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Nail Disease

There are many different types and causes of nail disease. Several of the more common nail diseases include onychomycosis (fungus infection), onychoschizia (nail splitting), onycholysis (nail separation), and paronychia (inflammation around nail).

Onychomycosis is a fungal infection under the nail. It often presents as yellow discoloration of the nail with crusty material present directly under the nail tip. This condition is most often painless and usually is of cosmetic concern. Onychomycosis is most often seen on the toenails in the context of athlete's foot (tinea pedis), but can occur in the fingernails. The treatment of a nail fungus infection may include topical prescription creams or lacquer, or oral medications. Treatment should specifically be sought by patients with diabetes or lower leg swelling. If given Lamisil®, the usual treatment course is one 250mg tablet daily for 90 days. This medication should not be taken by patients with a history of liver dysfunction. All patients taking this medication should be alert for yellowing of the skin, abdominal pain, nausea, or vomiting. Should any of these symptoms occur, alert your physician immediately.

If you are given Lamisil, you must get a lab test prior to initiation of therapy. Cure rates for Lamisil vary between 60-85%. Although you are only treated for 3 months, it will take one year for your new, normal nail to grow out. If you choose to do Penlac Lacquer, you must apply it to the affected nails nightly for one year.

If you are given Fluconazole, you must get a lab test prior to initiation of therapy.

Onychoschizia is superficial splitting of the nail tip. The cause is not directly known, but many nails tend to be affected and trauma / picking worsen this condition. It is neither dangerous nor progressive. Treatment of this condition is variably successful with the use of 2-2.5 mg of oral biotin vitamin daily.

Onycholysis is nail separation, usually towards the nail tip. It often presents at a white area under one or several nail tips that is not red or inflamed. These areas are often caused by trauma either by grabbing objects with the nail tip, forceful manicures, or forced removal of acrylic nails. Other diseases with onycholysis include nail fungus infections, psoriasis, and medication allergies.

Paronychia is inflammation of the nail folds around the nail itself. This condition presents with red, often painful, skin around the nail. Pressure on the area may sometimes produce pus at the site. Acute paronychia (most commonly due to bacterial infection) is painful, sudden, and often pus forming. Chronic paronychia (sometimes due to yeast infection) is sometimes painful, but usually presents as red, thickened, and cracking skin around the nails. Either type of paronychia may be caused by irritation or allergic reactions. Treatment of paronychia depends on the type, but may consist of oral antibiotics, topical antibiotics, topical anti-fungals, topical steroids, or topical thymol solutions. In either case, prolonged contact with water should be avoided.

Don Mehrabi MD, FAAD
Dermatologist, Certified by the American Board of Dermatology
Los Angeles, California

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