What Is Onychia?In their original healthy state, the fingernails and toenails are designed to repel infection and remain waterproof. But when any part of the nail bed, cuticle, nail itself or surrounding tissues gets compromised, this protective seal can be breached by pathogens. Onychia is caused by bacteria or a fungus. These microorganisms often initially gain entry because you have been injured. Often the infection will begin at the base of the nail (nearest the cuticle) with some redness and swelling. But sometimes the infection will begin along the sides of the nail – the initial point of entry can depend on where the injury occurred. Here, it is important to know that untreated onychia can over time become chronic. An acute case of this condition that is untreated may resolve on its own but then recur at a later date. This indicates that the microorganisms were never completely eliminated from the area. For this reason, it is very important to determine what is causing the onychia symptoms and have them treated properly during the first occurrence. According to Remedy Land, if treatment is not obtained and onychia becomes chronic, it could result in a total loss of the affected nail.(2)
CausesThere are various possible causes for this nail disorder. According to NAILS magazine, one of the less well known causes for onychia is having a manicure or pedicure done under less than sterile conditions.(3) If shared manicurist tools are not disinfected between uses, this can also transfer the microorganisms that cause this problem from one client to the next. For this reason, it is important to choose your salon with great care and an eye towards hygiene and overall sanitation. As outlined by UMed: Medically Sound, other causes of onychia include the following possibilities:(4)
Nail trauma. If you have had an injury to your foot, nail bed, cuticle or nail fold or to other nearby tissues, bacteria or fungi can invade through even micro-injuries and begin to cause symptoms of onychia.
Poorly fitting footwear. If you regularly wear high heels, narrow-toed shoes, too-short athletic shoes or a combination thereof, over time this can cause micro-injuries to your toenails that could permit microorganisms entry.
Inadequate foot or hand hygiene. There are many activities of daily life, such as gardening, cooking, sports and similar others that could cause minor or major injuries to hands or feet and nails. Present bacteria or fungi could invade from unwashed produce or raw meats, soil or even less clean locker room conditions and cause onychia. Onychia can also sometimes occur in elderly individuals who are no longer available to tend to their personal hygiene needs in full on their own.
Complications from diabetes. Because diabetes is a disease that impacts blood flow and blood toxicity, it can lower the body’s own natural immune response to the presence of bacteria or fungi. This can increase cases of nail diseases in both hands and feet.
Complications from skin conditions. Psoriasis and eczema are two skin conditions that sometimes manifest onychia as side effects.
Nutritional deficiencies. If the body does not get adequate, balanced, daily nutrition, this can cause nail beds to become weak and cracked, producing increased susceptibility to conditions like onychia.
Use of artificial nails. For individuals who have artificial nails to extend their natural nails, an infection can sometimes begin underneath the artificial nail and begin to spread without the person even realizing it. This can in time lead to nail disorders and abnormalities.
Ingrown nail. An ingrown fingernail or toenail can damage surrounding tissues and make a path for microorganisms to enter and cause infection.It is important to note that these are not the only possible causes for onychia. If you are experiencing symptoms of onychia but are unaware of having any of these health issues, it is still vitally important to seek medical care to resolve your symptoms. As The Clinical Advisor points out, untreated onychia may recur and evolve into more serious health issues over time.(5)
SymptomsAs you can likely imagine (or may already be experiencing), one of the main symptoms onychia tends to be physical discomfort in the area where the infection is occurring. Here are other commonly reported patient symptoms of onychia:(6)
» Redness or discoloration of surrounding tissues. » Existing presence of an ingrown nail. » Discomfort and irritation at the infection site. » Swelling and inflammation, including edema (fluid buildup) near the infection site. » Discoloration of the nail bed (may be yellow, brown, black, white or some other color). » Fluid buildup may produce pus or discharge that begin to drain and spread the infection from the nail bed to the surrounding tissues or vice versa. » The pus may cause an abscess, an open area surrounded by inflamed tissue. » Fever or heat accompanied by reddish streaks around the affected area of the nail/nail bed/tissues. » Muscle or joint aches or weakness.These are not the only possible symptoms that onychia can cause. For this reason, it is very important to keep a written log of your symptoms to share with your doctor or dermatologist. This can be useful to identify what is causing your onychia and identify the right treatment approach without delay.
How to Diagnose OnychiaAccording to American Family Physician (AAFP), it is relatively easy to confuse onychia with similar skin disorders such as psoriasis and eczema as well as other types of infections.(7) For this reason, it is important to culture the nail bed or affected tissues to determine which pathogen(s) may be present. When seeking a diagnosis for suspected onychia, MD Edge states that the physician or dermatologist will ask for a self-report of medical and medication history and also a history of hand or foot habits.(8) For instance, continual hand/foot washing in strong solutions, regular manicure/pedicure appointments, a known past history of allergic contact dermatitis (eczema) or psoriasis, diabetes, UTIs, a latex allergy or a recent trauma to the area can all indicate the possibility of onychia. The physical exam will focus on the affected area and will include palpation to detect areas of discomfort and inflammation, as well as the possibility of the abscess. A visual examination will look for redness or rash, thickened nail beds, swollen tissues, pus or discharge and other signs of possible onychia and/or paronychia. If pus or discharge is present, a culture may be done to attempt to determine the specific microorganism causing the irritation. This can be helpful in choosing the best medication for treatment.
TreatmentOnce a definitive diagnosis of onychia is achieved, treatment can begin. The type and level of treatment will depend on two factors: whether the onychia is acute or chronic and how severe the infection is.(9) Home remedies, such as soaking the affected area in warm salt water, vinegar or another doctor-recommended preparation, can be helpful in mild cases of onychia. For more serious cases, topical or systemic oral antibiotics are often prescribed to wipe out the pathogen completely. At-home comfort helps, such as those described in Primary Care Geriatrics; the pressure is relieved from the infected area by the use of elevation, shoe modifications and tube foam to ease discomfort.(10)
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If you suspect you may be suffering from this health issue, these are the steps you should take:
» Keep a written symptoms log and write out your personal medical history.
» Make an appointment with your family doctor or dermatologist.
» Have the necessary diagnostic tests to obtain an accurate diagnosis of onychia.
» Follow the prescribed treatment plan as your doctor recommends.
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(6)London Medical Gazette: Or, Journal of Practical Medicine
(10)Primary Care Geriatrics: A Case-based Approach By Richard J. Ham