Our expert is Julia R. Nunley, MD, Professor of Dermatology, and Program Director, Dermatology, Virginia Commonwealth University.

Dr. Nunley will be presenting at Women’s Health 2016: The 24th Annual Congress, April 14-17, 2016 in Washington, DC. She’ll be one of the many outstanding presenters.

If there’s a topic you’d like covered in this blog, be sure to let me know!

Best to all of you,



In contrast to toenail infections, fingernail infections, especially those caused by candida, impact more women than men. This happens because often women’s jobs as housekeepers or dishwashers involve “wet work,” that is work where they’re putting their hands in water. This increases their vulnerability to infection. Women may also experience a bacterial fingernail infection, especially due to pseudomonas species. Damage to the cuticle during a manicure procedure, that is, the cuticle is pushed back too aggressively, or the cuticle clipping involves anything beyond removing dead skin, will predispose women to these infections. Bacterial or fungal infections can develop where the nail and the skin meet at the base or the sides of the finger. In a healthy fingernail, there’s a seal between the nail and the surrounding skin. When there are cuts, even microscopic ones, or small separations between the nail and nail bed, or the nail and the cuticle, pathogens can enter and infect the nail.


Dermatophyte fungi are the most common cause of toenail fungus. Various medications are available; however, many are cost-prohibitive, or associated with adverse effects that require monitoring of liver enzymes. Furthermore, treatment can be ineffective, especially if the entire nail plate is dystrophic at the time therapy is initiated. In addition, unless there is pain or recurring cellulitis, or the patient is at increased risk for morbidity associated with complications from recurring tinea pedis, it is not medically imperative to treat toenail fungus.

Fingernail infections can be a little more complicated: 30-50% of cases of fingernail fungus are caused by candida, not dermatophyte fungi. If the infection develops in a distal to proximal fashion, affecting the nail from the very tip of the finger, the most likely organism is a dermatophyte. However, should the nail infection follow an episode of acute paronychia (infection of the nail fold, also known as the cuticle), then the more likely culprit is candida. Recurring acute, or persistent, chronic, paronychia can make this type of nail infection more problematic than dermatophyte onychomycosis.

A good clinical outcome, that is a normal nail, depends on treating the right organism with the right drugs. Cultures are necessary to determine which pathogen to treat. Treating the right pathogen is particularly important, given the side effects of oral medications and the fact that some fungi are more susceptible to certain medications than they are to others.


The less the nail plate is damaged, the higher the cure rate. Returning to a normal nail also depends on treating the condition before the nail matrix is damaged. A badly damaged nail matrix will not make a normal nail.


People whose jobs require frequent or prolonged soaking in water should wear gloves. For those who have manicures, the cuticles should be treated gently, including not pushing the cuticles back aggressively, and avoiding cracking and tearing. Moisturizing the cuticles first is a good idea, and creams and ointments do a better job of moisturizing than most lotions. Creams and ointments have a greater proportion of oil, in contrast to most lotions, which have a higher proportion of water and can be drying. When trimming the cuticles, clip only the dead skin. In addition, good nutrition is essential for healthy nails and a multi-vitamin with essential minerals including zinc, selenium and calcium may be desirable. One nail condition that can’t be prevented is the longitudinal ridges that develop on fingernails as we grow older. These ridges are a normal part of aging, much the same way that graying hair is a normal part of aging.