Acrylic-nail infections

How does one diagnose and treat infections that develop under acrylic nails?
—Abigail H. Faerber, DO, Delaware, Ohio

Artificial fingernails are more likely to harbor pathogens, especially gram-negative bacilli and yeasts, than native nails. The longer artificial nails are worn, the more likely it is that a pathogen can be isolated. Signs of a fungal or bacterial infection are discoloration, thickening of the nail plate, lifting of the nail away from the nail bed, or development of soft, spongy areas. Anyone who suffers from such problems as diabetes, cancer, or HIV infection or who is in any other way immunosuppressed is more likely to develop infections and would not be a good candidate for artificial nails. If clinically warranted, a section of nail should be taken for bacterial and/or fungal culture as well as possible histopathologic evaluation. Appropriate topical or oral antibacterial or antifungal therapy can then be initiated.
—Jeffrey M. Weinberg, MD (110-13)