Nail infections

Nail infection should be suspected if the following changes are seen in the nails:

• Occurrence of white or yellow spots on the nail
• Whitish or yellowish discoloration of the nail
• Thickening of the nail
• Brittle, crumbly, and easily breakable nails
• Distorted shape of the nail
• Foul-smelling nails
• Pain, redness, and swelling in the nails and surrounding area in cases of acute bacterial nail infection
• Yellow pus formation and discharge from the nail in paronychia
• Accompanying fever in acute bacterial nail infection

Your body has a way of signaling when something is wrong, and your nails are no exception. Here’s what your nails can reveal about your health. Know More!

• Nail infections are commonly caused by bacteria such as Staphylococcus aureus, Streptococcus pyogenes, and Pseudomonas.
• Fungal infections may be caused by Trichophyton, Microsporum, Epidermophyton, and Candida albicans.

Chances of getting a nail infection are higher if:

• Age is more than 60 years.
• Living and sharing toiletries with someone who has a nail infection.
• You have diabetes or suffer from immunocompromised conditions, such as HIV, cancer, or are undergoing chemotherapy.

Nail infections occur if the nail is constantly exposed to moisture or trauma, or both, in conditions such as:

• Wearing tight-fitting shoes or moist, dirty socks that allow no space for breathing.
• Spending too much time in the water every day.
• Wearing plastic gloves for a prolonged period.
• Walking for a long time in hot and humid places, such as public showers.
• An injury to the nail or surrounding area.

The chances of fungal infections increase during the summer season due to hot and humid weather conditions and excessive sweating. Here are a few ways to help you deal with fungal infections during the summer season. Read More!

Doctors can usually determine the type of nail infection based on the presenting symptoms and history. The symptoms of nail infection may appear as:

• Patchy discoloration or flaking of the nail
• Brittle nails
• Alteration in the shape of the nail
• Pus formation
• Swelling

Certain laboratory tests may be suggested to confirm the exact cause of nail infection, such as:

Suspected Bacterial Nail Infection

• Complete blood count (CBC) and erythrocyte sedimentation rate in cases of fever accompanying acute bacterial nail infection
• Pus culture to identify the causative microorganism in the pus
• Nail clippings for culture and direct microscopic examination

Suspected Fungal Nail Infection

• Nail clippings for culture and direct microscopic examination
• Fungal susceptibility testing to assess the response of antifungal drugs
• KOH testing: Also known as potassium hydroxide test, used for the diagnosis of fungal infection in the skin, hair, and nails
• PCR testing: Polymerase Chain Reaction (PCR) testing is used to enhance sensitivity in detecting the causative fungi in nail specimens from patients with suspected onychomycosis (a fungal infection that occurs at the edge of the nail)

The chances of getting a nail infection increase with age and due to certain habits. The following measures can be taken to minimize the risk of nail infections:

• Maintain good hand and foot hygiene. Wash your hands and feet daily with soap and water, ensuring that all dirt is cleared, especially the dirt stuck between the fingers or under the nails.
• Wear comfortable footwear that offers ample room for the toes to move.
• Trim your nails at least once a week with a clean nail trimmer.
• Wear dri-fit socks that help wick away moisture from the feet. If your feet get too sweaty, change the socks twice a day or more if needed.
• Use gumboots while working in wet areas, such as farms or fields.
• Moisturize your hands and feet daily.
• Dust your hands and feet with antifungal absorbent powder daily.
• Always insist on sterilized equipment for manicures and pedicures in salons.

Treatment for nail infection broadly comprises:

• Oral antibiotics: Usually, simple bacterial nail infections can be managed at home with topical antibiotic creams. Oral antibiotics are prescribed in more severe stages of infection. Available medicines include:
  • Ampicillin
  • Doxycycline
  • Clindamycin
• Oral antifungals: Antifungals are given as oral medications to treat fungal nail infections. Available medicines include:
  • Itraconazole
  • Fluconazole
  • Terbinafine
• Topical antibiotics:
  • Mupirocin: An antibiotic medicine used to treat bacterial infections by preventing the synthesis of essential proteins necessary for the survival of bacteria, thus preventing the infection from spreading.
  • Fusidic acid: An antibiotic that prevents the synthesis of essential proteins required by bacteria, stopping their growth and preventing the infection from spreading.
  • Retapamulin: This antibiotic inhibits bacterial growth and prevents the infection from spreading.
• Topical antifungals: Available as creams, absorbent powders, or solutions for dressing to be applied directly to the infected nail:
  • Ciclopirox: Available in cream or lacquer form that can be applied like nail polish over the infected nail, working by inhibiting protein synthesis in fungal cells.
  • Amorolfine: Applied directly to the nails, inhibiting the enzymes necessary for the growth of fungal infections.
  • Antifungal dusting powder to prevent moisture in the affected area.
• Topical antiseptics: In acute bacterial nail infections, the affected part may be soaked in a diluted antiseptic solution and then covered with antibiotic ointments. Examples of antiseptics include:
  • Povidone Iodine: An antiseptic that kills harmful microorganisms to prevent and treat infections.
  • Chlorhexidine: A disinfectant and antiseptic used for skin disinfection, cleaning wounds, preventing dental plaque, and treating yeast infections.
• Topical steroids: This class of drugs is used to lower inflammation in the body. When applied topically, they relieve redness, swelling, itching, and irritation caused by nail infections. Methylprednisolone aceponate cream is the most common medicine used.
• Surgery: In cases of severe nail infection, such as the collection of pus around the nail or the formation of an abscess, surgery may be required to drain the pus or abscess and remove the nail in extreme cases of disfigurement.
• Laser therapy (Phototherapy): A treatment for fungal nail infection (onychomycosis) where laser devices emit a pulse of energy that penetrates through the toenail to the nail bed where fungal growth is present. Fungal infections of the nails usually require several laser treatment sessions before they completely resolve.

If you suffer from a nail infection, you can do the following things to care for yourself at home:

• Always keep the infected part clean and dry.
• Before applying medications, wash hands thoroughly with soap and water.
• Do not wear dirty socks or gloves.
• Do not allow dirt to accumulate under the nail.
• Trim your nails regularly with a sterile nail trimmer.
• Do not share toiletries, such as towels or napkins, with anyone who has an infection.
• Do not regularly cover nails with nail polish.

Pro Tip: Dry your feet well, especially between the toes, to prevent fungal infections. Wash your feet with warm water. You can add a few drops of an antiseptic liquid to clean the feet. Avoid using harsh soap or excessive antiseptic liquid, as it can cause the skin to become dry. Ensure you dry your feet thoroughly, particularly in the areas between the toes, as these spots are often neglected and can create an ideal environment for fungal infections. You may also use antifungal powder to help keep your toes dry and reduce the risk of infection. For more information, consult our doctors.

A severe case of nail infection can spread to adjoining areas, such as the skin, potentially causing serious skin infections known as cellulitis.

Diabetic patients and immunocompromised individuals are at a higher risk for complications resulting from nail infections.

Additional complications may include:

• Permanent damage to the affected and surrounding nails
• Increased risk of foot damage in severe cases

Treatment with Non-Prescription Agents

Non-pharmacologic agents such as:

• Vicks Vaporub
• Tea-tree oil
• Snakeroot extract

have been found to be effective in treating fungal nail infections. Applying any of these agents directly to the affected toenail regularly may yield beneficial effects.

Ayurveda

An Ayurvedic treatment known as Shaman Chikitsa has been found to be effective in treating fungal nail infections. Medicinal preparations containing Terminella exhibit considerable antimicrobial activity and are effective against nail infections.

If you are suffering from a nail infection, do not ignore it, even if it isn't painful yet. At any time, if you see your nails becoming yellow or disfigured, or if spots start appearing on your nail, you must consult a doctor to prevent the condition from getting worse.

Chronic nail infections tend to take a long time to heal and also require prolonged medications. You must complete your prescribed course and regularly consult your doctor for follow-up visits to ensure that the infection is resolved completely.

To prevent nail infections, follow these hygiene practices:

• Maintain good hand and foot hygiene, especially if you are diabetic.
• If you experience recurrent nail infections, this may indicate an underlying immunocompromised condition.
• Please consult your doctor for appropriate treatment.