RISK FACTORS: Acute - trauma to skin surrounding nail, ingrown nails, Chronic - frequent immersion of hands in water (cooks, chefs, bartenders), diabetes mellitus
GENERAL MEASURES
β’ Acute - warm compresses or vinegar soaks, elevation
β’ Chronic - keep fingers dry
SURGICAL MEASURES Incision and drainage (I&D) of abscess, if present. If there is a subungual abscess or ingrown nail present, will need partial or complete removal of nail.
DRUG(S) OF CHOICE
. Acute (if diabetic, suppurative or more severe cases):
. Dicloxacillin 125-500 mg q6h
. Cloxacillin 250-500 mg q6h
. Erythromycin 500 mg q6h
. Cephalexin (Kefl ex) 250 mg q6h
. Chronic:
. Bacterial - mupirocin (Bactroban)
. Yeast or dermatophyte - topical imidazoles (econazole, ketoconazole, terbinafi ne
. Systemic:
. Itraconazole (Sporanox) 200 mg/day for 90 days (may have longer action because incorporated in nail
plate). Pulse therapy may be useful: 200 mg BID for 7 days, repeated monthly for 2 months
. Terbinafine (Lamisil) 250 mg q/d x 6 weeks (fingernails) or 12 weeks (toenails)
. Fluconazole (Difl ucan) 150 mg/week for 4-6 months
ALTERNATIVE DRUGS Antipseudomonal drugs, e.g., third generation cephalosporin, aminoglycosides
PATIENT MONITORING Routine followup until healed
PREVENTION/AVOIDANCE
β’ Chronic - avoid frequent wetting of hands, wear rubber gloves with cloth liner
β’ Good diabetic control
POSSIBLE COMPLICATIONS
β’ Acute - subungual abscess
β’ Chronic - secondary ridging, thickening and discoloration of nail, nail loss
EXPECTED COURSE/PROGNOSIS With adequate treatment and prevention, healing can be expected