What to Do If Your Nail Turns Black: Fungal Infections

What should I do if the inside of my nail has turned very dark?

Hello, I visited a dermatologist yesterday because I had trimmed my nails in an attempt to address the dark areas.
However, the doctor informed me that this could easily lead to a bacterial infection.
It was later determined that I have a fungal infection, specifically onychomycosis (I regret having delayed treatment for so long).
The doctor prescribed topical medication for me to apply, and if that doesn't work, I may need to take oral medication that could be harmful to my liver.
I also asked him how to shower, and he said it’s impossible to avoid water (implying that it’s okay to get them wet), but he advised me to keep the area dry.
However, he didn’t mention anything about disinfection or the risk of paronychia.
This morning, I noticed that the dark area under my nail has taken on a U-shape.
Does this indicate that it’s a normal response to starting the medication, or could it mean that bacteria have entered the area? Here’s the link to the photo: https://upload.cc/i/N0uhRY.jpg (this shows the part where I originally trimmed my nails).

Awei, 20~29 year old female. Ask Date: 2017/07/12

Dr. Wu Yuxin reply Dermatology

Medical regulations stipulate that "physicians must personally examine patients before administering treatment or prescribing medications," and therefore, online diagnosis is also not permitted.

Reply Date: 2017/07/12

More Info

When dealing with a blackened nail, particularly in the context of a suspected fungal infection (often referred to as onychomycosis or "gray nail"), it's essential to understand the underlying causes, treatment options, and preventive measures. Fungal infections of the nails can lead to discoloration, thickening, and even separation of the nail from the nail bed.

Understanding Fungal Infections
Fungal infections occur when fungi invade the nail bed, often leading to symptoms such as discoloration (black, yellow, or white), brittleness, and a foul odor. The black color you are observing may be due to a few factors:
1. Fungal Growth: The most common cause of nail discoloration is a fungal infection. The fungi thrive in warm, moist environments, making feet and nails particularly susceptible, especially if they are often in shoes or damp conditions.

2. Trauma: If the nail has experienced trauma (like aggressive trimming), it can lead to bleeding under the nail, which may appear black. This is known as a subungual hematoma.

3. Bacterial Infection: If the nail has been compromised, bacteria can enter and cause an infection, which may also lead to discoloration.

Treatment Options
Your doctor has prescribed topical antifungal medication, which is a common first-line treatment for fungal nail infections. Here are some key points regarding treatment:
- Topical Antifungals: These are applied directly to the affected nail and surrounding skin. They can be effective for mild to moderate infections. However, they may take several weeks to months to show improvement, as nails grow slowly.

- Oral Antifungals: If the infection is severe or does not respond to topical treatments, your doctor may prescribe oral antifungal medications. These can be more effective but may have side effects, including potential liver toxicity, which is why monitoring is essential.

- Nail Care: It’s crucial to keep the affected area clean and dry. Although your doctor mentioned that you cannot avoid water, it’s important to minimize prolonged exposure to moisture. After bathing, dry your feet thoroughly, especially between the toes.

Preventive Measures
To prevent further fungal infections or complications, consider the following:
1. Foot Hygiene: Maintain good foot hygiene by washing your feet regularly and drying them thoroughly. Pay special attention to the areas between your toes.

2. Footwear Choices: Wear breathable shoes and moisture-wicking socks to reduce moisture buildup. Avoid tight-fitting shoes that can cause trauma to the nails.

3. Avoid Sharing: Do not share nail clippers, shoes, or towels with others to minimize the risk of spreading fungal infections.

4. Regular Nail Care: Keep your nails trimmed and filed. Avoid cutting them too short, as this can lead to injury and increase the risk of infection.

5. Monitor Symptoms: Keep an eye on the condition of your nails. If you notice worsening symptoms, such as increased pain, swelling, or spreading discoloration, seek medical attention promptly.

Conclusion
The change in the shape of the blackened area under your nail could indicate either the progression of the fungal infection or a reaction to the treatment. It is essential to follow your doctor's instructions carefully and maintain regular follow-ups to monitor the condition. If you have concerns about the treatment or if symptoms worsen, do not hesitate to reach out to your healthcare provider for further evaluation. Early intervention can help prevent complications and promote healing.

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