Thumb dented underneath nail, and now infected.

Hi

About three-four years ago I trapped my thumb in a sliding door, and as expected it immediately turned purple with the blood underneath it. It was incredibly painful and the pressure was quite high underneath as well. At that time, I didn't know that it was adviable to relieve the pressure by heating a needle and piercing a hole in the thumb, etc, so I just left it. (This bit isn't particularly pleasant, but:) eventually all the dried blood came out, and I cut the nail quite far down to try and grow it back in a relatively normal fashion. Anyway, three or four years later, I now have a normal and straight thumb nail, but the finger underneath it is permanently dented, to the point where I can actually push a piece of paper or a pin or something similarly small right down underneath my nail to where the base of the nail starts. In this gap underneath the nail, there is an infection growing, and has been for three years,

I've been to the doctors several times, but no matter how infantly I spell out the problem, they don't seem to understand what's wrong, and they just prescribe me tablets which are intended to relieve nail infections. They don't work. I've had Terbinafine and Itraconazole, and I've even been prescribed some Nail Lacquer, which did absolutely nothing. It's not particularly painful, and I periodically remove some of the fungal stuff myself with a needle, because like I said I can get a needle underneath my nail with ease and without pain, however it is very unsightly. I'd be grateful for any suggestions, or even a script with which I could go to my GP to get them to understand the problem!!

Thank you

Paul

[Bhupinder Kaur, MD]

Hello,

I cannot confirm anything without examination but these symptoms at the base of nail can be due to paronychia. It results from a breakdown of the protective barrier between the nail and the nail fold. Diagnosed by gram staining and KOH wet mounts from the skin and nail scrapings.

Treatment includes warm water soaks of the affected finger 3-4 times per day, oral antibiotics, topical antifungals and surgical intervention in more severe cases. My sincere advice would be to consult a dermatologist.
If the symptoms persist then please consult a dermatologist. It is very difficult to precisely confirm a diagnosis without examination and investigations and the answer is based on the medical information provided. For exact diagnosis, you are requested to consult your dermatologist. I sincerely hope that helps. Take care and please do keep me posted on how you are doing.