Understanding Nail Infections in the Indian Context
Nail infections affect 10-20% of adults in India, driven by humid climates, communal bathing, shared footwear, and diabetes prevalence. Onychomycosis (fungal nail infection) accounts for 50% of all nail disorders, causing thickened, discolored, crumbling nails. Paronychia (nail fold infection) results from bacterial invasion (staph, strep) or chronic moisture exposure.
Common nail infection types:
- Distal subungual onychomycosis: Fungus under nail tip (most common; yellow/brown discoloration)
- White superficial onychomycosis: White chalky patches on nail surface
- Proximal subungual onychomycosis: Fungus at nail base (HIV marker if recurrent)
- Acute paronychia: Painful, pus-filled nail fold (bacterial; staph aureus)
- Chronic paronychia: Red, swollen nail fold (chronic moisture, yeast—candida)
At Ajuda Hospitals Dermatology, we provide IADVL-aligned nail infection care:
- Fungal culture and KOH microscopy for definitive diagnosis
- Oral antifungals (terbinafine, itraconazole) for effective cure
- Surgical drainage for paronychia or nail removal for severe fungal nails
- Preventive education to reduce recurrence
Our multilingual team (Telugu, Hindi, Urdu, English) delivers evidence-based nail care with compassion.
When to Consult Our Nail Infection Specialists
⚠️ Seek Expert Care If You Experience:
- ✓ Thick, yellow, brown, or white discolored nails
- ✓ Painful, swollen, red nail fold with pus drainage (paronychia)
- ✓ Nails separating from nail bed (onycholysis)
- ✓ Recurrent nail infections despite OTC treatments
Schedule a consultation for accurate diagnosis, culture-guided treatment, and prevention strategies.
Our Diagnostic Approach
Clinical Examination & Nail Dermoscopy
Dermatoscopic nail examination magnifies nail changes:
- Fungal onychomycosis: Spikes, longitudinal streaks, subungual debris, onycholysis (nail separation)
- Psoriasis: Nail pitting, oil drop sign, salmon patches, splinter hemorrhages
- Paronychia: Red, swollen nail fold; pus under cuticle; loss of cuticle
- Melanoma: Irregular dark streak (Hutchinson's sign—urgent biopsy)
Differential diagnosis:
- Fungal vs psoriasis: Fungal culture differentiates (psoriasis is culture-negative)
- Fungal vs trauma: History of injury; dermoscopy shows hemorrhage (trauma) vs spikes (fungal)
KOH Mount & Fungal Culture
Nail clippings or subungual debris:
- KOH microscopy (same-day): Visualize fungal hyphae or yeast
- Fungal culture (2-4 weeks): Identify species:
- Dermatophytes (T. rubrum, T. mentagrophytes)—most common; best response to terbinafine
- Candida (yeast)—chronic paronychia; needs fluconazole
- Non-dermatophyte molds (Aspergillus, Fusarium)—resistant; may require itraconazole or voriconazole
Sensitivity testing: Guides therapy for resistant infections.
Bacterial Culture (Paronychia)
Pus swab from nail fold abscess:
- Gram stain (same-day): Preliminary bacterial identification
- Culture & sensitivity (48-72 hours): Isolate staph aureus, strep, Pseudomonas; test antibiotic susceptibility (MRSA detection)
Nail Biopsy (Atypical Cases)
Nail plate + nail bed biopsy for:
- Melanoma (dark streak, Hutchinson's sign)
- Psoriasis (culture-negative nail dystrophy)
- Lichen planus (nail thinning, pterygium formation)
Treatment Pathways
Fungal Nail Infections (Onychomycosis)
Oral Antifungals (Gold Standard)
Terbinafine 250mg daily:
- Mechanism: Fungicidal; accumulates in nail plate
- Duration:
- Fingernails: 6 weeks
- Toenails: 12 weeks (slower growth)
- Effectiveness: 70-80% cure for dermatophyte infections
- Monitoring: Baseline liver function (AST, ALT); repeat at 6 weeks
- Side effects: GI upset (5%); liver toxicity (<1%); taste disturbance (rare)
- Contraindications: Liver disease, pregnancy
Itraconazole pulse therapy:
- Dose: 200mg twice daily for 1 week/month × 2 months (fingernails) or × 3 months (toenails)
- Effectiveness: 60-70% cure (slightly lower than terbinafine)
- Advantage: Shorter daily dosing (pulsed); alternative if terbinafine intolerant
- Drug interactions: CYP3A4 metabolism (avoid with certain statins, calcium channel blockers)
Fluconazole (for Candida nail infections):
- 150-300mg weekly for 6-12 months
- Less effective for dermatophyte infections
Topical Antifungals (Mild Disease or Adjunct)
Ciclopirox 8% lacquer:
- Apply daily to affected nails; file nail surface weekly
- Cure rate: 30-40% as monotherapy (better when combined with oral therapy)
- Duration: 6-12 months
Efinaconazole 10% solution:
- Higher nail penetration than ciclopirox
- Cure rate: 50-60% as monotherapy
- Duration: Daily for 48 weeks
Best used: Mild, superficial white onychomycosis; or combined with oral therapy for synergy.
Surgical Nail Removal (Severe or Painful Cases)
Partial or complete avulsion under local anesthesia:
- Indications: Thick, painful nails unresponsive to oral antifungals; onycholysis with recurrent infections
- Procedure: Remove nail plate; apply topical antifungals directly to nail bed
- Recovery: Nail regrows in 6-12 months (toenails slower)
- Effectiveness: Speeds cure when combined with oral antifungals
Chemical matricectomy (permanent removal):
- Phenol application to nail matrix for recurrent, painful infections
- Prevents nail regrowth (reserved for chronic, severe cases)
Paronychia (Nail Fold Infections)
Acute Paronychia (Bacterial)
Abscess drainage:
- Incision and drainage under local anesthesia if pus present
- Relief within 24-48 hours
Oral antibiotics:
- Cephalexin 500mg QID or cloxacillin 500mg QID for 7-10 days (staph/strep coverage)
- Doxycycline or trimethoprim-sulfamethoxazole if MRSA suspected
Warm compresses: Promote drainage; apply 3-4x daily
Chronic Paronychia (Moisture + Yeast)
Moisture avoidance:
- Keep hands dry; wear cotton-lined gloves for wet work
- Avoid biting nails, picking cuticles
Topical antifungal/steroid combination:
- Clotrimazole-betamethasone cream twice daily for 2-4 weeks
- Suppresses candida and inflammation
Oral fluconazole (resistant cases):
- 150mg weekly for 4-8 weeks
Prevention & Recurrence Management
Hygiene measures:
- Trim nails straight (avoid ingrown edges)
- Dry thoroughly after bathing/swimming
- Antifungal powders in shoes and socks
- Breathable footwear (leather, mesh); avoid tight shoes
- Sterilize nail clippers with alcohol; don't share tools
High-risk patients (diabetes, immunosuppression):
- Podiatry foot exams every 3-6 months
- Prophylactic antifungal lacquer (amorolfine 5% weekly) after successful treatment
- Blood sugar control (target HbA1c <7%)
What to Expect: Your Care Journey
Fungal Nail Infection Visit (45 min)
- Nail exam with dermoscopy
- Nail clipping for KOH microscopy (results in 15 min) and fungal culture (2-4 weeks)
- Prescription: Oral terbinafine ± topical ciclopirox
- Baseline liver function test ordered
- Nail care and hygiene counseling
6-Week Follow-Up
- Repeat liver function test (if on terbinafine)
- Assess early response (healthy nail growth at base)
- Review fungal culture results; adjust therapy if resistant species
Month Review
- Visible nail clearing documented with photos
- Continue oral therapy until completion (12 weeks total for toenails)
- Reinforce prevention strategies
Month Outcome
- Complete healthy nail regrowth
- Transition to maintenance: Prophylactic antifungal lacquer weekly if high-risk
- Annual check-ups for recurrence monitoring
Paronychia Visit (Emergency or Scheduled)
- Exam and pus culture swab
- Drainage under local anesthesia if abscess
- Oral antibiotics initiated
- Follow-up in 48-72 hours (telemedicine) to confirm improvement
Technology & Innovation
Nail Dermoscopy & In-House Mycology Lab
Dermatoscopic nail exam provides immediate visual diagnosis (fungal spikes vs psoriatic pitting). In-house KOH microscopy confirms fungal infection same-day, enabling prompt oral antifungal initiation. Fungal culture identifies resistant species, guiding therapy adjustments.
Benefits:
- Same-day fungal confirmation (no empirical treatment delays)
- Species identification for targeted therapy
- EMR photo tracking documents regrowth progress
Telemedicine Follow-Up
- Photo uploads of nails for remote progress monitoring
- Lab result interpretation via video consult
- Prescription refills without clinic visits for stable patients
Preventing Complications
Untreated nail infections cause:
- Cellulitis: Bacterial spread to surrounding skin (especially in diabetics)
- Permanent nail deformity: Chronic fungal infections destroy nail matrix
- Diabetic foot ulcers: Infected ingrown toenails → non-healing wounds
- Onychogryphosis: Thick, ram's horn nails (painful; impair walking)
Our Prevention Strategy:
- Early treatment prevents nail matrix damage
- Diabetes control (HbA1c <7%) reduces infection risk
- Podiatry coordination for high-risk foot care
- Hygiene education prevents recurrence
Why Ajuda for Nail Infection Care?
🔬 Definitive Diagnosis
Same-day KOH microscopy and fungal culture identify exact species, enabling targeted oral antifungals and avoiding empirical treatment failures.
💊 High Cure Rates
Oral terbinafine achieves 70-80% cure for fungal nails; surgical drainage resolves paronychia within 48-72 hours.
🔁 Recurrence Prevention
Hygiene education, antifungal powders, and prophylactic lacquers reduce reinfection by 40-50% in high-risk patients.
Take the First Step
Nail infections are persistent but curable with proper diagnosis and treatment. Culture-guided oral antifungals restore healthy nails; prompt drainage relieves painful paronychia.
Call 9010550550 or WhatsApp for nail infection consultations. Our dermatology specialists are available Monday-Saturday, 9 AM-7 PM, with same-day KOH microscopy and expert care.
Healthy, clear nails are achievable—let Ajuda Hospitals guide your journey to lasting nail health.