Nail fungus is a septic infection of the soft tissues around the finger (toe) nail, caused by bacteria that grow and multiply under the skin through a minimally invasive break in the skin next to the nail. In the fingers, it is most often caused by injuries such as puncture wounds, tearing flesh spurs or trimming the nail too deeply. In the toes, it is most often caused by ingrown nails or tight shoes, mostly in the bunions. Nail fungus is most often seen in adolescents or women. It can occur in the fingers or in the toes, but in the fingers it is often caused by a bad habit of gnawing on the fingers and in the toes it is often caused by secondary infection from ingrown nails. In the toes, it is often caused by ingrown nails or tight shoes, mostly in the bunions.
Basic introduction
Nail infections start with mild pain and redness on one side of the nail, and then become aggravated by pus, which spreads to the other side or under the nail, forming an abscess under the nail, where yellowish-white pus can be seen, separating the deep nail from the nail bed. On the side of the ingrown toe nail there is often chronic hyperplasia of the flesh tooth tissue, which makes the wound not heal for a long time.
The proximal side of the nail (nail root) is closely attached to the skin, and the skin extends along both nails distally to form a nail groove. A nail groove is an infection of the nail groove or its surrounding tissue. It is mostly caused by injuries such as tiny puncture wounds, contusions, barbs (reverse stripping) or nail clipping that is too deep, and the causative organism is mostly Staphylococcus aureus.
Clinical classification
Nail fungus can be classified as acute nail fungus, chronic nail fungus, septic nail fungus, simple nail fungus, and ingrown nail fungus depending on the cause and clinical presentation.
1. Acute nail infection: Acute nail infection is mostly caused by Staphylococcus and Candida infections. These bacteria are present on the human skin and are generally not easily infected by the human body. They usually enter through barbs, nail contour injuries or epidermal breaks caused by chronic irritation (such as water and decontaminants) causing nail fungus. Acute onychomycosis can spread rapidly to the entire nail and even form an abscess under the nail. The local pain is severe and pulsating, and it increases when the arm is lowered, so the patient often holds the hand in front of the chest. The inflamed finger throbs painfully with the heartbeat, that is, the ten fingers are connected to the heart, and there is obvious tenderness.
2. Chronic nail fungus: Mostly occurs when acute nail fungus is not treated in time or is re-infected, and the nail becomes uneven with pitted lines. The nail may show green, yellow or black signs of infection under the nail. Mostly caused by fungal infections, diabetics and those who work with hands often immersed in water, such as housewives, fishermen, cleaners, bartenders, chefs, etc., are prone to chronic onychomycosis.
3, septic nail infection: septic nail infection is a septic inflammation caused by untimely treatment of acute nail infection. The nail groove is mildly red, painful, the small skin of the nail peels off, a small amount of pus flows from the nail groove, the edge of the nail and the nail groove becomes black, and can gradually produce nodular or myxoid protrusions of inflammatory granulation tissue, from time to time secrete pus, easy to bruise bleeding, part of the nail is damaged, the nail deformation shrinks, the nail has longitudinal ridges or transverse grooves, under the nail there is pus sneaking. In severe cases, the nail can be completely loosened and fall off.
4, simple nail fungus: simple nail fungus is mostly located in the first toe of the foot, one or two angles of the front of the toenail pierced deep into the nail groove, can not grow out, every 2 weeks to 1 month, the toe will have a sense of swelling and pain, accidentally touched will have a sharp pain, the pain will disappear after cutting with a knife, but after a while it will appear again. If you walk for a long time or do not trim your toenails, your toes may become swollen and red, and there may even be oozing fluid and granulation-like tissue in the nail grooves.
5. Ingrown toenail: Ingrown toenail is a type of nail infection caused by a toenail growing into the flesh. After more than 3 weeks of inflammation in the nail groove of the toe, it is considered to be due to an ingrown nail. Most often seen in the thumb, the laterally growing nail plate grows into the nail crease wall, causing pain and inflammation and, in severe cases, septic symptoms.
Dangers
Nail infections and ingrown toenails do not heal on their own without treatment and can become septic after a long period of time. If the nail is left untreated for a long time, the nail will be seriously deformed, resulting in the destruction of the nail bed and eventually the loss of the nail or, in severe cases, the lack of nail growth. If the toenail is repeatedly inflamed, it can easily cause an abscess under the nail, and in severe cases, it may cause osteomyelitis. In some cases, if the nail is left untreated for a long time, the immunity of the nail area is lowered and the natural protective barrier of the nail is lost, leading to infection with the fungal disease onychomycosis (gray nail), which is a highly contagious fungal disease that may lead to ringworm of the head, ringworm of the hands, and a host of other diseases if left untreated.
Consequences of untreated onychomycosis and ingrown nails.
(1) Nail fungus and ingrown toenails do not usually heal on their own without treatment, and they always walk with a limp, which affects the image.
(2) The toenail will be seriously deformed, resulting in the destruction of the nail bed, and finally the toenail is missing.
(3) Repeated inflammation of the toenail can easily cause an abscess under the nail, and in serious cases, it may cause osteomyelitis.
Therefore, it is important to treat nail infections in a timely manner.
Description of the disease
At the beginning of nail fungus, one side of the nail is mildly painful and red and swollen, then it becomes more pus-filled and the pus spreads to the other side or under the nail, forming a sub nail abscess. On the side of the ingrown toe nail there is often chronic hyperplasia of the flesh tooth tissue, which makes the wound not heal for a long time.
The proximal side of the nail (nail root) is closely attached to the skin, and the skin extends along both nails distally to form a nail groove. A nail groove is an infection of the nail groove or its surrounding tissue. It is mostly caused by injuries such as tiny puncture wounds, contusions, barbs (reverse stripping) or nail clipping that is too deep, and the causative organism is mostly Staphylococcus aureus.
Complications of nail fungus
Acute nail fungus is mostly caused by staphylococcal infection. This bacterium is present on the human skin and is usually only contaminated and does not become infected, because the body has local and systemic defenses. Only when the body’s defenses are lowered, the integrity of the skin around the nail is destroyed, or the number and virulence of the pathogenic bacteria are too high, does the infection occur. Chronic nail infections are caused by Pseudomonas aeruginosa, fungi (Candida, Aspergillus, etc.) and common Aspergillus due to frequent moisture and impregnation. Inadequate treatment results in the formation of sub nail abscesses, which can also develop into chronic nail sulcus and chronic osteomyelitis of the finger bone, with chronic sinus tracts and granulation tissue protruding outward from the sinus opening.
1. If the nail abscess is not treated in time, the abscess spreads under the nail and infection occurs between the nail plate and the nail matrix. The skin is swollen and painful around the nail, and yellowish-white pus can be seen under the nail. Some patients will have systemic symptoms such as low fever and elevated white blood cells.
2. Purulent dactylitis nail infection worsens and the infection spreads to the end skin of the finger, making the finger swollen and tingling.
What are the symptoms of nail infection?
What are the symptoms of nail infection? How can I know if I have nail infection by identifying the symptoms of nail infection? It is important to know the symptoms of nail infection to prevent and treat it.
What are the symptoms of nail fungus? The main symptoms of nail fungus are redness, swelling and pain in the subcutaneous tissue on one side of the nail. A small portion of the nail will subside on its own, but some will rapidly become pus, and the pus will spread down the side of the nail groove to the subcutaneous nail root and the opposite nail groove, forming a semi-ring-shaped abscess. The main manifestations of nail fungus symptoms are mostly seen in adolescents or women. Nail fungus symptoms can occur in both the fingers and the toes. In the case of nail fungus, it is often caused by a bad habit of biting the fingers, while in the case of toe fungus, it is often caused by secondary infection of the ingrown nail.
Initial symptoms of nail fungus
The initial symptoms of nail fungus are redness, swelling and pain on the side of the nail. The pus spreads from one side of the nail via the nail root subcutaneously to the opposite side of the nail to form a semi-ring-shaped abscess. Inadequate treatment results in the formation of an abscess under the nail, which can also develop into chronic nail sulcus and chronic finger bone osteomyelitis, with chronic sinus tracts and granulation tissue protruding outward from the sinus opening.
Symptoms and signs
Inflammation of the nail often occurs first under the skin of the nail groove on one side, showing redness, swelling and pain, and generally no systemic symptoms. If treated early, the inflammation may improve and subside. Otherwise, the lesion becomes pus, and there is a sense of fluctuation and white spots in the red and swollen area, but it does not easily break out of the pus. Inflammation can also occur at the nail root or extend to the other side of the nail groove, and when the infection worsens, there are often systemic symptoms such as increased pain and fever. The infection can spread to the deeper layers of the nail and form dactylitis because the nail prevents the drainage of the pus.
Clinical manifestations
At the beginning, the subcutaneous tissue on one side of the nail becomes red, swollen, and painful, some of which may subside on their own, while others rapidly become purulent. The pus spreads from one side of the nail groove to the subcutaneous part of the nail root and the opposite nail groove, forming a semi-ring-shaped abscess. Most nail infections do not have systemic symptoms, but if the nail is not cut and drained, the abscess can spread under the nail and become an abscess under the nail, and yellowish-white pus can be seen under the nail, which separates the nail from the nail bed. Abscesses under the nail can be caused by direct stabbing of the nail with a foreign object or traumatic hematoma infection under the nail. If left untreated, it can become chronic onychomycosis or chronic phalangeal osteomyelitis. In chronic onychomycosis, there is a small pus sinus opening with granulation tissue protruding outward from the nail groove. Severe nail fungus should be treated actively as soon as possible, usually by first reducing inflammation and pain, using iodophor or oxycodone cream to avoid infection and pus, eliminating the nail fungus and avoiding inducing fungal infections, which can sometimes occur secondary to chronic nail fungus. Clinical treatment is generally carried out using pure Chinese medicine, topical preparations once every 2 to 3 days, half a month is healed, can Taobao online purchase.
Etiology
The pathogen is mainly Staphylococcus aureus which is often found on the surface of the skin. Infection can occur after various minor injuries to the hand, such as puncture wounds, abrasions, small cuts, nail clipping too deep, reverse peeling new skin barbs, etc.. In classical medicine, it is called “snake-eye furuncle” and “substitute finger”. It is caused by traumatic infection or disease invading the nail groove, causing stagnation of qi and blood, and the flesh rotting into carbuncles when heat is strong, which belongs to the category of sores.
1.The toenail is cut too short, and the soft tissue next to it grows upward because there is no toenail to cover it, and as a result, the toenail grows out and pierces into the soft tissue.
2, Wearing unsuitable shoes. Unsuitable shoes, such as pointed shoes, too narrow in front, will squeeze up the soft tissue of the toe, and over time, will also form ingrown nails.
3, the toe has been traumatized. As a result of kicking a soccer, collision, smash, etc., so that the toe to produce damage, affecting the nail bed or nail mother cells when the toenail will also appear deformed.
4, In addition, infection fungus, body too fat, etc. are also triggering factors.
5.Very few people believe that it is caused by the stage of human evolution that
Pathophysiology
When the ingrown nail is not accompanied by infection, the soft tissue of the nail groove is keratinized and hyperplastic, and there is slight pain when walking. When infection occurs, there are obvious local symptoms of redness, swelling, heat and pain, often with secretions, and chronic infection within the nail hook is often accompanied by granulation tissue formation, which can cause lymphangitis in severe cases.
Some scholars believe that the pathological changes of ingrown nails have three conditions.
1, normal toenail, but the nail edge has spurs or grooves growing into the surrounding soft tissue
2. The edge of the toenail grows inward on one or both sides, compressing the tissue in the nail groove.
3, normal nail, but the nail lip is enlarged, blocking the nail groove.
4, congenital bunion toenail curvature is more obvious that the curvature of the large, and the habit of cutting the toenail too deep, so that the toenail cut edge and the surrounding nail groove to form an acute angle, and lead to the onset.
Local compression may be the main reason for the pathology of ingrown toenail, inflammation is only the result, and injury accelerates the process of pathological changes. Therefore the effective volume of the compression of the nail hook is lifted in order to avoid its recurrence at the root.
Diagnosis
1.Redness, swelling and pain in the proximal end of the nail groove on one or both sides of the finger or toenail, followed by the appearance of pus spots and granulation tissue visible after the flow of pus.
2. When the infection spreads to the nail bed, the local pus may cause the entire finger and toenail to float and fall off.
3. If the infection is not treated in a timely manner, a nail abscess may be formed, and it may develop into chronic nail infection and chronic finger osteomyelitis, with chronic sinus tracts and granulation tissue protruding outward from the sinus opening. Acute nail infections are mostly caused by staphylococcal infections. This bacterium is present on the human skin and is usually only contaminated and does not become infected because the body has local and systemic defenses. Only when the body’s defenses are lowered, the integrity of the skin around the nail is destroyed, or the number and virulence of the pathogenic bacteria are too high, does the infection occur.
Nail infections and ingrown nails
Differentiating between a nail infection and an ingrown nail
Because of the diversity of early symptoms of nail infections, it is common to have similar symptoms to other nail disorders. One of the most difficult diseases to distinguish between a nail infection and an ingrown nail is a nail infection. As the two are common nail disorders with very similar symptoms, let’s analyze the differences between the two.
Ingrown toenail is a disease in which the toenail (nail) penetrates into soft tissue and is repeatedly squeezed, resulting in pain, swelling, and pus in the toe.
Ingrown toenail is an inflammatory disease caused by bacterial infection on both sides of the toenail (nail), which also has symptoms such as pain, swelling, and pus. Having ingrown toenails often predisposes to onychomycosis; repeated onychomycosis can cause toenail deformation and the formation of ingrown toenails, and the two diseases are complementary and can transform each other. Both diseases are common and prevalent in clinical practice. Chronic nail infections that do not heal are most often seen on the inside and outside of the first toe of the foot.
Classification of nail fungus and ingrown nail
1. Simple onychomycosis
It is common in the fingers, and people who work in catering and washing are prone to it. It is treated by traditional methods such as topical gold paste, fish fat, and alcohol soaking, and the effect of treatment varies from person to person.
2.Simple ingrown nail (later easy to develop into nail infection)
Most of them are located in the first toe of the foot, and one or two angles at the front of the toenail pierce deep into the nail groove and do not grow out. Every 2 weeks to 1 month, the toe will have a swelling and pain, and if you touch it accidentally, you will have a sharp pain, and the swelling and pain will be eliminated immediately after you cut off the angles with small scissors. The number of people with this type is large, and when they go to the hospital for treatment, the doctor says it is not a disease; when they go to a pedicure place, they do not feel comfortable, so most of them are in a state of helplessness. If you walk for a long time or don’t remember to trim, the toe may swell and become red, and even ooze and granulation-like tissue may appear in the nail groove, at which point the ingrown nail has been transformed into a nail infection.
3. Ingrown nail
This type is the “incurable disease” that plagues many patients across the country. When there is inflammation in the nail groove of the toe for more than 3 weeks, it is considered to be due to an ingrown nail, and usually only when the ingrown nail is cured can the nail infection be cured. The treatment of ingrown toenails is not easy, the domestic medical community usually use nail extraction, but toenail removal, the growth of about 70% or the original, Professor Zhou Yanxiong pointed out that in the clinical encounter with nail extraction 13 times; pedicure sector is the uniform use of “repair treatment”, only temporarily help patients to relieve pain, but after a month to come, the more repair On the deeper, some people even have to keep pedicure for life, because of this, across the country has created a lot of “a knife”. If the direction of growth of the toenail does not change, it is almost impossible to cure the ingrown nail, and the ensuing nail fungus cannot be cured.
4. Mycosis fungoides
It is often seen in conjunction with tinea pedis, and Candida nail fungus is the most common type of nail fungus. It is characterized by flushing at the nail groove, slight swelling and pain, and often a little oozing. This type of nail infection is also more troublesome to treat, often taking several months to heal, and thoroughly killing the fungus is the key to treatment.
5. Mycosis fungoides nail infection
In other words, “gray toenail”, ingrown toenail and nail fungus exist at the same time. In this case, the treatment difficulty will escalate. But everything is mutually reinforcing, Professor Zhou Yanxiong analysis, in clinical findings, gray toenail and ingrown nail seems to exist in a mutually antagonistic relationship, it is reasonable to say that the coexistence of the three will reach the most serious state, however, some patients with ingrown nail in the infection with mold, but the symptoms are reduced, the reason for this, the original mold has “eat toen nail” characteristics, toenail infection After the mold, the front of the toenail will appear powder, so it is difficult to form a “horn spur”, the patient does not feel pain, really “the opposite of what is”.
Treatment measures
In the early stage, pure Chinese medicine products, hot compresses, physiotherapy, etc. can be used, and sulfa drugs or antibiotics can be applied. If pus is present, a longitudinal incision can be made in the nail groove to drain it. If the infection has involved the subcutaneous area at the base of the nail, make a longitudinal incision in each side of the nail groove, turn up the skin piece on the nail root, remove the nail root, and place a small piece of petroleum jelly gauze or latex sheet to drain. If pus has accumulated under the nail bed, the nail should be removed or the nail should be cut off from the pus cavity. When removing the nail, care should be taken to avoid damaging the nail bed so that the new nail does not become deformed in the future.
General conservative treatment for nail infections.
(1) Antibiotics
There are many types of antibiotics, including intramuscular, intravenous and topical.
Advantages: strong inhibitory effect on bacteria, with some anti-inflammatory and pain-relieving effect.
Disadvantages: It seems to have no effect on ingrown toenails due to physical toenail piercing.
(2) Anti-inflammatory and analgesic agents
Such as salicylic acid preparations, etc. There are oral, ointment, injection and other types.
Advantages: can reduce pain and swelling, suitable for use when pain is unbearable.
Disadvantages: ineffective in the treatment of ingrown nails, if used for a long time, the stimulation of the gastrointestinal tract is large, people suffering from gastrointestinal disease should be used with caution.
(3) Urea ointment
Pros: It can soften the skin and also the toenail, which helps to correct it.
Disadvantages: the time required to soften the toenail is very long and troublesome, and it is not effective when used alone, that is, even if the toenail is softened without the use of corrective means, it is difficult to cure the toenail deformity.
(4) Silver nitrate
Advantages: less pain during treatment, usually no anesthesia is needed, flattening of granulation tissue, and inhibition of pus and exudate.
Disadvantages: It is corrosive and can darken the skin and toenail, which can seriously affect the aesthetics. It is only useful for granulation tissue, and the correction of toenails is not very helpful.
(5) “Cotton cushion method” and “rubber tube cushion method”
Advantages: simple and convenient, can be handled by themselves.
Disadvantages: easy to fall off, insufficient filling force, poor results, easy to recur.
Instead of cotton, a drip tube is used to fill in the nail groove and is glued with a special glue.
(6) Chinese herbal medicine therapy
Chinese herbal preparations are applied externally, herbal infusions, etc., or traditional pedicure techniques, etc.
Advantages: There are usually no side effects and it is more effective in eliminating inflammation.
Disadvantages: The effect of cure needs to be determined according to the personal experience of the physician, and there is no uniform standard.
(7) Surgical treatment
Not all patients with nail infections are suitable for incision and drainage. Clinically, nail infections with pus accumulation should be incised and drained. Pre-operative preparation.
1. Select antibiotics reasonably according to the condition.
2. For severe hand infection and weakened general condition, attention should be paid to improve the general condition and increase the body resistance.
3. When the hand is incised with deeper abscess, it is appropriate to control the hemostasis with tourniquet to make the surgical field clear and ensure the safety of surgery.
[Anesthesia]
1. For purulent dactylitis with incision and drainage or nail extraction with pus accumulation under the nail, anesthesia with nerve block at the root of the finger is generally used. No epinephrine should be added to the anesthetic to avoid spasm of small arteries, resulting in impaired blood flow to the finger.
2. In the case of palmar gap abscess, septic tenosynovitis or bursitis of the hand with incision and drainage, brachial plexus nerve or wrist nerve block anesthesia is used; ketamine intravenous anesthesia can also be used.
[Surgical procedure]
A longitudinal incision is made along the nail root angle on the side of the lesion. In the case of total nail fungus, a longitudinal incision is made on each side, with the proximal end not exceeding the base of the nail bed. A sharp separation is made with a sharp-edged knife inserted between the nail root and the skin, and the flap is turned upward to release the pus and drainage by placing a gelatinous skin piece [Figure 1]. If there is pus accumulation under the nail, the nail should be removed and the pus drained while the nail is being drained, covered with petroleum jelly gauze and then bandaged. In cases of pus accumulation under the nail root only, partial nail excision and drainage can be performed by picking up the nail root and cutting it off. Care should be taken to cut out all the nail corners to avoid residual healing.
[Postoperative treatment]
1, hand infection after incision and drainage, should pay attention to the careful change of medication. First soak the wound with 1:5000 potassium permanganate solution, ask the patient to gently move the affected hand or finger, clean the wound with sterile cotton to facilitate the discharge of residual pus in the pus cavity, then dry the skin of the affected hand with dry gauze and disinfect it with alcohol, and dress it after drainage with a gum skin piece or Vaseline gauze strip.
2, generally 3 to 5 days after surgery can be removed drainage strips. After the redness and swelling have subsided and the pain has been relieved, functional finger exercises should be started to avoid tendon adhesions and scar contractures that may cause dysfunction.
(8) Chinese medicine treatment
Chinese herbal medicine is effective in treating nail infection. The author and many of my friends had their toenails removed years ago due to nail fungus. In recent years, a simpler and painless and non-invasive method has been found: use sore cream (which may have been discontinued) or plucking cream, softened by heating with a hairdryer, and apply to the affected area.
Prevention
1, usually take care of the skin around the nail, do not make any damage to it, nails should not be cut too short, and should not be used to pull “barbs”.
2, prevention is better than cure. Wooden thorns, bamboo thorns, sewing needles, fish bone thorns, etc. are the easiest foreign objects to pierce the nail groove in daily life, and should be extra careful when participating in labor or busy with household chores.
3, usually pay attention to finger care, after washing hands, before going to bed rub some Vaseline or skin cream, can enhance the skin around the nail groove resistance to disease.
4, the finger has a small injury, can be coated with 2% iodine, band-aid bandages to prevent infection.
6, if the pus has been septic should go to the hospital in time to cut, the pus drainage out. Prevent the infection from spreading and causing osteomyelitis of the finger bone.
7.If pus accumulates under the nail, the nail should be removed to facilitate adequate drainage and complete healing.
8, wear shoes of appropriate size, fat and thin, suitable and lightweight shoes.
9, diligently cut toenails, cut into arcs, nail grooves on both sides of the tip of the toenail, do not casually cut the nail groove, found that the toes squeeze each other to apply the appropriate amount of sterilized cotton, soft objects into the toe seam to separate, so that the toes normal development, to prevent pressure on the toenail into the nail groove.
10, develop good hygiene habits, do not pull out the barbs at will, once the barbs appear to use scissors to cut, do not hard to pull out.
11, nail clipping should not be too short, fingers have tiny wounds, can be coated with tincture of iodine, with sterile gauze wrapping protection, to avoid infection.