Nail Disorders

Onychomycosis (nail fungus) presents as thickened, brittle nails with discoloration ranging from yellow to brown to white, along with a crumbly texture and nail separation from the nail bed. Ingrown nails cause pain, redness, and swelling along the nail edges, with drainage or pus if infected. Psoriatic nails show pitting, thickening, discoloration, and nail separation, often accompanied by skin symptoms. Other nail dystrophy may present as ridging, splitting, peeling, or brittleness. Across these conditions, patients may experience pain or tenderness, particularly with ingrown nails. Difficulty wearing certain shoes or performing daily activities is common, as is cosmetic concern affecting self-confidence.

Onychomycosis results from fungal infection by dermatophytes, non-dermatophytes, or yeasts, and is more common in warm, moist environments. Ingrown nails develop from improper nail trimming, tight shoes, nail injury, or curved nail growth patterns. Psoriatic nails stem from psoriasis affecting the nail matrix, and skin psoriasis often accompanies nail involvement. Age and immunosuppression increase fungal infection risk, as does diabetes, which increases infection susceptibility. Nail trauma or damage, prolonged moisture exposure (common in swimmers and healthcare workers), and nail salon visits with inadequately sterilized tools all contribute to nail disorders.

Oral antifungal medications including terbinafine and itraconazole are effective for moderate to severe onychomycosis. Terbinafine (Lamisil) has higher cure rates, and treatment duration is typically 6 to 12 weeks depending on the medication and severity. Topical antifungal medications like efinaconazole (Jublia), which is FDA-approved for toenail fungus and shows good penetration, and ciclopirox (Penlac) work best for mild to moderate fungal infections or as adjunct therapy.

Specialized laser treatments, such as 1064-nanometer Nd.YAG laser, eliminate fungal infections with minimal side effects, though multiple sessions are often needed for good cosmetic outcomes. Chemical ablation or surgical removal of the infected nail plate allows topical antifungal application directly to the nail bed and is effective for severe cases or treatment failures. For ingrown nails, conservative management with proper trimming and padding may help, though partial or complete nail plate removal is necessary if conservative measures fail. Intralesional corticosteroid injections into the nail matrix may reduce inflammation and pitting for psoriatic nails.

Nail disorder treatment varies by condition and severity. For fungal infections, oral medications require 6-12 weeks of treatment with periodic monitoring. Topical medications are applied daily and may require 6-12 months of consistent use. Laser therapy sessions take 15-30 minutes, most patients require 3-4 sessions spaced 4-6 weeks apart. Results from any treatment take time because nails grow slowly. Healthy nail replacement is visible only after 3-6 months as the new growth emerges from the cuticle.

Ingrown nail procedures are quick office visits under local anesthesia. Recovery is typically quick with minimal discomfort, though activities should be modified for 1-2 weeks.

You should see a dermatologist if you notice discoloration, thickening, or damage to your nails, or if nail fungus is suspected since early treatment improves outcomes significantly. Ingrown nails causing pain or recurring infections warrant professional evaluation. If nails are separating from the nail bed or if you have psoriasis affecting your nails, professional care is important. If home remedies or over-the-counter treatments haven't worked or if nail problems are affecting your quality of life or causing discomfort, seek expert help.

The dermatologists at Cleaver Dermatology can quickly diagnose your nail disorder and recommend the most effective treatment. Call (770) 800-3455 today.

Keep nails clean and trimmed straight across without cutting too short. Control moisture by keeping feet dry and changing socks if they become damp, while avoiding prolonged water exposure. Wear breathable, well-fitting shoes that don't cause nail trauma. Choose reputable nail salons with proper sterilization, or consider bringing your own tools. Wear shower shoes in gyms, pools, and communal bathing areas to protect against fungal exposure. Be careful not to injure nails and trim cautiously to prevent ingrown nails. Control underlying conditions such as diabetes and psoriasis, as these increase nail disorder risk. Finally, ensure adequate protein, zinc, and biotin in your diet for optimal nail health.