Nail infections

Symptoms Of Nail Infection

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

1. Occurrence of white or yellow spots on the nail

2. Whitish or yellowish discoloration of the nail

3. Thickening of the nail

4. Brittle, crumbly, and easily breakable nails

5. The shape of the nail is distorted

6. Foul smelling nails

7. Pain, redness, swelling in the nails and surrounding area in cases of acute bacterial nail infection

8. Yellow pus formation and discharge from the nail in paronychia

9. Accompanying fever in acute bacterial nail infection

Your body has an art of letting you know when something is wrong somewhere. Your nails are no exception. Here’s what your nails can reveal about your health.
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Causes Of Nail Infection

Nail infections are commonly caused by bacteria like Staphylococcus aureus, Streptococcus pyogenes, Pseudomonas, or fungi like Trichophyton, Microsporum, Epidermophyton, and Candida Albicans.

Types Of Nail Infection

Nail infections can be caused by microorganisms like bacteria, fungi and viruses as described below:

Bacterial nail infection
If the infection is caused by bacteria like Staphylococcus aureus, Streptococcus pyogenes, Pseudomonas, it is called a bacterial nail infection or Paronychia. Based on the duration for which the nail infection persists, bacterial nail infections are divided into the following types -

• Acute bacterial nail infection: This type of infection is caused by bacteria that cause inflammation in the surrounding areas. It may last for less than six weeks, causing pain around the area.

• Chronic bacterial nail infection: This type of infection is also  caused by bacteria that cause inflammation in the surrounding areas. It lasts for more than six weeks, causing periodic, painful flare ups.
  
  

Fungal nail infection

If the infection is caused by fungi like Trichophyton, Microsporum, Epidermophyton, Candida Albicans, it is called a fungal nail infection or Onychomycosis. Based on the area involved or the causative agent, fungal nail infections are further divided into the following subtypes -

• Distal subungual onychomycosis: This is the most common type of onychomycosis where the fungal infection starts from the nail bed and spreads across the edges.

• Proximal subungual onychomycosis: It is a rare type of onychomycosis which is usually seen in patients who suffer from immunocompromised states. The infection begins as white spots in the center of the nail and moves outward as the nail grows.

• White superficial onychomycosis: This type of infection affects only the surface of the nail. It may cause white spots on the surface of the nail that turns powdery and can make the nail crumble.

• Candida onychomycosis: This is caused by a fungus called Candida albicans. It is more commonly seen in nails that have been previously affected by injury or infection.
  
  

Viral nail infection

Viral warts can cause changes in the shape and thickness of the nails leading to a viral nail infection. It is usually caused by Human Papillomavirus (HPV). In some cases, viruses can also lead to skin growth under the nail, known as Periungual warts. It may also lead to a condition known as Onychomadesis in which the nails begin to shed at the proximal end.

Risk Factors For Nail Infection

Chances of getting a nail infection are higher if

1. Age is more than 60 years.

2. Living and sharing toiletries with someone who has a nail infection.

3. You have diabetes or suffer from immunocompromised conditions, such as HIV or cancer or undergoing chemotherapy.
   
   

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

4. Wearing tight-fitting shoes or moist, dirty socks that allow no space for breathing.

5. Spending too much time in the water every day.

6. Wearing plastic gloves for a prolonged period.

7. Walking for a long time in hot and humid places, such as public showers.

8. An injury to the nail or surrounding area.
   
   

The chances of fungal infections increase during the summer season, owing 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.
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Diagnosis Of Nail Infection

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

Suspected bacterial nail infection

• Complete blood count (CBC), 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 test the response of antifungal drugs.

• KOH testing: Also called potassium hydroxide test, is used for the diagnosis of fungal infection in the skin, hair, and  nails. 

• PCR testing: Polymerase Chain Reaction (PCR) testing is used to improve sensitivity in detecting the causative fungi in nail specimens from patients with suspected Onychomycosis (a fungal infection that occurs in the edge of the nail). 

Prevention Of Nail Infection

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 -

1. Maintain good hand and feet hygiene. Wash your hands and feet daily with soap and water. Ensure that all dirt is cleared, especially the dirt stuck between the fingers or under the nails.

2. Wear comfortable footwear that offers ample room for the toes to move.

3. Trim your nails at least once every week with a clean nail trimmer.

4. 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.

5. Use gumboots while working in wet areas, such as farms or fields.

6. Moisturize your hands and feet daily.

7. Dust your hands and feet with antifungal absorbent powder daily.

8. Always insist on sterilized pieces of equipment for manicures and pedicures in salons. 

Specialist To Visit 

For cases of acute bacterial, fungal and viral nail infection, immediate medical care must be sought. Acute nail infection develops with a break in the skin and is usually seen at the side of the nail. This type of nail infection is often caused by a bacterial infection but may also be caused by herpes, a type of viral infection. Symptoms of acute bacterial nail infection may include fever, swelling, pus formation around nails, or red streaks around nails.

For chronic infections, treatment must be started as soon as symptoms like discoloration or patchy nails are observed. Chronic nail infection occurs most often in people whose hands are constantly or often exposed to moisture. This disorder often results from contact dermatitis, a type of skin inflammation caused by exposure to chemicals that are irritating to the skin, and worsened due to fungus or bacteria.

Doctors who can help you to diagnose and treat the condition are:

• General physician

• Dermatologist

Treatment Of Nail Infection 

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 are:

• Ampicillin 

• Doxycycline

• Clindamycin

 
Oral antifungals: Antifungals are given as oral medications to treat fungal nail infections. Available medicines are:

• Itraconazole

• Fluconazole 

• Terbinafine

 
Topical antibiotics: 

• Mupirocin: It is an antibiotic medicine used to treat bacterial infection. It kills the bacteria that cause skin infections by preventing the synthesis of essential proteins necessary for the survival of bacteria. Thus, it prevents the infection from spreading.

• Fusidic acid: It is an antibiotic that works by preventing synthesis of essential proteins required by bacteria to carry out vital functions. Thus, it stops the bacteria from growing, and prevents the infection from spreading.

• Retapamulin: This antibiotic is helpful in treating bacterial infection by inhibiting the bacteria from growing, and prevents the infection from spreading.

Topical antifungals:These are available as creams, absorbent powders, or solutions for dressing to be applied directly to the infected nail:

• Ciclopirox: These are available in a cream form or lacquer form that can be applied like a nail polish over the infected nail. They work by inhibiting protein synthesis in the fungal cells, thereby preventing further growth of the fungi.

• Amorolfine: These are to be applied directly to the nails. They work by inhibiting the enzymes necessary for growth of fungal infection.

• Antifungal dusting powder to prevent moisture in the affected area.

Topical antiseptics: In acute bacterial nail infection, the affected part may be soaked in a diluted antiseptic solution and can then be covered with antibiotic ointments. A few examples of antiseptics are: 

• Povidone Iodine: Povidone Iodine is an antiseptic. It kills harmful infections causing microorganisms to prevent and treat infections.

• Chlorhexidine: It is a disinfectant and antiseptic that is used for skin disinfection. It is also used for cleaning wounds, preventing dental plaque, and  treating yeast infections. 

Topical steroids: This class of drugs are the most powerful medicines used to lower inflammation in the body. When applied topically, it relieves the redness, swelling, itching and irritation of the skin that is caused due to nail infection. Methylprednisolone aceponate cream is the most common medicine used.

Surgery: In cases of severe nail infection, like collection of pus around the nail or the formation of abscess (pus), surgery may be required to drain the pus or abscess and remove the nail in extreme cases of disfigurement.

Laser therapy (Phototherapy): This is a treatment for fungal nail infection (onychomycosis). The laser devices emit a pulse of energy that penetrates through the toenail to the nail bed where the fungal growth is present. Fungal infections of the nails usually require several laser treatment sessions before they completely resolve.

Home Care For Nail Infection

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

1. Always keep the infected part clean and dry.

2. Before applying medications, wash hands thoroughly with soap and water.

3. Do not wear dirty socks or gloves.

4. Do not allow dirt to accumulate under the nail.

5. Trim your nails regularly with a sterile nail trimmer.

6. Do not share toiletries, such as towels or napkins, with anyone who has an infection.

7. Do not regularly cover nails with nail polish.
   
   

1mg ProTip
Dry your feet well, especially between the toes, to prevent fungal infections
Wash your feet with warm water. You can even add a few drops of an antiseptic liquid to clean the feet. Do not use harsh soap or excess of antiseptic liquid as it can cause the skin to become dry. Dry your feet well, especially in the area between the toes. These places are often neglected which in the long run can act as the ideal ground for fungal infections. You can also use antifungal powder to prevent infection as it helps to keep your toes dry and thus lower the risk of infection.Know more about this by taking advice from our doctors. 
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Complications Of Nail Infection

A severe case of nail infection can spread to adjoining areas, such as the skin, and may cause serious infection of the skin known as cellulitis. Diabetic patients and immunocompromised patients are more prone to complications resulting from nail infections.

It may also cause permanent damage to the affected and surrounding nails. Along with that, severe cases of nail infections may increase the risk of foot damage.

Alternative Therapies Of Nail Infection

Treatment with non-prescription agents

Non-pharmacologic agents such as Vicks Vaporub, tea-tree oil, and snakeroot extract have been found to be effective in treating fungal nail infections. Applying either of these agents directly over the affected toenail regularly may start showing the beneficial effects.

Ayurveda

An ayurvedic treatment known as Shaman Chikitsa is found to be effective in treating fungal nail infections. Medicinal preparations containing Terminella have considerable antimicrobial activity and are effective against nail infections.

Living With Nail Infection

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 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 on follow up visits to ensure that the infection is resolved completely. 

As there is a possibility of nail infection due to poor hygiene, you must follow good hand and foot hygiene, especially if you are a diabetic. If you experience recurrent nail infections, this may indicate the case of some immunocompromised underlying condition. Please consult your doctor for appropriate treatment.