Tips for dealing with fungal nail infections

Donya Betancourt, Pediatrician, Sanur, Bali drdonya@hotmail.com

After introducing fungal nail infections last week, this week we shall learn about its treatment. This may be required for a prolonged period and is expensive.

Partially treated infection may be impossible to spot for many months as anti-fungal drugs can be detected even a year later.

Mild infections affecting less than 80 percent of one or two nails may respond to topical antifungal medication but cure usually requires an oral antifungal medication.

Here are some things you can do to take care of your nails if you have a fungal infection:

* Keep your nails short and file down any thick areas.

* Don't use the same nail trimmer or file on healthy and infected nails. If you have your nails professionally manicured you should take your own nail files and trimmers from home.

* Avoid walking barefoot in public areas, such as locker rooms.

Paronychia refers to inflammation of the nail fold. It can be acute or chronic.

Acute paronychia develops over a few hours when a nail fold becomes painful, red and swollen. Sometimes yellow pus appears under the cuticle. In some cases, acute paronychia is accompanied by fever and painful glands under the arms. It is usually due to a bacterial infection treated with oral antibiotics. Sometimes an abscess forms and has to be lanced.

Acute paronychia usually clears completely in a few days, and rarely recurs.

Chronic paronychia is a gradual process and much more difficult to get rid of. It may start in one nail fold but often spreads to several others. Each affected nail fold is swollen and lifted off the nail plate. It may be red and tender from time to time, and sometimes a little pus can be released from under the cuticle.

The nail plate becomes distorted and ridged as it grows. It may become yellow or green and brittle. After recovery, it takes up to a year for the nails to grow back to normal.

The inflammation results in debris which builds up, encouraging more infection.

Treatment:

* Keep the hands dry and warm.

* Avoid wet work, or use totally waterproof gloves.

* Keep scrupulously clean.

* Wash thoroughly after dirty work with soap and water, rinse off and dry carefully.

* Don't let the skin dry out.

* Apply an emollient hand cream frequently -- dimethicone barrier creams may help.

* Apply antiseptic or antifungal lotions regularly twice daily to the nail fold.

* A course of an oral antifungal agent may be recommended by a dermatologist.

It often takes months to clear chronic paronychia, and it can recur in predisposed individuals.

Another common nail problem is an ingrowing toenail.

When a toenail becomes ingrown, the sides or corners of the nail curl down and dig into the skin, causing swelling, pain and redness.

The major causes are shoes that do not fit well and improperly trimmed nails. Shoes that are too tight press the sides of the nail and make it curl into the skin. Nails that are peeled off at the edge or trimmed down at the corners are also more likely to become ingrown.

To avoid ingrown toenails, you should cut your nails straight across. The top of the nail should make a straight line.

What is the best treatment for a painful ingrown toenail?

When the problem is mild, you may only need to soak your foot in warm water for 15 to 20 minutes and place dry cotton, such as part of a cotton ball, under the corner of the nail.

Signs that the problem is getting worse include increasing pain, swelling and drainage of the area. Sometimes minor surgery is needed to remove the part of the nail that is poking into the skin. Don't pick at your nails or tear them at the corners.