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Treatment of Common Nail Diseases

  1. Acute Paronychia
    Bacterial infection (Staph. Aureus, Strep. Pyogenes) is the commonest cause. There is acute swelling, tenderness and collection of pus in the nail fold. A swab should be taken if possible.
    Give ampicillin 250 mg qid and cloxacillin 250 mg qid for 10 days. Analgesic e.g. panadol should also be prescribed. Consider incision and drainage if swelling and pain does not improve quickly.
  2. Chronic Paronychia
    This is a multi-factorial condition:
    1. Irritant dermatosis
    2. Infection: candidal; bacterial sometimes
    3. Background eczema of psoriasis
      All of the factors should be eliminated.
      Protection: Avoid water, detergent, soap if possible. Use rubber glove with inner cotton glove.

      Emollient: frequent application of blend emollient and use as a soap substitute.
      Antibiotic: A course of systemic antibiotic should be consider in the first week.

      Topical treatment: A combination of topical steroid and antifungal to the nail fold.
  3. Nail Diseases in Psoriasis
    Nail dystrophy in psoriasis is difficult to treat. Patients should be informed of the limited effectiveness of various treatments.
    1. General care: Avoid trauma. Keep nail short. Rubber with inner cotton gloves. Use emollient as soap substitutes. Exclude concomitant fungal infection.
    2. Steroid: Ultra-potent steroid to the nail fold with or without occlusion. Intralesional steroid is an alternative but is painful.
    3. PUVA: Nail disease may improve with systemic PUVA for the whole body. Topical PUVA may worth trying.
    4. Retinoids: While subungual hyperkeratosis improves, pitting and onycholysis get worse with etretinate.
Others: Topical calcipotriol, topical 1% fluorouracil, topical cyclosporin A have been tried with variable success.

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