Onychomycosis does not necessarily spread and does not need treatment if the patient is not bothered by it.

Fungal infections can enter a nail by one of three routes – the proximal nailfold (especially in the presence of chronic paronychia), the distal/lateral subungual areas, or the dorsum of the nail itself.

Even systemic treatment has less than an 80% success rate in treating onychomycosis. Sometimes the best bet is to remove the whole nail (which can be done either surgically or chemically with 40 – 50% urea).

Spoon-shaped nails (koilonychia) can be a sign not just of anaemia but of haemachromatosis, which sounds a bit paradoxical.

Loss of all nails can be a sign of connective tissue disorder or of hand, foot & mouth infection.

Ingrowing nails can be caused by poor nail-cutting techniques, tight-fitting footwear, or bad posture, in addition to various other less modifiable factors. If an ingrowing nail is being operated on it is important to address possible causes to minimise the risk of recurrence.

Onychogryphosis (thickened distorted dark-coloured nails) is not caused by onychomycosis but can be difficult to differentiate from it, so taking nail scrapings is perfectly reasonable. It is caused by chronically poor nail care and the treatment is cutting and filing of the nails, with good general foot care.

Brittle nails are most commonly caused by exposure to detergents/chemicals, and soft nails most commonly by excessive immersion in water (hence both tend to show up most often in people who are cleaners/domestic workers). Both types of nail fragility can also be caused by iron deficiency, thyroid problems, or peripheral neuropathy; also by age, some types of skin disease such as psoriasis or lichen planus, onychomycosis, poor nutrition and poor circulation. Treat any underlying cause and also recommend avoidance of soaps/detergents and use of cotton gloves and emollients; in stubborn cases, applying strong topical steroids to the proximal nail fold.

I wondered about the difference between chiropodists & podiatrists, but it turns out they’re the same thing but podiatry is the newer term. Proper qualifications are the DipPodMed (DPodM) or BSc in Podiatry. FCPod(S) is the advanced qualification, and MChS or FChS indicate membership of the Society of Chiropodists and Podiatrists (who have a list of qualified members for those looking to find one). It is possible to register with the Health Professions Council even if not fully qualified, so registration with the HPC is, unexpectedly, not a guarantee of training.

(Notes taken from Pulse on-line learning module)


About Dr Sarah

I'm a GP with a husband and two young children.
This entry was posted in Dermatology, Fungal infections, Nails. Bookmark the permalink.

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