Differential Diagnosis for Nail Infection after Trauma with Acrylic Nail
Single Most Likely Diagnosis
- Onychomycosis: This is a fungal infection of the nail, which can be more likely after trauma, especially with an acrylic nail that can trap moisture and create an ideal environment for fungal growth. The trauma can also cause onycholysis (separation of the nail from the nail bed), making it easier for fungi to infect the nail.
Other Likely Diagnoses
- Bacterial Onychitis: Bacteria can infect the nail and surrounding tissue, especially after trauma that compromises the nail's integrity. The presence of an acrylic nail can increase the risk by providing a conduit for bacterial entry.
- Paronychia: An infection of the skin around the nail (perionyx), paronychia can occur after trauma, especially if the nail is artificially enhanced and the seal between the nail and the skin is compromised, allowing bacteria to enter.
- Candidal Onychitis: Candida species can infect the nail, particularly in individuals with compromised immunity or after trauma that disrupts the nail's natural barrier. The moist environment under an acrylic nail can facilitate Candida growth.
Do Not Miss Diagnoses
- Herpetic Whitlow: A viral infection caused by herpes simplex virus, herpetic whitlow can present as a painful infection of the finger or nail area. It's crucial to distinguish it from bacterial infections, as the treatment is antiviral rather than antibiotic.
- Osteomyelitis: Although less common, osteomyelitis (infection of the bone) can occur if the infection spreads from the nail or surrounding tissue to the bone. This condition requires prompt and aggressive treatment to prevent serious complications.
Rare Diagnoses
- Sporotrichosis: A fungal infection caused by Sporothrix schenckii, sporotrichosis can affect the nail and is typically associated with gardening or other outdoor activities involving soil. It's rare but should be considered in the appropriate clinical context.
- Nocardial Infection: Nocardia species can cause infections in immunocompromised individuals, and while rare, they can affect the nail area, especially if there's a history of trauma or an underlying condition that compromises the immune system.