Cuticle removal can induce onychomycosis

Denver - When addressing onychomycosis caused by cosmetic procedures, says Zoe D. Draelos, M.D., cuticle removal represents a key culprit. Dr. Draelos spoke about onychomycosis treatment options at the 72nd Annual Meeting of the American Academy of Dermatology.

She is a dermatologist in private practice in High Point, N.C.

"Unfortunately, for some reason the cuticle is considered cosmetically unattractive," although the main purpose in removing it is to make the manicure easier to perform and ensure that polish around the edges of the nail doesn't chip, Dr. Draelos says.

However, she says, the cuticle functions as a gasket that connects the proximal nail fold to the nail plate. When it's gone, "Water enters the proximal nail fold. Fungus and yeast love the proximal nail fold - a warm, dark, moist environment."

To prevent fingernail paronychia, "Do not allow the nail artist to remove the cuticle. You can push it back carefully (and paint around it), but it does require some skill. If the cuticle is traumatized, put a drop of vinegar into the proximal nail fold to lower the pH and eliminate the trapped water."

Dr. Draelos says her favorite trick to treat periungual onychomycosis (which is often mixed with other infections) is to place a drop of betamethasone clotrimazole cream on each nail and rub it proximally into the nail fold twice daily.

"The corticosteroid takes care of the inflammation and enhances the efficacy of the topical antifungal," particularly for prevention, she says. Additionally, Dr. Draelos says, patients should treat damaged cuticles until they completely regrow, which takes four to six weeks. Keeping the hands dry also helps.

As for prosthetic nails, she says, onycholysis frequently occurs because the prosthetic adheres to the nail surface more strongly than the nail plate adheres to the nail bed.

"So any kind of trauma to the nail prostheses will remove the nail from the nail bed," creating a haven for fungus. This area is area difficult to access with cream medications, Dr. Draelos notes. Therefore, she recommends that patients keep nails short and type flat-fingered to reduce trauma on the prostheses.

Fungal infections also can result from contaminated nail equipment. To prevent such infections, she says, autoclaving works best, although many nail technicians find it impractical. Foot spas are impossible to sterilize, Dr. Draelos notes, because their filters can't be removed.