Infections


Onychomycosis

Fungal infection of the nails is increasingly common with age and frequently ignored as it is often asymptomatic. Clinically this presents as asymmetrical whitening (or yellowish black discoloration) of one or more nails, which usually starts at the distal or lateral edge before spreading throughout the nail. The nail plate appears thickened. Crumbly white material appears under the nail plate. The nail plate may become destroyed with advanced disease.

Management

  • Oral antifungals like itraconazole or terbinafine
  • Amorolfine nail lacquer

Paronychia

Acute paronychia presents as painful swelling and erythema involving the nail folds. It may also be associated with purulent discharge. It usually occurs secondary to trauma superimposed with bacterial infection. Other microbial infections like candida or herpes may also be responsible.

Chronic paronychia is a common occupational hazard and certain occupations and working conditions predispose to or foster its development. Housewives, domestic help, bar staff, canteen workers, laundry workers, butchers, and fishmongers are particularly susceptible. The common link among these is a constant need to immerse hands and feet in soap and water. Exposure to alkalis, solvents and oils may also cause paronychia.

Management

  • Treatment depends on the causative organism
  • Correction of predisposing factors

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