Nail Dystrophy

If a fungal infection is suspected then the first step is to send clippings of the nail for analysis. Initial results are usually available within 1-2 weeks.

If fungal infection is confirmed

Fungal infections generally require a course of tablet treatments for 3 months. The most commonly used tablet is terbinafine. Itraconazole is also sometimes used. Topical treatments such as nail laquers are unlikely to be effective as they do not penetrate sufficiently deeply into the nail.

Fungal infections are not dangerous and it is not essential to treat.

If there is not fungal infection

If the dystrophy is caused by trauma e.g. running or picking of the nail then this should be avoided. If there is suspicion of a tumour or cancer then Dr Lynch will recommend a nail biopsy (see below).

If there is no fungal infection and no evidence of a tumour or trauma then the most common causes of dystrophy are inflammatory conditions such as psoriasis or lichen planus.

Options for inflammatory conditions are as follows:

• Conservative management (doing nothing)
• Nail biopsy to learn more about the cause of the dystrophy.
• Steroid injections in the base of the nail - this is very painful, may not lead to an improvement and needs to be repeated every few months. You can learn more at the following link: steroid injections
• Topical treatments: Topical steroids or steroid tapes can be trialled, however in my experience I have not found them to be effective.
• Systemic therapies: These are tablet or injection immunosupressants. These generally need to be taken for many years or for life. They can be very effective, however they are associated with some important risks and it is important that you are monitored closely whilst taking them. This is a specialised area and I do not prescribe these medications. If you would like to learn more about this option then I can refer you to a suitable specialist to discuss further.

Nail biopsy

A nail biopsy can be performed to learn more about the cause of the dystrophy, however this is a very invasive procedure and often results in permanent damage to the nail growth. It is important to perform this if cancer is suspected but for other conditions the risks may outweight the benefits.

A nail biopsy is performed under local anaesthetic requiring two injections either side of the digit. The digit will usually take a number of weeks to heal and will be painful during this time limiting activity. There is a risk that the biopsy does not give a clear diagnosis and in this eventuality either re-biopsy or monitoring may be considered. The biopsy will often result in permanent damage or distortion of the nail including either loss of part of the nail or a ridge or gap in the nail. Other risks include bleeding, infection, pain (which rarely may be persistent), nerve damage or vascular damage to the digit, numbness or burning (which rarely can be permanent) and the need for further treatment according to the results of pathology. When you attend for surgery you will be asked to sign a consent form. Please read this carefully before the procedure: https://www.drmagnuslynch.com/consent/skin-surgery