Almost fifty percent of the general population and forty percent of people more than sixty years of age are victims of an infected toenail.
An infected toenail can present itself as acute paronychia, most commonly cased by staphylococcus aureus infection and it mostly affects the nails of children.
Predisposing factors for the infection is usually trauma, however if finger nails are affected, then nail biting or nail sucking are also common factors.
In this condition the proximal fold of the nail is red, painful and swollen.
As the bacteria invade and grow underneath the nail, pus develops in the lesion, which is discharged when pressure is applied to the area.
Other conditions which may mimic acute paronychia are Herpes simplex virus infection and dermatitis.
These are relapsing conditions.
In Herpes simplex infection, there is much more pain as compared to a bacterial infection and the infection is usually recurrent.
The drug of choice in acute paronychia is Cephalosporin, a broad spectrum antibiotic.
The purulent discharge should be collected from the lesion and sent for a cultural evaluation in order to know the exact organism causing the infected toenail.
Green nails is a bacterial infection caused by Pseudomonas aeruginosa, which is a gram negative bacterium.
Bacteria are not capable of invading a healthy and strong nail plate, so these bacteria colonize the nail plate under favorable conditions like acute paronychia or onycholysis ( broken nails).
Pyocyanin staining is used to reveal the presence of the bacterium in the nails.
The staining gives a greenish-black color to the lesion.
The pigment usually disappears by using chlorhexidine drops three to four times daily.
Systemic antibiotics are usually not required.
Fungal infection of the toenail, medically termed as onychomycosis, is caused by organisms like dermatophytes, nondermatophytes and candida species.
It is a common toenail disease more prevalent with the increase of age.
The type of nail invasion determines the clinical features of this infection.
In mold onychomycosis the proximal nail fold is infected, this is usually associated with bilateral swelling and inflammation of the nail beds.
However, the entire nail plate is involved in white superficial onychomycosis.
Nondermatophytic onychomycosis of the toenail is spreading worldwide and is a point of concern in dermatological settings because the disease responds poorly to systemic antibiotics.
Systemic antifungals like Terbinafine and Itraconazole have proven beneficial in cases of toenail onychomycosis.
The cure rate is approximately eighty percent.
However, recurrence does occur in almost twenty percent of these infected toenail cases.