Q. I am a 41-year-old woman in Great Britain who has had a Pseudomonas bacterial infection on a nail for three years. I have taken several courses of different antibiotics, but they have not cured the infection. The infection is so bad that my finger throbs in pain a lot of the time. The doctor has recommended that the entire fingernail be removed. I am on the waiting list for treatment. It could be several months, even as long as a year, before I get the treatment. How would you treat this?
Dr. Paul Kechijian
. Pseudomonas infections commonly occur under the nail plate. They almost never respond to oral antibiotic therapy. The quickest way to clear the infection is to remove the nail that overlies the infection. Unfortunately, a year is too long to wait for this treatment because it appears that a more deep-seated infection is developing.
If a physician cannot remove the nail plate, perhaps a competent manicurist can. This will allow the area to dry out and the infection to clear. After the nail plate is removed, you should apply a mixture of equal parts clear tincture of iodide and rubbing alcohol each time you wash and dry your hands. This mixture will kill the organisms that are present.
I also recommend you don’t wear nail polish for a while after the infection clears to prevent it from recurring.
Q. A client’s nail has partially detached from the nail bed (it is still attached at the cuticle and sidewall.) The client banged her nail very hard some time ago. Now it appears that skin is growing out from between the nail bed and nail plate. I trim the growth but it keeps coming back. What is causing this? Are the injury and the growth related?
A. Injuries to the nail frequently result in the formation of a growth called pyogenic granuloma. I see pyogenic granuloma commonly in patients with ingrown toenails. This growth is a benign tumor that is comprised of “healing tissue.” Unfortunately, sometimes the healing process goes overboard, and a benign growth persists.
Unless the growth is entirely removed, it is likely to recur. Trimming leaves the base of the growth intact so that it continues to grow. Frequent trimming may also lead to an infection. I recommend you refer this client to a dermatologist who is familiar with pyogenic granulomas. The growth can be removed in its entirety under local anesthetic and a biopsy obtained to confirm that it is benign.
In response to your final question, the two conditions are probably related. The trauma led to nail bed injury, which failed to heal properly and resulted in the formation of a pyogenic granuloma.
Q. I have a new client whose nails on the index and middle fingers on both hands always peed from the free edge. She has worn silk wraps and tried various creams, lotions, and cure-alls to make her nails grow normal. I am wondering if there is some nutritional imbalance or physiological reason for her problem.
A. The fact that the same two nails on either hand are involved suggests that there is a problem with the formation of those four nails. It is unlikely that peeling is caused by something she is doing to her nails.
It is also unlikely that she has a nutritional problem because a nutritional disorder would affect all of the fingernails in a similar manner. I would guess that she has an underlying problem with nail formation that is the result of a matrix disorder, such as psoriasis or lichen planus. It is difficult to speculate further without examining her nails. I don’t believe there is anything you can do to help her; nor do I believe that a change in diet will have an impact on her problem. She should consult with a dermatologist to identify the cause of her problem. There may be a treatment, depending on what is causing the peeling.