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MEDICAL DERMATOLOGY

Nail Disorders

Nail problems are easy to ignore and easy to misdiagnose. A thick yellow toenail is not always fungus, and a swollen, painful finger tip is not always something antibiotics will settle. At Venus Aesthetics, nails are handled as medical dermatology: the diagnosis is confirmed first, usually with a laboratory test, and treatment is built around the result. Dermatology appointments are by appointment only and cost Rs 3,500.

Dermatology consultation Rs 3,500By appointment only. Aesthetic treatment consultations remain free.
0311 111 7546
What it is

Understanding Nail Disorders

Nail disorders cover disease of the nail plate, the nail bed and the skin folds around the nail. This category at Venus Aesthetics includes onychomycosis, the fungal infection that thickens, discolours and crumbles nails; nail psoriasis, which pits and roughens the nail and lifts it from the bed, often alongside skin or joint disease; nail dystrophies, where the nail grows abnormally because of trauma, tight footwear, eczema, lichen planus, thyroid disease or iron deficiency; and paronychia, infection or inflammation of the nail fold, which can arrive suddenly and painfully or settle in as a chronic problem in hands that are constantly wet. More than one of these can affect the same nail.

Signs we treat

Come in if you recognise any of these

  • A toenail or fingernail that is thickened, yellow or brown, and crumbling at the free edge
  • Small pits or dents in the nail surface, or an orange brown patch showing through the nail
  • The nail lifting away from the nail bed, leaving a visible gap or a hollow you can feel
  • Sudden redness, throbbing pain and swelling in the skin beside a nail, sometimes with pus
  • Skin around the nail that stays puffy and sore, has lost its cuticle, and flares every time the hands are wet
  • Nails that have become ridged, split, brittle or spoon shaped over several months
  • A single dark streak in one nail, or any nail change that keeps worsening despite treatment, which should be seen promptly
How we treat it

Your plan, step by step

1

A full nail examination, not just the nail you are worried about

The doctor looks at all twenty nails, the skin, the scalp and the joints, because the answer is often outside the nail itself. You will be asked how long the change has been there, what you have already applied, what shoes you wear, whether your hands stay wet at work or at home, and whether you have diabetes, thyroid disease or anaemia. Bring any old photos of the nail if you have them.

2

Testing before treatment, not after

Thick yellow nails are not automatically fungal. A small clipping or scraping is usually taken and sent for microscopy and culture, and the nail may be examined under dermoscopy. If you have been using an antifungal cream or lacquer, the doctor may ask you to stop it for a period before the sample is taken so the result is reliable. Nobody should be on months of antifungal tablets without a confirmed reason.

3

Treatment matched to the actual diagnosis

Confirmed onychomycosis may be treated with topical nail therapy, oral antifungal medicine, or both, depending on how much of the nail is involved and whether the root is affected. Nail psoriasis is treated on its own lines, which may include topical therapy, injections into the nail fold, or systemic treatment when the skin and joints are also involved. Acute paronychia may need drainage and antibiotics. Chronic paronychia is managed mainly by keeping the hands dry and protected.

4

Dealing with the damaged nail itself

Medicine kills infection and calms inflammation, but the damaged part of the nail still has to grow out. Where a nail is very thick, painful or pressing into the skin, the doctor may thin it, soften it chemically, or remove part of it in selected cases. Ingrown and repeatedly traumatised nails are assessed at the same visit, since footwear and nail cutting habits often keep the problem going.

5

Follow up while the nail grows out

Progress is judged by the new, clear nail appearing at the base, not by how the old damaged tip looks. Review appointments are arranged so treatment can be stopped, continued or changed on evidence. If oral antifungal tablets are used, the doctor may request liver function testing before and during the course, and will check your other medicines for interactions.

6

Preventing the next episode

Recurrence is common in our climate, so prevention is part of the plan: drying the feet and the web spaces properly after wudu and after bathing, breathable footwear in Lahore and Karachi humidity, treating athlete's foot on the skin at the same time as the nails, using your own instruments at the salon, gloves for wet work, and no random steroid creams bought over the counter, which make fungal infection worse. Nail appointments are available at all eight Venus Aesthetics branches in Lahore, Karachi, Islamabad, Faisalabad and Gujranwala on 0311 111 7546.

FAQs

Nail Disorders, answered honestly

How do I know if my nail problem is fungus or something else?
You cannot tell by looking alone, and neither can we. Thick, yellow, crumbling nails can be fungal, but psoriasis, repeated trauma from tight shoes, lichen planus and old injuries look almost identical. The dermatologist takes a small clipping and sends it for microscopy and culture. That test matters, because months of antifungal tablets are the wrong plan if the cause was never fungal.
Can fungal nails be treated with cream alone, or do I need tablets?
Cream or medicated lacquer alone works only in limited cases: when a small part of the nail surface is involved and the root of the nail is spared. Topical treatment cannot reach infection sitting under a thick nail plate. Established toenail infections usually need oral antifungal treatment, sometimes combined with thinning or partial removal of the nail. The doctor decides after the lab result and after reviewing your other medicines.
How long before my nail looks normal again?
Treatment clears the infection, but it does not repair the part of the nail already damaged. That section has to grow forward and be cut off at the tip. A fingernail takes several months to replace itself and a toenail can take close to a year, so judge progress by the healthy new nail appearing at the base. Stopping early because the tip still looks ugly is the most common reason treatment fails.
Are antifungal tablets safe, and do I need blood tests?
They are widely used and generally well tolerated in healthy adults, but they are real medicines with real interactions. The doctor will ask about liver disease, pregnancy or planned pregnancy, heart medicines, statins and anything else you take, including herbal and hakeem preparations. Liver function testing is often requested before starting and sometimes repeated during a longer course. Report any yellowing of the eyes, rash or persistent nausea immediately.
What does nail psoriasis look like, and can it be cured?
Nail psoriasis typically shows as small pits in the nail surface, oil drop patches of orange brown discolouration, crumbling, and the nail lifting away from its bed. It often appears with psoriasis on the skin or scalp, and sometimes with joint pain that should be assessed. Psoriasis is a long term condition: it is controlled rather than cured, using topical treatment, injections into the nail fold, or systemic therapy in more severe disease.
Why does the skin around my nail keep swelling and hurting?
That is paronychia, inflammation or infection of the nail fold. Sudden red, painful, sometimes pus filled swelling is the acute type, usually bacterial, often triggered by a hangnail, nail biting or an aggressive manicure, and it may need drainage along with antibiotics. The slow, recurring type is chronic paronychia, common in people whose hands stay wet: cooks, cleaners, salon workers and mothers of small children. That type is managed by protecting the hands, not by repeated antibiotic courses.
Can I wear nail polish or get a pedicure while I am being treated?
Polish, gel and extensions hide the nail and block topical treatment from reaching it, so you will usually be asked to keep the nails bare during treatment and to arrive with polish removed for your appointment. Salon instruments carry fungal infection from client to client, so take your own tools. Infection also spreads inside a home through shared slippers, bathroom floors and prayer mats, so keep footwear personal.
What happens at the first nail appointment, and what does it cost?
Dermatology appointments at Venus Aesthetics are by appointment only and cost Rs 3,500. Come with nails free of polish and bring every cream, tablet and home remedy you have already tried. Mention diabetes, thyroid disease, pregnancy or any regular medicine. The doctor examines all the nails and the surrounding skin, usually takes a clipping or scraping for the laboratory, and explains the likely diagnosis and timeline. Call 0311 111 7546 to book.

Worried about your skin?

Bring it to a dermatologist. Diagnosis first, honest plan second, treatment only when it genuinely helps.

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