Nails are more than simple protective coverings for sensitive fingers and toes. Your nails are living, growing parts of your body, and as such, they can get sick just like the rest of your body.
Infections of the nails and the surrounding skin can result from injury, ingrown nails, split and separated nails and other more serious conditions. Infections not only cause pain, but they can also affect the way your nails grow and can impact your overall health.
Nails seem vastly different from the outer layer of skin known as the epidermis, but they are merely the hardening of the top layers of epidermis. On thicker-skinned parts of your body, such as your palm, the epidermis comprises five layers — at the tips of your fingers and toes, these outermost layers of the epidermis harden into nails. These nails, made from a protein called keratin, protect the sensitive tissue underneath and make it possible to use fingers and toes for scratching and other purposes.
An infection occurs when foreign bodies, such as viruses, fungi and bacteria, get inside your body. Infections may seem like mild matters, but they can become serious complications for people with other medical conditions or if they go untreated and spread. Signs of infection include redness, swelling, irritation and pain. Infected tissue is also warm and tender to the touch and may produce pus.
No infection should go untreated — not even one in the smallest toenail. On the next few pages you’ll learn why nail infections occur and how you can treat them.
Chemotherapy and Nail Infections
If you’re undergoing chemotherapy, you’re likely to experience some of the side effects associated with these powerful drugs. Chemotherapy drugs specifically attack the fast-growing cells in your body, such as those in your hair and your nails, which can make you more prone to nail injuries and infections.
During chemotherapy, you may experience several changes in your nails. They may look bruised, develop blemishes such as lines or indentations, become dry and thin or grow more slowly. Your nails are likely to break more easily, your cuticles may fray, and sometimes a nail may fall off. These side effects are temporary, but they can lead to a more serious problem: infection.
Chemotherapy suppresses your immune system, which is the set of processes in your body designed to fight infection — with a weaker immune system, your nails and other tissues lose strength. You’ll be more likely to develop an infection through a skin opening where your cuticle has frayed or in the nail itself, and you’ll be less able to combat it. If you suspect that you have a nail infection, see your doctor immediately.
A variety of nail infections can occur among chemotherapy patients and other people:
A fungal infection, called onychomycosis, usually starts on your big toe as a discolored spot and spreads to the cuticle, causing the end of your nail to rise. Occasionally, infection can also begin at the cuticle and raise your nail from there. Once the fungus sets sin, it causes your nails to thicken and flake. The most common fungus to cause these symptoms is Trichophyton rubrum.
Yeast, a specific type of fungus, can also get under your nails when your immune system is compromised. A yeast infection causes your nails to thicken and turn yellow, brown or white. People who develop yeast infections in their fingernails may spread the infection to their mouths.
Paronychia, a bacterial or fungal infection of the nails, causes inflammation and redness at the base of your nails and in the cuticles. Pseudomonas, commonly referred to as “green spots” or “green nails,” results when bacteria get under the nail plate or between the natural nail and an artificial nail. Bacterial infections can be short- or long-term and are more likely to discharge pus. Keeping the skin around your fingernails and toenails clean and dry reduces the likelihood of contracting paronychia.
On the next page you’ll learn what physicians can do to treat nail infections.
Protect Your Nails
The last thing you need when you’re undergoing chemotherapy is a nail infection. Here are some tips for avoiding one:
Wear rubber gloves when gardening, cleaning house or washing dishes.
Keep your nails trimmed and clean, and don’t pick, bite or tear your nails or cuticles.
Use moisturizing cuticle and nail cream.
Use mild soaps and cleaners, and avoid nail polish removers that contain drying chemicals like acetone.
Limit the amount of time your nails are in water, and dry them thoroughly after bathing or showering.
Don’t get a manicure unless you bring your own sanitized equipment, and avoid artificial nails — the adhesives can trap bacteria.
Treating Nail Infections
Different types of nail infections call for different treatments, and some infections are easier to treat than others.
Fungal nail infections, including yeast infections, can be stubborn and often recur even with treatment. If you suspect that you have a fungal nail infection, see your doctor. Over-the-counter remedies are inadequate for fighting fungal infections, and you don’t want to waste time while the infection worsens.
A doctor can treat infected nails in several different ways. One method is to prescribe an oral antifungal medicine, such as terbinafine or itraconazole — these medicines help a new fungus-free nail grow. If your doctor prescribes an oral medicine, you’ll need to take it for six to 12 weeks, and you probably won’t have a completely clean, healthy nail for at least four months. Antifungal medications can also cause side effects, including rashes and liver damage.
For mild infections, your doctor may prescribe ciclopirox, an antifungal nail polish that you paint on daily for a week. After a week, you wipe the nail clean with alcohol and start again, repeating the weekly applications 52 times. This treatment requires you to apply the medicated polish every week for a year, and the nail polish isn’t guaranteed to clear up the infection. A doctor may also recommend applying over-the-counter creams that contain urea, or he or she may file down the nail, which is known as debridement, to increase healing time.
Finally, for severe or particularly painful infections, your doctor may suggest removing the infected nail entirely. The surgery is quick and simple, but you may have to wait as long as a year for the new nail to grow.
Bacterial infections, such as paronychia and pseudomonas, require different treatment. People with bacterial infections can alleviate pain and swelling by soaking their hands or feet in warm water three to four times a day. Your doctor may prescribe an oral or topical antibiotic, depending on the cause of the infection. Some forms of paronychia may result from fungal infections, meaning the doctor will probably prescribe an antifungal medical as described above.