Nailing Down Nail Infections


By: Joseph Jorizzo

The condition of your nails may point directly toward the condition of your health.

If you are in good health, your fingernails and toenails tend to be smooth, somewhat curved and slightly pink. Abnormalities in the color, shape or condition of your nails, however, may indicate medical problems of varying severity.

Novartis Pharmaceuticals Corporation recently commissioned a survey of 1,017 adults, conducted by Roper Starch Audits and Surveys Worldwide. The survey revealed that only 48 percent of Americans know that unexpected physical changes in their nails can signal a significant medical problem including infection, anemia and—in extreme circumstances—even cancer or kidney problems. Furthermore, of those who noticed unexpected changes in the appearance of their nails, a mere 40 percent had them examined by a physician.

Implications for People With Diabetes

The fungal infection known as onychomycosis is the most common nail infection, accounting for approximately 50 percent of all nail problems. Onychomycosis results in thick, brittle nails that can be sharp and pointed, causing injury to the surrounding skin.

An estimated 30 million individuals in the United States suffer from onychomycosis.

According to the November 2000 issue of the Journal of the American Academy of Dermatology, onychomycosis is also the most common nail disorder among people with diabetes, representing about 30 percent of cutaneous fungal infections. One study published in the October 1998 issue of the British Journal of Dermatology, involving 550 people with diabetes, found that 26 percent of patients had onychomycosis and 46 percent had abnormalities in their nails.

Individuals with type 1 or type 2 diabetes who have sensory neuropathy and impaired circulation of the lower extremities are at additional risk for onychomycosis. A person with diabetes who has neuropathy might not notice small cuts and breaks in the skin, which can become portals of entry for bacteria. When ignored, these minor infections can escalate into serious secondary bacterial infections that can, in turn, cause foot ulcers and gangrene.

Good Hygiene Is the Best Preventive Measure

The first line of defense against onychomycosis is good hygiene.

People with diabetes should wash and dry their feet thoroughly, wear shoes in any public shower areas and change socks daily. Nails should be trimmed to the tip of the toe. Shoes should fit comfortably—not tightly.

Socks made of synthetic fibers that “wick” moisture away from the skin are recommended for people with athletic lifestyles.

It’s best to limit the use of artificial nails because they trap water under the nail, encouraging fungal growth. And everyone should disinfect home pedicure tools and avoid using nail polish whenever redness, swelling or other evidence of infection exists.

Preventing onychomycosis is the best option, but quick and effective treatment is available if all else fails.

Don’t Overlook Nail Problems – Some Changes to Watch Out For

Dermatologists and podiatrists caution that the presence of the following nail problems may indicate potential medical conditions:

  • A fingernail or toenail that turns red may be a sign that the individual has a fever.
  • Pale or white nails usually suggest anemia.
  • Nails shaped like the back of a spoon (“clubbing”) may indicate chronic lung or heart disease, certain forms of cancer, or a long-standing infection.
  • A purple or black nail could be a sign of congenital heart disease.
  • Thick, discolored, flaky or brittle nails usually indicate onychomycosis. Symptoms may also include build-up of white, yellow or black debris under the nail plate.

    Treatment Options for Onychomycosis

    Onychomycosis can be a serious ailment, but some simple and effective treatments are available.

    • Having a healthcare professional regularly trim the nails and file down the nail plate with a surgical burr—a procedure called debridement—tends to reduce pain and fungal load, prevent ulceration and at least temporarily improve the nail’s appearance. This procedure can also be performed in conjunction with topical and oral antifungal therapies.
    • Topical antifungals have traditionally been unsuccessful in treating onychomycosis. However, using the antifungal lacquer ciclopirox for up to one year can often help diminish the infection.
    • The oral antifungal treatment Lamisil (terbinafine hydrochloride tablets) has a cure rate of about 70 percent, with few side effects and minimal drug interactions. With oral therapies, the patient’s liver function must be monitored for any rarely occurring hepatic complications.
    • In extreme cases of onychomycosis, the nails may have to be permanently removed and the nail matrix (root) destroyed to prevent regrowth.



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