footwear that allows room for toes to move comfortably.
• Trim nails regularly using a clean, sterilized nail clipper.
• Use moisture-wicking socks to keep feet dry. If your feet sweat excessively, change your socks twice or more daily.
• Wear protective boots when working in damp areas, such as farms or gardens.
• Moisturize feet and hands daily to prevent dryness and cracks.
• Apply antifungal powder on your feet and hands to reduce moisture and prevent fungal growth.
• Ensure sterilized equipment is used during manicures and pedicures at salons.

Specialists to Consult

For bacterial, fungal, or viral nail infections, seeking prompt medical attention is essential. Acute nail infections often occur due to skin breaks, commonly appearing around the sides of the nails. These cases are typically caused by bacterial pathogens but may occasionally involve viral infections, such as herpes. Symptoms like fever, pus, redness, or swelling near the nail require immediate care.

For chronic infections, treatment should be initiated as soon as symptoms like discoloration, patchiness, or thickening of nails appear. Chronic infections are often seen in individuals whose hands or feet are frequently exposed to moisture. They may result from contact dermatitis worsened by fungal or bacterial involvement.

The following specialists can diagnose and treat nail infections:

• General Physician
• Dermatologist

The treatment for nail infections typically involves:

Oral Antibiotics

For mild bacterial infections, topical antibiotic creams are often sufficient. However, in more severe cases, oral antibiotics are prescribed, including:

• Ampicillin
• Doxycycline
• Clindamycin

Oral Antifungals

Oral antifungal medications are used to treat fungal nail infections. Common options include:

• Itraconazole
• Fluconazole
• Terbinafine

Topical Antibiotics

Applied directly to the affected area, topical antibiotics treat bacterial nail infections by preventing bacterial growth. Common topical antibiotics include:

• Mupirocin: Works by blocking bacterial protein synthesis, preventing the infection from spreading.
• Fusidic Acid: Inhibits bacterial growth by interfering with essential protein synthesis.
• Retapamulin: Restricts bacterial growth, preventing the spread of infection.

Topical Antifungals

These antifungals come in the form of creams, powders, or solutions applied directly to the infected nail:

• Ciclopirox: Available as a cream or lacquer, it blocks protein synthesis in fungal cells, stopping further fungal growth.
• Amorolfine: Applied to the nails, it disrupts the enzymes necessary for fungal proliferation.
• Antifungal dusting powder: Reduces moisture and prevents fungal growth in the affected area.

Topical Antiseptics

For acute bacterial infections, antiseptic solutions can be used for soaking the infected area before applying antibiotic ointments. Common antiseptics include:

• Povidone-Iodine: An antiseptic that kills microorganisms, preventing and treating infections.
• Chlorhexidine: Used as a disinfectant and antiseptic for skin cleaning, wound care, and treatment of yeast infections.

Topical Steroids

These anti-inflammatory medications reduce redness, swelling, and itching caused by nail infections. Methylprednisolone aceponate cream is frequently used.

Surgical Treatment

In severe cases, surgical intervention may be necessary. This includes draining pus or removing the nail entirely in cases of disfigurement or abscess formation.

Laser Therapy (Phototherapy)

Laser treatment is an option for fungal nail infections (onychomycosis). The laser penetrates the nail bed, targeting fungal growth. Multiple sessions are typically required for complete resolution.

In severe cases, nail infections can spread to nearby areas, including the skin, leading to a serious condition called cellulitis. Individuals with diabetes or weakened immune systems are at a higher risk of developing complications from nail infections.

Additionally, nail infections can cause permanent damage to the affected nail and the surrounding ones. In extreme cases, severe infections may increase the risk of foot injury or more extensive damage.

Non-Prescription Treatments

Certain over-the-counter remedies, such as Vicks Vaporub, tea tree oil, and snakeroot extract, have shown effectiveness in managing fungal nail infections. Regular application of these agents directly onto the infected nail may help improve the condition over time.

Ayurveda

In Ayurveda, a treatment method known as Shaman Chikitsa is considered effective for fungal nail infections. Herbal preparations containing Terminella exhibit antimicrobial properties and have been found useful in treating nail infections.

If you have a nail infection, you can follow these self-care tips at home:

• Keep the infected area clean and dry.
• Always wash your hands thoroughly before applying any medication.
• Avoid wearing dirty socks or gloves.
• Prevent dirt accumulation under the nails.
• Trim nails regularly using a clean, sterile trimmer.
• Do not share personal hygiene items, such as towels, with others.
• Avoid applying nail polish regularly, as it can trap moisture and worsen the infection.

If you have a nail infection, it is essential not to ignore it, even if it is not causing pain. If you notice yellowing, disfigurement, or the appearance of spots on your nails, consult a doctor promptly to prevent the infection from worsening.

Chronic nail infections often take longer to heal and may require extended treatment with regular follow-ups. It is important to complete the full course of prescribed medications and attend all follow-up visits to ensure the infection clears completely.

Since poor hygiene can contribute to nail infections, practicing good hand and foot hygiene is crucial, especially for individuals with diabetes. Recurrent nail infections may indicate an underlying immunocompromised condition, which requires proper medical evaluation.