💅 Men's Health

Nail Disorders: Causes and Treatment

Fungal nail infections, ingrown nails, and other common nail problems

Nail disorders are common in Nigeria, with fungal nail infections (onychomycosis) and ingrown toenails being the most frequently seen conditions. Hot and humid conditions, communal bathing areas, and tight or ill-fitting shoes all contribute. Many people tolerate nail problems for years, but some cause pain, infection, and difficulty walking. Treatment is available and effective when started early.

Signs and Symptoms

✓ Thickened, discoloured (yellow-brown-white), crumbly nails — fungal nail infection

✓ Separation of the nail from the nail bed (onycholysis)

✓ Pain, redness, and swelling at the nail edge — ingrown toenail

✓ Pitting, ridging, or oil spots on nails — associated with psoriasis

✓ Black streak under the nail — may be a bruise (subungual haematoma) or rarely melanoma

✓ Soft, painful nail fold with pus — paronychia (bacterial or candida infection)

✓ Spoon-shaped nails (koilonychia) — associated with iron deficiency anaemia

Risk Factors

Fungal infection: communal swimming pools, gym changing rooms, shared footwear, athlete's foot
Ingrown toenails: cutting nails too short or curved, tight shoes, hyperhidrosis (excess sweating)
Psoriasis: 50% of patients have nail involvement
Diabetes: increases risk of fungal and bacterial nail infections
Immunosuppression: HIV, chemotherapy
Iron deficiency anaemia (koilonychia)

When to Seek Help

See a doctorAny nail with a dark streak that was not caused by trauma, especially if it is growing or involves the nail fold (Hutchinson's sign) — must exclude subungual melanoma

Podiatry or surgeryIngrown toenail with recurrent infection — partial nail avulsion (removal of the nail edge) under local anaesthetic is curative

DermatologyNails associated with psoriasis, alopecia, or other skin conditions for integrated management

Tests & Diagnosis

🧪 Nail clipping for microscopy and culture (MC&S)

Definitive diagnosis of fungal nail infection — send nail clippings and subungual debris to lab; results take 2–6 weeks

🧪 KOH preparation

Microscopic examination with potassium hydroxide — quick test for fungal elements; faster than culture

🧪 Blood tests

FBC for koilonychia (iron deficiency); blood glucose if fungal infection in diabetic patient

🧪 Skin biopsy (nail matrix biopsy)

Rarely needed — for suspected melanoma or when diagnosis is unclear

Treatment Options

Fungal nail infection: oral terbinafine

Most effective — 250mg daily for 6 weeks (fingernails) or 12 weeks (toenails); avoid in liver disease; check LFTs if prolonged course

Fungal nail infection: topical amorolfine or ciclopirox

Nail lacquer applied weekly for 6–12 months; less effective than oral but useful for mild infection or when oral antifungals are contraindicated

Ingrown toenail: conservative

Warm soaks 3× daily; gently lift nail edge; wear wider shoes; proper nail cutting technique (straight across, not curved)

Ingrown toenail: surgery

Partial nail avulsion under local anaesthetic — permanent cure when combined with phenolisation of the nail matrix; performed by surgeons or trained podiatrists

Paronychia (acute)

Antibiotics (flucloxacillin) for bacterial; antifungal (fluconazole) for candida; incision and drainage if pus is present

Nail psoriasis

Potent topical steroids, vitamin D analogues, or biologics (if severe psoriasis elsewhere) — nail improvement takes 12+ months

Frequently Asked Questions

How long does fungal nail treatment take?

Nails grow slowly — toenails take 12–18 months to fully regrow after starting treatment. Oral terbinafine courses are 3 months for toenails, and nail appearance improves over 6–12 months.

Can I use tea tree oil for fungal nails?

Tea tree oil has mild antifungal properties and may help prevent spread of mild infection, but is not effective treatment for established nail fungus — use proven medications.

Is nail fungus contagious?

Yes — the same fungi that cause athlete's foot can spread to nails and to other people. Avoid sharing footwear, use flip-flops in communal showers, and treat athlete's foot promptly.

Does nail varnish cause nail damage?

Frequent use of nail varnish, especially with acetone-based removers, can cause nail brittleness and white discolouration (keratin granulations) — this is cosmetic, not a fungal infection.

Can diabetes cause nail problems?

Yes — diabetic peripheral neuropathy means reduced sensation, so diabetics may not notice nail pain. Poor circulation delays healing. All diabetics should inspect their nails daily and see a podiatrist regularly.