- Nails appear dystrophic with marked subungual hyperkeratosis.
- Toe nails more commonly affected.
- Fungal infections may be present in other areas such as axillae, groin and scalp.
- Very dystrophic nails may cause discomfort.
- Can affect multiple nails.
- Trichophyton rubrum is the commonest causative organism. This invades the nail bed then spreads through the nail.
- Nails clippings and subungual debris sent for mycology.
- Microscopy may reveal hyphae. If not sample can be cultured, but it may take a few weeks to obtain the results.
- Topical antifungal agents may help if mild disease not affecting the matrix.
- Oral antifungals such as terbinafine usually required.
- Prolonged course of up to six months.
- Recurrence is common.
- Damaged nails will need to grow out.
- Nails look dystrophic and may have surface pitting.
- The nails have discolouration in the form of oil spots.
- Finger nails more commonly affected by psoriasis than tinea.
- Both toe and finger nails maybe affected.
- Psoriasis may be present elsewhere such as skin.
- Chronic condition which may be hereditary and for which at present there is no curative treatment.
- Topical steroids applied directly to the nail.
- Injection of corticosteroid into the nail bed.
- Systemic therapy with either methotrexate or systemic retinoids may be required in more troublesome cases.
- PUVA may sometimes help.
Contributed by Dr Nigel A Stollery, a GP at Kibworth Health Centre, Leicestershire and Clinical Assistant in Dermatology at the Leicester Royal Infirmary.