Onychomycosis
Presentation
- Very common cause of discoloured and dystrophic nails
- Toenails more commonly affected than fingernails
- Caused by a fungal or yeast infection, most commonly Trichophyton rubrum
- Nail often becomes thickened and may be difficult to cut
Management
- Diagnosis can be confirmed by microscopy
- Treatment unnecessary in most cases
- A course of an oral antifungal for three to six months is required
- Recurrence after treatment not uncommon
- Nail varnish is an alternative to treatment
Onychogryphosis
Presentation
- Thickened dystrophic nail, usually caused by self-neglect
- Surface of nail may be ridged
- May also occur secondary to trauma or peripheral vascular disease
- In most cases, toenails affected rather than fingernails
- In fingernails, usually only a single nail is affected
- More common in the elderly
- May be quite painful and debilitating
Management
- Treatment usually undertaken by podiatrists, who are able to file and cut the nails
- With continuing chiropody, should not recur
Onycholysis
Presentation
- Relatively common condition
- Separation of the nail from the nail bed
- Usually starts distally and extends proximally, except in psoriasis
- Causes include psoriasis, circulation problems such as Raynaud's and thyroid disease
- May occur as a side-effect of medication, for example, tetracyclines
Management
- Treatment can be difficult
- Keeping nails short should help
- Secondary infection may occur, which can be treated with antifungals or antibiotics
Psoriasis
Presentation
- Affects fingernails and toenails
- Changes occurring with psoriasis include surface pitting, onycholysis and subungual hyperkeratosis
- Nail psoriasis occurs in about 50% of patients with psoriasis
- Can rarely occur without skin psoriasis
Management
- Diagnosis usually clinical
- Management includes keeping nails short and avoiding false nails and moisture
- Treatment can be difficult and includes topical steroids
- In severe cases, oral treatment such as methotrexate can be helpful.
