Nail pitting and yellowing

[Phindatalus]

I am a 24 year old male, generally healthy. About 6 months ago I noticed that 1 of my fingernails started to yellow in the corners at the distal part of my nail, at the site of yellowing the nail also got hardened. With time, the same happened in some of my other fingernails ( but stayed well demarcated at the corners. Also, both my toenails show a slow regression in the line where the nail is attached to the nail bed. Lastly, about a month ago the ring fingers in both my hands show fine pitting, 5-6 pits per nail, needle head size.
I saw a dermatologist that without any lab tests prescribed me with itraconazole. After one session of the drug (200mg Twice a day for one week) now I'm one week before starting the next dose and there is absolutely no change. I would like your opinion whether itraconazole treatment sounds suitable, and to know what others conditions could yield the symptoms I described. Thank you

[Bhupinder Kaur, MD]

Hello,

Thanks for posting your query.

I can understand your concern for the pitting and yellowish discoloration of the nails. Two possibilities which can cause both pitting and yellowish discoloration of the nails are:

1) Fungal infection of the nails. It is also called onychomycosis and the commonest presenting feature is thickening and discoloration of the nailbed which may be white, black, yellow or green. As the infection progresses the nail can become brittle, with pieces breaking off or coming away from the toe or finger completely.


2) Second possibility is of psoriasis nails. The presenting symptom includes small pits which appear on the surface of the nail. There may be one pit or many pits on the surface of a single nail. Then a white or yellowish patch appears which may separate the nail from the nailbed.

The treatment that you have been prescribed i.e. itraconazole is an antifungal drug which is used for moderate to severe fungal infection. However for mild to moderate fungal infection, topical antifungals are used. But before using any of them diagnosis needs to be confirmed and antifungal drugs have potential side effects.

The three main diagnostic tests are potassium hydroxide smear, culture and histology. I suggest you to get a potassium hydroxide smear of the nail clipping done and if it comes out negative then get a biopsy of the nail done to rule out any psoriatic nail. Treatment is different for both and is dependent on diagnosis. However treatment of both is difficult and takes time. Treatment of onychomycosis is more difficult because the infection is embedded within the nail and is difficult to reach. Moreover full removal of symptoms is slow and may take a year or more.

So my sincere advice is to get it checked from a dermatologist and get the diagnosis confirmed.

Hope that this information helps and hope that you will get better soon.

Wishing you good health.

[Phindatalus]

In case you want me to upload pictures I would be able to do so