Nail Infections

Question 1

What is Acute Paronychia?

Answer 1

Localised superficial infection of the folds of tissue surrounding the nail
Most commonly caused by Staph aureus

Question 2

What are clinical features of Acute Paronychia?

Answer 2

Painful swelling of the skin tissue at the base of the nail bed

O/E
- lateral/proximal nail folds are erythematous, painful and swollen
- may have pus

Question 3

What is the management of Acute Paronychia?

Answer 3

Warm Soaks
If collection- I&D
Topical abx for minor infections e.g. fusidic acid
Oral abx
- fever
- extensive area of infection
- I&D not performed

Question 4

What is Onychomycosis?

Answer 4

Fungal infection of all or any part of the nail
Toenails are more at risk than fingernails

Causative organisms
- Dermatophyte fungi e.g. Trichophyton Rubrum/Mentagrophytes most common
- Other causes include moulds and yeast

Question 5

What are clinical features of Onychomycosis?

Answer 5

May affect part or all of the nail
Discolouration- may look green/white/yellow
Nail can appear flaky or crumbling
Dystrophy of nail- thickening and hyperkeratosis

Question 6

What are investigations for Onychomycosis?

Answer 6

Nail clippings/scrappings for cultureW

Question 7

What is the management of Onychomycosis?

Answer 7

If dermatophyte or candida nail infection confirmed
- Topical antifungal
- Amorolfine 5% nail lacquer tx for 6 months once weekly- high failure rate

If topical measures do not succeed or inappropriate
- Dermatophyte- Oral terbinafine 1st line
- Candida- Oral Itraconazole 1st line