What is the management for a patient with a toenail infection from an acrylic nail?

From the Guidelines

The management of a toenail infection from an acrylic nail should prioritize removing the artificial nail, keeping the area clean and dry, and applying topical antifungal medications, with oral antifungals like terbinafine 250mg daily for 12-16 weeks being the most effective treatment option for severe fungal infections, as supported by the British Association of Dermatologists' guidelines 1.

Initial Management

• Remove the artificial nail to prevent further moisture trapping and fungal growth
• Keep the area clean and dry to reduce the risk of bacterial infection
• Apply topical antifungal medications like clotrimazole 1% cream or terbinafine 1% cream twice daily for 1-2 weeks

Severe Fungal Infections

• Oral antifungals such as terbinafine 250mg daily for 12-16 weeks may be necessary for severe fungal infections that extend into the nail bed, as recommended by the British Association of Dermatologists' guidelines 1
• Terbinafine has been shown to be more effective than itraconazole in treating dermatophyte onychomycosis, with higher efficacy rates and lower relapse rates 1

Bacterial Infections

• Mupirocin 2% ointment applied three times daily for 7-10 days is effective for bacterial infections
• Oral antibiotics like cephalexin 500mg four times daily for 7-10 days are indicated for more extensive bacterial infections with surrounding cellulitis

Prevention and Follow-up

• Patients should avoid applying new artificial nails until the infection resolves completely, typically allowing 2-4 weeks of healing time
• Soaking the affected toe in warm water with Epsom salt for 15 minutes daily can help reduce inflammation
• Prevention includes ensuring proper nail salon hygiene practices and allowing natural nails to breathe between artificial nail applications, as well as taking measures to prevent reinfection, such as wearing protective footwear and applying antifungal powders in shoes 1

From the FDA Drug Label

Terbinafine tablets are indicated for the treatment of onychomycosis of the toenail or fingernail due to dermatophytes (tinea unguium) Prior to initiating treatment, appropriate nail specimens for laboratory testing [potassium hydroxide (KOH) preparation, fungal culture, or nail biopsy] should be obtained to confirm the diagnosis of onychomycosis Toenail onychomycosis: One 250 mg tablet once daily for 12 weeks

The management for a patient with a toenail infection from an acrylic nail includes:

• Confirmation of diagnosis: Obtain appropriate nail specimens for laboratory testing to confirm the diagnosis of onychomycosis
• Treatment with terbinafine: Administer 250 mg of terbinafine orally once daily for 12 weeks for toenail onychomycosis
• Monitoring for adverse effects: Monitor patients for signs of liver injury, taste disturbance, and smell disturbance, and discontinue treatment if any of these occur 2
• Follow-up: Follow up with patients after completion of therapy to assess for clinical cure and mycological cure 2

From the Research

Management of Toenail Infection from Acrylic Nail

The management of a patient with a toenail infection from an acrylic nail involves several steps:

• Identification of the causative agent: The infection can be caused by fungi, bacteria, or a combination of both 3.
• Treatment of fungal infections: Topical antifungal agents such as amorolfine or ciclopirox can be used for mild cases, while oral antifungals like terbinafine, fluconazole, or itraconazole may be necessary for more severe cases 3, 4, 5.
• Treatment of bacterial infections: Topical antiseptic agents or antibiotics may be used, depending on the type of bacteria causing the infection 3.
• Removal of the acrylic nail: This may be necessary to allow for proper treatment and healing of the underlying nail and surrounding tissue.
• Prevention of future infections: Patient education on proper nail care and hygiene is essential to prevent recurrence.

Treatment Options

Some treatment options for toenail infections include:

• Topical antifungal agents: Efinaconazole 10% solution and tavaborole 5% solution are newer agents that have shown promising results in clinical trials 6.
• Oral antifungal agents: Terbinafine, fluconazole, and itraconazole are commonly used oral antifungals for the treatment of toenail infections 3, 4, 5.
• Topical antibiotics: May be used for bacterial infections, but oral antibiotics may be necessary in severe cases 3, 7.

Special Considerations

In cases where the infection is caused by an acrylic nail, it is essential to remove the nail to allow for proper treatment and healing. Additionally, patient education on proper nail care and hygiene is crucial to prevent future infections. Chronic paronychia, which can be caused by irritants such as chemicals, requires treatment aimed at stopping the source of irritation and reducing inflammation 7.