Proper Care of Finger and Toe Nails

INTRODUCTION

Appropriate nail care is an extremely important for those with lymphedema that affects their extremities. This care is essential because any damage to the nails, or the skin surrounding them, can cause painful problems and a potentially serious infections.

SKIN INFECTIONS AROUND FINGER and TOENAILS

The medical term bacterial paronychia describes a bacterial infection that develops around finger or toe nails. On the fingers this is commonly known as a hangnail. On the foot, it is commonly known as an ingrown toenail.

For most individuals such an infection is just a painful inconvenience; however for individuals with a lymphedema affected limb, this is a serious infection that requires prompt medical attention.

Another form of this condition is fungal paronychia which is often associated with Athlete’s foot. It is possible that both conditions can affect an area at the same time. When both bacterial and fungal infections are present, the bacterial infection may appear to be developing slowly. However in lymphedema affected tissues, this is not true. The infection is able to spread rapidly and even the slightest hint of an infection must be taken seriously and treated quickly.

PREVENTIVE CARE

• Check the areas around your nails daily. If you find unusual redness, increased swelling, or are not feeling well for no apparent reason, these can be indications of an infection and prompt medical treatment is essential.
• Keep your nails well trimmed. When nails are not properly trimmed, they can scratch the adjacent tissues and this break in the skin can lead to an infection.
• Do not cut your nails straight across. In the past cutting the nails straight across was common advice; however podiatrists now stress that gently curving the ends of the nails reduces the risk of developing an ingrown nail.

TREATING A HANGNAIL

For most people, a hangnail is an annoying tiny piece of skin near the fingernail that catches on clothing, slightly rips the skin, and hurts. For those with lymphedema affecting the hands, a hangnail is a break in the skin and an infection risk.

• Prevention is important. Keeping the skin around the nails well moisturized. If you must frequently have your hands in water, particularly in the winter, wear rubber gloves to protect your hands from drying and irritation.
• If you develop a hangnail, do not bite or tear it off! Instead trim to off very carefully by using manicure scissors on which the blades have just be disinfected by wiping them with alcohol.
  Also disinfect the skin surrounding the hangnail. After carefully trimming the hangnail, cover the area with an antibiotic ointment. Until the area has healed, repeat application of the antibiotic ointment each time the hand has been in water.
• Be Aware of infection. Watch this area closely for signs of infections such as redness and heat. Also pay attention if you just don’t feel well or if the swelling in this limb suddenly increases. At the first indication of a potential infection, contact your healthcare provider for treatment.
• Alert Medical Personnel. Since a hangnail sounds trivial, it may be necessary to remind the person handling scheduling appointments in the medical office that you have lymphedema in that area and any infection can be a serious problem for you.

PROFESSIONAL NAIL CARE 

If you see a manicurist or pedicurist, it is important that you inform this individual that you have lymphedema. Then be prepared to explain what it is and why you are at high risk for infection. Emphasize that sanitation of equipment is essential. Some clients with lymphedema purchase their own manicure set and bring it for their use during the appointment.

• Do not allow your cuticles to be cut. There is always the risk that they will be cut too close and this could create an opening for bacteria to enter and cause an infection.
• Do not allow the use of chemicals to remove excess cuticle. These chemicals are caustic and can be absorbed through the skin. One alternative is to soften the cuticle with vegetable oil and to use a clean orange stick to push back the excess tissue. (An orange stick is a disposable wood implement with tapered ends that is used in manicuring.)
• Do not allow the use of a nail polish remover containing acetone because this chemical can be absorbed into the skin and act as an irritant. If a manicure is a must, use a non-acetone nail polish remover and take care not to get it on the skin.

FUNGAL INFECTIONS OF THE TOENAILS 

Skin and nail  care are important.

A fungal toenail infection frequently affects the elderly and occurs among those with lower-extremity lymphedema. This condition, known by the medical term onychomycosis, appears most often under the toenails because socks and shoes create a perfect place for the fungus to grow by keeping these areas dark, warm, and moist.

Symptoms of Toe Nail Fungal Infections

• There is a foul odor.
• A toenail may thicken and make shoes hurt or feel tight.
• The color of the nail may change to yellow-green or brown.
• The nail may become flaky.
• Debris collects under the nail.
• An infected toenail makes it painful to stand or walk.
• Detachment (loosening) of the nail.

TRESTMENT OF TOE NAIL FUNGAL INFECTIONS

Toenail fungus is very difficult to treat and it may return. Many “cures” are promoted and some are more effective than others. Oral medications that travel through the bloodstream to reach the fungus are available. This treatment usually lasts at least 12 weeks and may have side effects of damaging the liver.

Topical treatment, such as ointments or prescription nail polish, may help; however, these must be approached keeping in mind that it is important not to damage the skin in this area.

REFERENCES

•  Paronychia Medline Plus
• Fungal nail infection, Medline Plus
• Living Well with Lymphedema by A. Ehrlich, A. Harrewijn PT, CLT-LANA, and E. McMahon PhD. Lymph Notes, 2005.
• Lymphedema Caregiver’s Guide by M.K. Kearse PT, CLT-LANA, E. McMahon PhD, A. Ehrlich MA. Lymph Notes 2009
• Lymphedema Management 2-E by J. Zuther. Thieme, 2009.

© LymphNotes 2014. This information does not replace the advice of a qualified health care professional.

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Category: Living With Lymphedema Updated: 2014-10-28