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Choose Any Three Nail Conditions and Give a Referenced Account of Their Causes(S) and Management. Please Note Not All References Will Give You the Same Method of Management and Some Will Give More Than One Method

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CHOOSE ANY THREE NAIL CONDITIONS AND GIVE A REFERENCED ACCOUNT OF THEIR CAUSES(S) AND MANAGEMENT. PLEASE NOTE NOT ALL REFERENCES WILL GIVE YOU THE SAME METHOD OF MANAGEMENT AND SOME WILL GIVE MORE THAN ONE METHOD

Nail fungi (onychomycosis) is caused by dermatophytes that invade the nail matrix. They possess the ability to thrive and grow on the protein keratin and favour damp and dark conditions, therefore the human toenail and nail bed provide the ultimate breeding ground. (Johnson 1993) The most common is Trichophyton Rubrum, the same causes “athletes’ foot”. This commonly affects the sole, dorsum, lateral borders and in between toes. If left untreated, the infection can spread to the nail matrix. (Bristow I. 1996)

Fungal infections can start by trauma to the toenail which leaves it vulnerable to infection. People who do not maintain a good standard of foot hygiene are predisposed to fungal infections. Failure to dry the feet thoroughly and the use of communal showers can all be causative factors. (Johnson M. 1993)

Treatment can be prolonged using topical products, in some cases up to 9 months. More often than not these are ineffective as the treatment cannot penetrate the thickened nail. The only topical agents giving some success in mild nail infection are amorolfine, cyclopiroxolamine and tioconazole. (Dawber R. 1996)

If there are more than 2 or 3 nails involved, it is better to use terbinafine orally together with amorolfine topically as recent evidence shows better success rates using both. (Turner & Merriman 2005) For ongoing management diligent foot hygiene, discarding of infected footwear and continuing preventative treatment advice should be given. (Bristow I. 1996)

INGROWING TOENAILS (ONYCHOCRYPTOSIS)
The most common causes of ingrowing toenails are poor cutting technique where nails are cut too short and ill-fitting shoes. (Bristow

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