II. Pathophysiology
- Pseudomonas pyocyanea or Pseudomonas aeruginosa infection
- Infection occurs after local Trauma lifts the nail from the nail bed, allowing entry of Pseudomonas
III. Risk Factors
- Workers in warm, moist environments
- Dishwashers
- Barbers
- Nail Salon Technicians
- Bakers
- Janitors
- Homemakers
- Chronic Paronychia
- Onycholysis
- Onychomycosis
- Artificial nails or nail polishes (possible)
- Immunocompromised State
IV. Signs
- Blue-green biofilm on the nail surface
V. Labs
- Clinical diagnosis is pathognomonic and no additional testing is needed
- Consider nail culture or biopsy if unclear diagnosis
VI. Management
- Best treatment protocol is unclear
-
General Measures
- Nail care (trim nails and keep dry)
- Avoid repeat Trauma to the area
- Home treatments
- Finger or toe soaks in dilute white vinegar (1:1 vinegar to water)
- Dilute bleech soaks (1 teaspoon bleach per gallon water) have also been used
-
Topical Antibiotics applied to nail bed twice daily (over 4 to 6 weeks)
- Topical Gentamicin
- Topical Fluoroquinolone
- Oral Antibiotics (severe infections or Immunocompromised state)
- Oral Ciprofloxacin
- Other measures
- Nail removal
VII. References
- Jhun, Raam and DeClerck in Herbert (2015) EM:Rap 15(12): 3-4
- Fawcett (2004) Am Fam Physician 69(6):1417-24 [PubMed]
- Quattlebaum (2021) Am Fam Physician 104(6): 645-6 [PubMed]