What causes swollen nailbeds and red lines on the nails?

Question

Hi doctor,

My nail beds were swollen one night after wearing gel nail paints. I removed my nail paints, I saw some red lines on my nails, and my nail beds were swollen. Now, I have white patches and flaky skin. I am not sure if I have a fungal infection on my nails. I took tablet Terbinafine 250 mg once per day for the past two weeks. But, the symptoms did not seem to get any better. I got the medicine from a local pharmacy and I did not consult any doctor. Also, I am waiting for my culture result. Please help. Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I saw your nail pictures (attachments removed to protect the patient's identity). It seems to be a nail fungal infection (onychomycosis). We can still have a few other differential diagnoses here. I suggest continuing Terbinafine 250 mg, it usually takes eight to ten weeks to show improvement on nail fungus. I also recommend getting a liver function test done for Terbinafine treatment protocol. I suggest starting Amorolfine nail lacquer as an external remedy. Also, please avoid frequent washing of hands and please trim the nails. Let me know the culture results once they arrive. This condition is entirely curable, and you need not worry. Also, no food restrictions are required. But, alcohol might interact with oral Terbinafine. So, please be cautious. Thanks and regards.

Answer 2

Hi,

Welcome back to icliniq.com.

I would suggest continuing the oral antifungal medication for six more weeks. There are possibilities for the report to be false negative. There is no harm with oral Terbinafine medication for a healthy person. The second possible diagnosis could be nail psoriasis, and it can be confirmed by a nail biopsy, which you can plan after a month if there is no improvement with Terbinafine. Other possible diagnoses would be lichen planus, yellow nail syndrome, Wilson’s disease, etc. Please do not research the internet. I suggest planning for a nail biopsy after a month. Then, we can conclude the underlying pathology. You need not worry. Thanks and regards.