Nail Infections

What Are Nail Infections?

• Nail infections are conditions where fungi, bacteria, or yeast invade the nail or the surrounding skin. They can affect both fingernails and toenails, though toenail infections are more common. These infections often cause discoloration, thickening, brittleness, and can sometimes be painful or embarrassing if left untreated.

What Causes Nail Infections?

Several different factors can lead to nail infections:

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• Fungal Infections (Onychomycosis):

  • The most common cause, usually from dermatophytes

  • Fungi thrive in warm, moist environments like sweaty shoes or public showers

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• Bacterial Infections:

  • Usually affect the skin around the nail (paronychia)

  • Often caused by Staphylococcus aureus entering through a cut or broken skin

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• Yeast Infections (Candida):

  • More common in fingernails, especially if hands are frequently wet

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• Other Risk Factors Include:

  • Wearing tight shoes or artificial nails

  • Having diabetes, poor circulation, or weakened immune system

  • Injuries to the nail or nail bed

  • Frequent exposure to moisture or chemicals

Types of Nail Infections

• Fungal Nail Infection (Onychomycosis)

  • Discolored, thickened, or brittle nails

  • Common in toenails

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• Paronychia (Bacterial or Fungal)

  • Redness, swelling, and pus around the nail fold

  • Painful to touch

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• Green Nail Syndrome

  • Caused by Pseudomonas bacteria

  • Nail may turn green or blue-green

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• White Superficial Onychomycosis

  • White spots or chalky patches on the nail surface

Symptoms of Nail Infections

• Thickened or brittle nails

• Yellow, white, brown, or green discoloration

• Nail separating from the nail bed (onycholysis)

• Crumbly or distorted nail shape

• Pain, swelling, or redness around the nail

• Foul smell in severe infections

• Fluid or pus (with bacterial infections)

Medications for Nail Infections

• Treatment depends on the type of infection and its severity. Some medications are topical, while others may need to be taken orally for deeper or stubborn infections.

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1. Topical Antifungal Medications

• Used for mild to moderate fungal infections:

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• Ciclopirox (Penlac nail lacquer):

  • Applied like nail polish daily for several months

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• Efinaconazole (Jublia):

  • A topical solution applied once daily

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• Tavaborole (Kerydin):

  • Penetrates the nail to kill fungus

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• These are less effective alone if the infection is deep or severe, but useful in early stages or with oral meds.

2. Oral Antifungal Medications

• Prescribed for moderate to severe infections or when topicals don’t work:

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• Terbinafine (Lamisil):

  • Usually taken once daily for 6–12 weeks

  • Most effective oral antifungal

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• Itraconazole (Sporanox):

  • Effective for different types of fungus

  • May be taken daily or in pulse doses

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• Side Effects May Include:

  • Headache, upset stomach

  • Liver function changes (requires monitoring with blood tests)

  • Skin rash or taste changes (rare)

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3. Antibiotics (for Bacterial Infections)

• Used if infection is bacterial and accompanied by pus, swelling, or pain:

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• Oral antibiotics:

  • Amoxicillin, Clindamycin, or Cephalexin

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• Topical antibiotic creams:

  • Mupirocin or Fusidic acid for minor infections around the nail

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4. Antiseptic and Natural Remedies (Supportive Care)

• Mild cases or early-stage infections may benefit from:

  • Tea tree oil (natural antifungal/antibacterial)

  • Vinegar soaks (acidic environment slows fungal growth)

  • Epsom salt soaks (for bacterial paronychia)

Side Effects of Nail Infection Treatments

• Common Side Effects:

  • Skin irritation or redness (with topicals)

  • Mild nausea or headache (with oral meds)

  • Temporary liver enzyme elevation (with oral antifungals)

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• Serious Risks (Rare):

  • Liver damage (long-term oral antifungals)

  • Allergic reactions (rash, swelling, or difficulty breathing)

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• Always follow your doctor’s guidance and complete the full course of treatment to prevent recurrence.

Diagnosis of Nail Infections

• A healthcare provider or dermatologist may:

  • Examine the nail visually

  • Clip a small piece of nail for lab testing (microscopy or culture)

  • Use KOH (potassium hydroxide) prep to detect fungal elements

  • In some cases, use nail biopsy to rule out other skin conditions

Prevention Tips for Nail Infections

• Keep nails clean and dry

• Trim nails regularly and file thickened areas

• Wear breathable shoes and moisture-wicking socks

• Avoid walking barefoot in public showers or pools

• Don’t share nail clippers, files, or footwear

• Disinfect nail tools after use

• Allow your nails to breathe between manicures or pedicures

• Choose nail salons that follow proper sanitation practices

Common Questions About Nail Infections

1. Can nail infections go away on their own?

• Mild infections may improve with better hygiene, but most fungal infections require treatment to fully clear up.

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2. How long does treatment take?

• Topical treatments: 6–12 months

• Oral antifungals: 6 weeks (fingernails) to 12 weeks (toenails)

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3. Can I wear nail polish during treatment?

• It’s best to avoid nail polish as it can trap moisture and reduce medication effectiveness—unless you're using medicated lacquer.

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4. Are nail infections dangerous?

• Usually not, but if left untreated, they can cause nail damage, spread to other nails, or lead to secondary infections—especially in people with diabetes or weakened immune systems.

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5. Can I treat nail fungus at home?

• Mild cases may respond to natural remedies or OTC creams, but persistent or severe infections need prescription medications.