Nail Infections: Types, Causes, Symptoms and Treatments

Changes in nail colour, texture, or the presence of pain around the fingernails or toenails can often indicate the early stages of a fungal nail infection. Such infections are widespread and may be caused by fungi, bacteria, or yeast microorganisms that thrive in warm, moist environments frequently encountered by the hands and feet. These infections can significantly affect the appearance, strength, and overall health of the nails. 

Fungal nail infections differ in nature and are classified according to the type of microorganism involved and the area of the nail affected. Here is everything you need to know about types, causes, symptoms, and treatment of a nail infection. 

Types of Nail Infections 

Nail Psoriasis

Nail psoriasis leads to visible changes in the nail, such as denting or crumbling.

Causes:

This condition develops when psoriasis impacts the skin of the nail bed or surrounding areas.

Symptoms of nail infection:

• Crumbling or pitted nails

• Yellow or brown discolouration

• Skin buildup beneath the nails

• Blood spots under the nails

• Detachment of the nail from the bed

Treatment:

Individuals diagnosed with psoriasis should consult a doctor upon noticing changes in their nails. Treatment options may include:

• Strong corticosteroid creams

• Tazarotene for pitting and discolouration

• Calcipotriol for subungual buildup

• Corticosteroid injections

• Laser therapy

Brittle or Splitting Nails (Onychoschizia)

This common condition results in weak, thin, or splitting nails. It is usually caused by repeated wetting and drying, though in some cases, it may be linked to iron deficiency or underlying health issues.

Symptoms:

Due to infection, the finger nails become fragile and break easily. If both fingernails and toenails are affected, the cause is often internal; when only the fingernails are involved, external factors are more likely responsible.

Treatment:

Moisturising regularly and protecting nails from harsh chemicals or frequent water exposure are the most effective remedies.

Onychogryphosis

Onychogryphosis is characterised by abnormally thick or overgrown nails, commonly affecting the big toe. In some cases, the nail may grow unevenly, taking on a curved or horn-like appearance, hence the name “Ram’s horn nails.”

Causes:

• Genetic predisposition

• Physical injury

• Poor circulation

• Psoriasis

• Ichthyosis

Symptoms

The nail becomes excessively thick or uneven, often resembling a horn shape.

Treatment

A podiatrist or dermatologist typically trims the nail and guides the patient on home care. Multiple visits may be necessary for proper management, though permanent treatment involves nail bed removal.

Ingrown Toenails

This condition occurs when the nail edge grows into the surrounding skin, leading to pain, redness, and swelling.

Causes:

According to the American Academy of Orthopaedic Surgeons, genetics can contribute to ingrown toenails. Other causes include:

• Improper trimming

• Wearing tight footwear

• Physical trauma

Symptoms:

• Swelling and tenderness

• Redness or soreness

• Presence of pus in infected cases

Treatment:

Possible remedies include:

• Soaking the nail in warm water several times daily

• Wearing comfortable shoes

• Keeping the feet dry

• Taking pain relievers like acetaminophen or ibuprofen

• Surgical correction for severe cases

Nail Fungal Infections

Fungal nail infections cause thick, discoloured, and brittle nails. They are more common in toenails than in fingernails.

Causes:

Fungal growth occurs when spores enter through cracks in the nail or nail bed. Risk factors include excessive sweating, athlete’s foot, and unsterilised salon tools.

Symptoms:

• Thickened nails

• Brown, yellow, or white discolouration

• Fragile or cracked nails

Treatment:

Antifungal medications, either topical or oral, are the main treatment. In some cases, complete nail removal is required. The Centers for Disease Control and Prevention (CDC) notes that recovery can take up to a year.

Onycholysis

Onycholysis occurs when a nail gradually and painlessly separates from the nail bed, often due to injury or an underlying health issue.

Causes:

• Nail trauma

• Excessive filing or chemical exposure

• Allergic dermatitis

• Prolonged submersion in water

• Psoriasis or fungal infection

• Certain medications

Symptoms:

Partial nail separation, discolouration (green, yellow, or white), thickened or bent edges, and tissue buildup beneath the nail.

Treatment:

Treatment depends on the cause and may involve:

• Medications for psoriasis or fungal infection

• Addressing iron deficiency

• Avoiding harsh chemicals

Preventive care includes trimming nails, wearing gloves during prolonged water contact, and managing underlying conditions.

Paronychia

Paronychia is an infection around the nail fold, causing swelling and discolouration. It can be acute or chronic.

Causes:

Acute cases usually result from trauma to the cuticle or nail fold, while chronic cases are linked to allergens or irritants.

Symptoms:

Acute:

• Swelling, redness, and pain

• Pus accumulation

• Fever or gland tenderness in severe cases

Chronic:

• Red or swollen nail folds

• Pus discharge

• Lifting of the nail from its bed

Treatment:

Treatment depends on severity:

• Warm compresses

• Topical or oral antibiotics

• Corticosteroid creams

• Surgical drainage if necessary

For chronic paronychia, managing underlying irritants and allergens is crucial. Full recovery may take several weeks or months.

Causes of Nail Infection 

Direct Contact with Fungi in Damp Environments

Fungi thrive in warm, moist, and dark areas. Walking barefoot in public places such as swimming pools, locker rooms, and communal showers increases the likelihood of exposure to these organisms. The damp surfaces in such environments serve as ideal breeding grounds for dermatophytes, which can easily transfer to the feet and nails.

Minor Skin or Nail Injuries

Small cuts, cracks in the skin, splinters, or a separation between the nail and nail bed provide an entry point for fungi and bacteria. Individuals involved in sports or physically demanding work are more prone to such minor injuries, which can compromise the protective barrier of the nail, increasing susceptibility to infection.

Poor Nail Hygiene and Maintenance

Using unsterilised nail tools or sharing items such as clippers, files, or towels with an infected person facilitates the spread of microorganisms. Neglecting proper nail care, prolonged dampness, or frequent exposure to harsh cleaning chemicals without protective gloves can weaken the nails and surrounding skin, increasing the risk of hand and foot nail infection. 

Treatment of Nail Infection

Oral Antifungal Medications

Prescription pills target the infection internally and are generally the most effective solution. Treatment duration typically lasts around two months for fingernail infections and up to three months for toenails.

Topical Antifungal Treatments

These are applied directly to the affected nails and are useful for mild cases. However, topical solutions may not penetrate deeply enough to treat severe infections. They are often used in combination with oral medications for better results.

Surgical Removal

In cases where medications fail, the affected nail may need to be removed to allow a healthy nail to grow. Though effective, reinfection remains a possibility if preventive measures are not followed.

Laser or Photodynamic Therapy

Emerging treatments involving focused light or laser therapy aim to destroy the fungal organisms without damaging surrounding tissue. Research continues to evaluate their long-term effectiveness.

A nail infection extends beyond cosmetic concerns; it can lead to pain, discomfort, and complications if not properly addressed, particularly in individuals with weakened immune systems or underlying health conditions. Factors such as environmental exposure to fungi, improper footwear, and inadequate hygiene practices often contribute to the problem. Maintaining clean, dry nails and practising good hand and foot care can significantly reduce the risk of infection and promote long-term nail health.