Foot Care from A to Z

Thomas P. Lyman, BS; Tracey C. Vlahovic, DPM, FAPWCA


Dermatology Nursing 

In This Article


Onychomycosis is the most common nail infection seen. It is caused by dermatophytes (most common pathogen is Trichophyton rubrum [T. rubrum]) and typically presents as thick, dystrophic, discolored, and sometimes painful nails with subungual debris. Nail care for onychomycosis may be challenging for the average patient to perform due to the nail thickness. In the office, these nails are debrided down to a manageable thickness (Malay, Yi, Borowsky, Downey, & Mlodzienski, 2009). Patients with diabetes should be discouraged from doing nail care at home; diabetics with neuropathy may inadvertently cut their skin and risk infection. Patients are instructed to cut their nails straight across, although generally the podiatric practitioner curves the corners with the nail nipper. In addition to debridement, the treatments for onychomycosis range from ciclopirox topical nail laquer (mild-to-moderate nail disease) to oral antifungals like terbinafine, itraconazole, griseofulvin ultramicrosize, and fluconazole for the moderate-to-severely infected nail (Robbins, 2003).