Brief Answer:
Both Fungal and Pseudomonas infection are likely- please see the advises relevant for each of them

Detailed Answer:
Hello,

Thank you for asking at healthcaremagic.

I carefully read your question and understand your concern.

By the picture you have uploaded the spot seems dark with a greenish nuance. Many times the fungal infection of the nails especially in the hands, due to frequent contact with water and humidity has a high risk for contracting pseudomonas infection which stains the nail with that color.
Pseudomonas growth is very much favored by the fungal infection of the nail also so you have both yeast and pseudomonas infection of the nail.

To help with those:
1. cut off the free edge of the nail regularly- this will reduce the amount of nail being infected.
2. local cream of bacitracin or polymixin B might be tried 3-4 times a day for 2-3 months to help with the pseudomonas infection and if no help than you can have oral antibiotic like ciprofloxacin (you will need to have it prescribed by your local doctor).
3. for the fungal infection: avoid wetting hands frequently (wear water proof gloves when need to clean) and dry hands well after they are wet.
4. local solutions for fungal infections are generally not effective if more than half of the nail is infected by the fungus (in your case by the picture it seemed it was more than half of the nail). In this case, if the local solution is not helping after being used for a few months than oral antifungals should be used- should be prescribed by a doctor due to potential side effects.
5. if the dark spot doesn't have a greenish nuance than please let us know as than the pseudomonas infection is less likely and we need to consider more important diagnosis.

I hope this is helpful and answers to your question but please feel free to reply if anymore clarification is needed on this.

Kind regards,

Antoneta Zotaj, MD

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Brief Answer:
Nail trimming is vital- explanations on local application of the solution and the cream

Detailed Answer:
Hello,

Ciclopirox is recommended in cases when not a huge part of the nail is effected by the yeast infection. You might try it as it is easy to use and does not have side effects, you will need several months to decide if it is helping or not.

If you have been using it for more than 4-5 months and not seen a improvement you will need to talk with the doctor to see the need for oral antifungals. These need to be taken for months also but have higher chance of healing the fungal nail infection.

It is difficult to use two kind of solutions on the nail and adding bacitracin on the cicloprirox might not be convenient. I would say that because ciclopirox is used only once a day, you can choose the time you use it and than at a distance of at least 2-3 hours from its use can apply bacitracin. The other times you use bacitracin should not be an issue as you will not be using ciclopirox at those times.
Bacitracin is needed at least 3 times a day.

Nail trimming is vital for both infections to heal. If you have extra free edge nail this serves as the source of infection and will not help you with the treatment. Please find a way to remove the extra free edge of the nail and also regularly trim the nail to remove as much as possible of the infected part of the nail, this will be very important for the healing.

I hope this is helpful and answers to your question but please feel free to reply if anymore clarification is needed on this.

Kind regards,

Antoneta Zotaj, MD

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Brief Answer:
trimming frequency is determined based on how fast the nail grows

Detailed Answer:
Hello,
It is very good you are going to have appointment to trim the nail as it is very important to control the infection.

Needed trimming frequency depends on how fast the nail grows. As long as the nail edge is more than 2-3 mm out of the flesh than it would be good to have it trimmed.

Some trimming machines have a metal part you can "scratch" the nail on and if you do this daily or once in 2 days, it will do nail filing little by little every day and not allow the nail to grow out of the flesh- this would allow you to shorten the nail little by little without needing the help of someone else and you can easily do nail filing even though you are right handed.

I hope this is helpful but please let me know of anymore concerns.

Kind regards

Antoneta Zotaj, MD

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