From the Guidelines
Green nail syndrome is best treated with a combination of nail trimming, keeping nails dry, and antimicrobial therapy, specifically with topical 2% povidone-iodine and daily dilute vinegar soaks to nail folds twice daily. The treatment approach should prioritize reducing moisture and creating an environment inhospitable to Pseudomonas aeruginosa, the bacteria responsible for the infection 1. Key steps include:
- Trimming and filing the affected nail to remove the infected portion
- Soaking the affected nail in a solution of white vinegar and water (1:2 ratio) for 10-15 minutes daily, as the acidic environment inhibits Pseudomonas growth
- Applying topical antimicrobial agents like 2% povidone-iodine directly to the nail bed twice daily for 2-4 weeks
- Keeping nails dry, avoiding nail polish, and wearing gloves when hands are in water for extended periods
- Considering additional treatments such as mid to high potency topical steroid ointment to nail folds twice daily for edema and pain management, as outlined in the treatment recommendations for nail unit toxicities secondary to targeted cancer therapy 1. The goal of treatment is to eliminate the infection, reduce symptoms, and prevent recurrence, with the understanding that complete nail regrowth may take several months.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Treatment Options for Green Nail Syndrome
- Topical ozenoxacin 1% cream has been shown to be effective in treating green nail syndrome, including cases with multidrug-resistant Pseudomonas aeruginosa 2
- Chemical nail avulsion with urea powder, combined with topical antibiotics, may be an effective treatment for green nail syndrome, especially in cases with onycholysis 3
- Topical and/or oral fluoroquinolone treatment has been used to successfully manage green nail syndrome, even in cases where Pseudomonas aeruginosa is not detected 4
- Cutting of the detached nail plate, brushing the nail bed with a 2% sodium hypochlorite solution twice daily, and moisture eviction by wearing latex gloves over cotton ones may be an effective treatment approach 5, 6
Considerations for Treatment
- The clinical management of green nail syndrome can be confusing, especially when the bacterial culture result is inconsistent or when non-Pseudomonas bacteria are isolated 2, 4
- Green nail syndrome may be caused by Pseudomonas aeruginosa, but other bacterial or fungal contaminations can also be responsible 5, 6
- The treatment approach may need to be tailored to the individual case, taking into account the presence of onycholysis, paronychia, and other associated nail diseases 3, 5, 6