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From onychomycosis to ingrown nails — diagnosis and treatment of nail pathology
Nail disorders affect up to 10% of the general population and are more common in older adults, athletes, and people with diabetes or peripheral vascular disease. At Dr. Bodh Raj’s clinic, foot nail conditions are evaluated systematically: fungal infection (onychomycosis) is confirmed by KOH preparation or culture; ingrown toenails are classified by severity (Grade I–III) and treated with conservative or surgical approaches; and nail dystrophy is differentiated from melanoma, psoriasis, and lichen planus. Proper nail care education is emphasized as a preventive strategy.
Kathmandu Neurology Clinic & Cognitive Center
Authored and reviewed by Dr. Bodh Raj Gautam (MBBS (KU), MS-Orthopedics (GMC), Cert. Podiatry & Diabetic Foot (India), NMC 23071). Evidence-based, no fabricated outcomes.
Nail disorders affect up to 10% of the general population and are more common in older adults, athletes, and people with diabetes or peripheral vascular disease. At Dr. Bodh Raj’s clinic, foot nail conditions are evaluated systematically: fungal infection (onychomycosis) is confirmed by KOH preparation or culture; ingrown toenails are classified by severity (Grade I–III) and treated with conservative or surgical approaches; and nail dystrophy is differentiated from melanoma, psoriasis, and lichen planus. Proper nail care education is emphasized as a preventive strategy.
Reviewed by Dr. Bodh Raj Gautam, MBBS, MS-Orthopedics — Consultant Orthopedic Surgeon & Foot Nail Specialist (NMC 23071), Kathmandu Neurology Clinic. For evaluation, book an appointment.
Onychomycosis (fungal nail infection) accounts for approximately 50% of nail pathology and presents with thickening, discoloration, brittleness, and subungual debris. Distal-lateral subungual onychomycosis is the most common pattern. Ingrown toenails (onychocryptosis) typically affect the hallux and range from mild inflammation (Grade I) to abscess formation (Grade II) to chronic granulation tissue with nail-fold hypertrophy (Grade III). Other conditions include nail psoriasis (pitting, oil-drop discoloration), subungual melanoma (longitudinal melanonychia, Hutchinson sign), and traumatic nail dystrophy.
Onychomycosis treatment involves topical antifungals (ciclopirox, efinaconazole, tavaborole) for mild cases and oral antifungals (terbinafine, itraconazole) for moderate-to-severe disease. Pulse dosing (itraconazole 1 week per month) reduces cumulative hepatic exposure. Ingrown toenail management progresses from conservative (warm soaks, cotton-wick elevation, proper nail education) to surgical (partial nail avulsion with or without matrixectomy using phenol or sodium hydroxide). Diabetic patients require special caution — nail surgery is performed under local anaesthesia with vascular assessment and prophylactic antibiotics.
Guidelines referenced:
de Berker D et al. Fungal nail infection. BMJRautiainen F et al. Onychomycosis: diagnosis and management. Am J Clin DermatolEriksson E et al. Ingrown toenails: systematic review and meta-analysis. J Am Podiatr Med AssocContent on this website is for general educational purposes only and does not constitute medical advice, diagnosis, or treatment. It is not a substitute for evaluation by a qualified healthcare professional. Always seek the advice of your physician or other qualified provider with any questions regarding a medical condition. Never disregard professional medical advice or delay seeking it because of something you have read on this website. In case of a medical emergency, contact emergency services immediately. No doctor–patient relationship is established by use of this site or by contacting the clinic through the site.