Fungal nail infections are among the most common nail diseases affecting people of all ages, but are more common in older adults[1]. These infections are caused by various fungal species that typically thrive in warm, moist and airless environments such as inside shoes[2]. Symptoms of fungal nail infections may include changes in nail colour, thickness and texture, as well as brittleness and detachment from the nail bed. Treatment of fungal nail infections varies depending on the severity of the infection: - Topical antifungal medications in mild cases - Oral medications for severe infections that spread to multiple nails[3] - In some cases, removal of the infected nail by a healthcare professional may be required[4] It is crucial that individuals consistently adhere to the prescribed treatment regimen to ensure effective eradication of the fungal infection, as irregular use can prolong the healing process and reduce treatment effectiveness[5].

Bacterial nail infections, although less common than fungal infections, can also cause significant difficulties and discomfort for individuals. These infections usually present with symptoms such as redness, swelling, and pain around the nail, often resulting from trauma or prolonged exposure to water and chemicals[6]. Unlike fungal infections, bacterial nail infections typically require immediate medical attention to prevent complications and facilitate healing. Treatment of bacterial nail infections may include: - Antibiotic therapy targeting the underlying bacterial pathogens - Appropriate wound care and hygiene practices to prevent further spread of infection Early diagnosis and appropriate treatment are crucial to effectively manage bacterial nail infections and prevent potential complications that can affect nail health and overall well-being.

Psoriasis and other skin conditions can also affect the nails, leading to various nail abnormalities and discomfort in individuals[7]. Psoriasis, a chronic autoimmune skin condition, can cause nail changes such as pitting, discolouration and thickening. In addition, other dermatological conditions such as lichen planus and eczema can also affect nails, causing changes in shape, colour or surface[8]. Treatment of nail disorders associated with skin conditions involves a comprehensive approach that addresses both the underlying skin disorder and the specific nail symptoms. Dermatologists play an important role in the diagnosis and treatment of nail diseases associated with skin conditions, providing personalised treatment plans to improve the nail health and overall quality of life of affected individuals[9].

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Diagnostic methods for detecting nail diseases

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One of the primary methods for diagnosing nail disorders is physical examination of the nails[10]. Dermatologists and healthcare providers often visually assess nails to identify any abnormality in colour, texture, shape or thickness that may indicate an underlying nail disorder[11]. Changes in nails such as discolouration, pitting, ridges or brittleness can provide valuable clues about the presence of fungal infections, psoriasis, trauma or other nail diseases[12]. In addition, the rate of nail growth may differ between individuals; fingernails grow faster than toenails at an average rate of 0.9 mm per week[13]. This variation in growth rate can also help diagnose specific nail conditions depending on the pattern of nail changes.

Microscopic examination of nail samples is another important diagnostic method used to identify nail diseases, especially fungal infections such as onychomycosis[14]. By analysing nail clippings or scrapings under a microscope, healthcare providers can detect the presence of fungal elements such as Microsporum, Trichophyton and Epidermophyton species, which often cause nail infections[15]. Positive findings on direct microscopy or culture methods can confirm the diagnosis of fungal nail diseases and guide appropriate treatment strategies[16]. In cases where direct microscopy cannot provide definitive results, additional techniques such as polymerase chain reaction (PCR) can be used to further analyse nail samples for accurate diagnosis[17].

Culture of nail samples for microorganisms is a valuable diagnostic approach to identify specific pathogens responsible for nail infections[18]. By isolating and growing microorganisms from nail samples in a laboratory setting, healthcare providers can identify causative agents of fungal, bacterial, or other infections affecting nails[19]. Culturing allows the identification of susceptible organisms and guides the selection of appropriate antifungal or antibacterial treatments for nail diseases[20]. Despite challenges such as the difficulty and length of treatment of nail lesions such as onychomycosis, accurate diagnosis by culture methods is crucial for the effective management and treatment of various nail diseases[4].

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Dermatological treatments for nail diseases

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Topical antifungal drugs are widely used in the dermatological treatment of nail diseases, especially fungal infections[5]. These drugs, such as medicated nail polish containing Cyclopyrox and Amorolfin, have shown successful results in the treatment of nail fungus[21]. While oral antifungal drugs are often preferred for faster clearance of the infection, topical treatments play an important role in the treatment of mild to moderate cases of nail fungal infection[22]. In addition, consistent and correct application of topical antifungal medications is crucial to effectively combat fungal infection and prevent recurrence[5].

Oral antifungal drugs are another important component of dermatological treatments for nail diseases, especially in cases of severe fungal infections that do not respond well to topical treatments[1]. Drugs such as terbinafine, itraconazole and fluconazole are usually prescribed for a period of 6 to 12 weeks to treat nail fungus, with some individuals requiring treatment for several months[1] [4]. Despite successful treatment, some individuals may experience relapse of the fungal infection, emphasising the importance of carefully following the prescribed treatment regimen to prevent relapse[23]. Oral antifungal medications are a vital part of comprehensive treatment plans for nail diseases and are often combined with other therapeutic approaches for optimal results[3].

In inflammatory conditions affecting the nails, such as nail psoriasis, corticosteroid creams play a crucial role in dermatological treatment[24]. Strong corticosteroid creams are used in combination with other drugs such as tazarotene cream and calcipotriol to remove the accumulation of skin cells under the nail associated with psoriasis[25]. These topical treatments help manage the inflammation and discomfort caused by nail psoriasis, contributing to improved nail health and appearance. Dermatologists may recommend a combination of corticosteroid creams and other topical medications to effectively address the underlying inflammatory processes[26]. Correct and consistent application of corticosteroid creams is important to ensure the efficacy of treatment and to minimise the risk of side effects associated with potent corticosteroids[27].