PSEUDOMONAS OF THE NAILS

The bacteria Pseudomonas may infect the undersurface of the nail if the nail becomes separated from the nail bed (onycholysis). It is common in persons whose hands are constantly exposed to water, soaps, and detergents or are subject to mechanical trauma, especially in the elderly.

Coexistent onychomycosis is common, occurring in 65% of cases in one study.

Clinical

The nail takes on a characteristic green color (chloronychia) in the area of the onycholysis. The infection and discoloration are on the undersurface of the nail.

Treatment

Gentamicin solution (e.g., Otic) applied under the nail BID is usually rapidly effective. In order to clear both the onycholysis and the Pseudomonas, it is best to cut the nail way back, removing most of the green portion of the nail and then applying the gentamicin solution QAM and clotrimazole solution at night to clear any Candida (or gentamicin QPM and clotrimazole QAM).

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