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Dermatology (Expert Forum)
Fingernail trauma/fungal infection
Answered by
Alan Rockoff, MD - dermatology, Child Skin Problems
The Rockoff Dermatology Center
Brookline - MA
This forum is for questions regarding Dermatology issues, such as: skin rashes, acne, birthmarks, skin infections, rosacea, and general skin care.
Fingernail trauma/fungal infection
by nancy, Oct 25, 2000 12:00AM
I have been reading quite a bit of info on the net related to fingernail fungus. About one year ago, I inflicted trauma to two of my fingernails while wearing acrylics. I began picking at the cuticles on one side of each nail (thumb on right hand and middle finger on left hand) to a point where I had separated the nail from the nail bed down to the base of the nail. I then developed a fungus as evidenced by the greenish color forming at the base of the nail where it was detached from the skin. I removed the acrylics and tried treating the fungus. My gen physician gave me about 1 month's supply of LAMISIL pills approx. 10 months ago, but I did not see a huge improvement - not sure if I did not take them long enough as I have read 6 six weeks supply is typical treatment. I have since obtained a gel topical treatment from my dermatologist that he formulated to treat toe nail fungus... applying it morning and night for approx. the last 6 months. It seems to have helped in that the nail is re-attached to the skin, but the nail is still discolored (yellowish), think and crumbly. I have been filing down the thickness on the surface of the nail, but not sure if that helps or hinders the situation. I am concerned, based on what I have read, that what I have is incurable or irreversible. I am planning to talk to a podiatrist if they typically see patients w/ fingernail fungus to get a treatment, or possibly consulting w/ my gen physician to get a prescription for a full LAMISIL (oral) treatment. Can you please make a recommendation(s)?
Doctor's Answer
by Alan Rockoff, MD, Oct 25, 2000 12:00AM
, Oct 25, 2000 12:00AM
Nancy:
Yes -- my suggestion is that you start by getting a proper diagnosis. What you describe is almost certainly not fungus. Fungus rarely affects the fingernails unless the toenails are infected first. Green pigment represents colonization with pseudomonas bacteria, the result of trauma, not fungus. It comes as no surprise that the Lamisil pills did not help.
Acrylic nails are not likely to cause permanent nail damage, but picking might. The only way to find out is to leave the nails alone for 6 months. You can trim them and polish them, but that's it. They're bound to improve, even if not completely.
If you have any doubts on this score, ask the dermatologist who gave you the special fungal formula whether he or she performed a culture, and whether an alternate diagnosis may be considered. Or get another opinion. Besides mine.
Best.
Dr. Rockoff
Yes -- my suggestion is that you start by getting a proper diagnosis. What you describe is almost certainly not fungus. Fungus rarely affects the fingernails unless the toenails are infected first. Green pigment represents colonization with pseudomonas bacteria, the result of trauma, not fungus. It comes as no surprise that the Lamisil pills did not help.
Acrylic nails are not likely to cause permanent nail damage, but picking might. The only way to find out is to leave the nails alone for 6 months. You can trim them and polish them, but that's it. They're bound to improve, even if not completely.
If you have any doubts on this score, ask the dermatologist who gave you the special fungal formula whether he or she performed a culture, and whether an alternate diagnosis may be considered. Or get another opinion. Besides mine.
Best.
Dr. Rockoff
I have also had problems with acrylic nails.
I worn them for several years and had no problems,
but recently had them removed because of severe
itching and drying on the skin and cuticle of several fingers.
The skin becomes dry and hard and it is impossible NOT
to pick this off. The end of the fingers can not even bend because of the tightness of the skin. It has been so aggravating.
I have tried a variety of ointments, vitamin E, sleeping with gloves on, and more. The gen. dr says to try an anti-bacterial cream like neosproium (sp). I dont have a dermatologist in the area-any advice?
Thank you,
Ramona