Nail Disorders

Common problems affecting the nail unit (nail and the skin around and under the nail) are:

Paronychia: It is the painful swelling of the nail fold; it can be acute or chronic.

  • Acute paronychia: Usually caused by bacterial infection following trauma to the nail folds
  • Chronic paronychia: Caused by fungal infection; secondary to the destruction of the cuticle due to detergents and water. It is common in individuals who do wet jobs – house wives, hotel workers, maids, gardeners etc. It is also common in diabetics.

Paronychia can lead to nail changes in the form of ridging, scaling and discoloration.


Acute paronychia – if pus is present, incision and drainage should be done. Antibiotics should be directed against the most common pathogenStaphylococcus aureus and the drug of choice is cloxacillin.

Prevention is by avoiding trauma to the nail unit during manicure.

Chronic paronychia – It can sometimes present with acute exacerbation due to secondary bacterial infection and a course of antibiotics as mentioned above would be needed. In addition, systemic antifungals like fluconazole or itraconazole (for moulds) or terbinafine (for dermatophytes) should be taken for 3-4 months for finger nails and 4-6 months for toe nails.

Preventive measures:

  • Do not use harsh detergents
  • Wipe the hands dry every time the hands are washed
  • Do not destroy the cuticle during manicure and pedicure
  • Use moisturizers regularly to prevent chapping and cracking of nail folds

Other common problems involving the nails are:

  • Brittleness of the nail
  • Discoloration
  • Pitting an ridging of the nail
  • Separation of the nail from the nail plate
  • In-growing nail