What is the treatment for skin peeling around the nail bed?

Treatment of Skin Peeling Around the Nail Bed

For simple skin peeling around the nail bed without signs of infection, apply topical emollients daily to the periungual folds and nail plate, keep the area clean and dry, and avoid trauma or irritants. 1, 2

Initial Assessment

Before initiating treatment, determine the underlying cause:

• Examine for fungal infection signs: Look for nail discoloration (white, cream, or yellow), nail plate thickening, subungual hyperkeratosis, or onycholysis, which suggest onychomycosis requiring mycological confirmation before treatment 1
• Check for infection indicators: Assess for erythema, swelling, pain, purulent discharge, or abscess formation that would require antibiotic therapy 3, 4
• Evaluate for inflammatory conditions: Consider psoriasis if there are pits, salmon spots, splinter hemorrhages, or other nail dystrophy patterns 5
• Rule out trauma or chemical exposure: Ask about occupational exposures, manicuring practices, artificial nails, or repetitive trauma 6

Treatment Algorithm Based on Clinical Presentation

For Non-Infected Peeling (Most Common)

Primary management focuses on barrier restoration and protection:

• Apply topical petrolatum or hypoallergenic moisturizing creams/ointments once daily around the nails for lubricant and smoothing effects 2
• Use protective nail lacquers to limit water loss from the nail plate 1
• Keep the area clean using pH5 neutral bath formulations with tepid water, avoiding harsh soaps 2
• Wear cotton gloves to protect the area, especially during sleep 1

Critical preventive measures to implement immediately:

• Avoid manipulation of cuticles, nail biting, and using fingernails as tools 1, 2
• Limit prolonged water exposure and avoid solvents or harsh chemicals 1
• Do not apply artificial nails, which can harbor microorganisms 4
• Cut nails straight across and avoid tight-fitting shoes if toes are affected 2

For Peeling with Inflammation or Edema

• Apply mid to high potency topical steroid ointment to nail folds twice daily 2, 3
• Consider daily dilute vinegar soaks to reduce inflammation 2, 3
• Continue with emollient therapy as above 2

For Suspected Fungal Involvement

Do not treat empirically—mycological confirmation is mandatory before initiating antifungal therapy: 1

• If dermatophyte infection is confirmed, consider topical antifungals such as Amorolfine 5% lacquer once or twice weekly after gentle filing, or Ciclopirox 8% lacquer once daily for up to 48 weeks 2
• Systemic antifungals (itraconazole, terbinafine, fluconazole) may be required for extensive involvement but should only be prescribed after confirmed diagnosis 1, 7

For Infected Peeling

If signs of bacterial infection are present:

• Obtain bacterial cultures if purulent discharge is present 8, 3
• Initiate antibiotics with anti-Staphylococcus aureus and gram-positive coverage 8, 3
• If abscess or subungual hematoma is present, drainage is mandatory before other therapies 2
• First-line oral outpatient therapy is Amoxicillin-clavulanate for coverage of common pathogens 3

Common Pitfalls to Avoid

• Never use greasy creams for basic care, as they may facilitate folliculitis development due to occlusive properties 2
• Avoid topical acne medications on the nail bed, as they cause drying and irritation 2
• Do not use topical steroids inappropriately, as prolonged use may cause perioral dermatitis and skin atrophy 2
• Never treat suspected fungal infections without mycological confirmation, as 50% of nail dystrophy is non-fungal in origin 1
• Avoid underestimating seemingly minor trauma, which can progress to serious infections 3

Follow-Up Care

• Reassess after 2 weeks of treatment and consider alternative diagnoses if healing is not progressing 2
• Monitor for signs of recurrent infection or abnormal nail regrowth 2
• Continue preventive measures even after resolution to prevent recurrence 1, 2