Lasers and Photodynamic Therapy

Question: Discuss about the Lasers and Photodynamic Therapy. Answer: Introduction: The essay discusses three nail conditions and explains the causes and management. The essay discusses about onycholysis, splinter haemorrhages and paronychia. Nail fungus is a chronic infection also called as onychomycosis. This infection is caused by dermatopytes (molds, ringworms, and yeasts) affecting finger and toe nails gradually destructing the nail plate. The symptoms of nail fungus involve orange/brown and white/yellow streaks or patches on the nails. In some cases it results in emission of foul smell causing onycholysis that is falling of nail from the nail bed (Becker and Bershow 2013). The causes of onycholysis are trauma, skin diseases, genetic factors, and other systemic diseases. Pseudomonas aeruginosais known to grow under the nails during onycholysis. This condition is treated with topical and oral therapy. Oral fungal therapy is effective method as it penetrates the nail plate and the nail bed. Oral medications that provide complete cure of nail infection terbinafine, fluconazole, itraconazolewhich stimulants the growth of new noninfected nail. Topical cream such as Efinaconazole (Jublia) and tavaborole (Kerydin) are appro ved by US FDA and are highly effective in curing onychomycosis. General practices for preventing of nail fungus are keeping nail dry, short and clean, use of breathable socks and other aesthetic maintenance (Iorizzo 2015). Splinter haemorrhages are another type nail disorder. These infections occur parallel to the long axis to or finger nails. It is commonly caused by infective endocarditis, haematological malignancy, severe anaemia, trauma and vasculitis such as systemic lupus erythematosus, polyarteritis, and rheumatoid arthritis. They appear as thin brown, red or reddish brown lines under the nails in the direction of the growth of the nails and look like splinter. There is no specific care for this nail condition. In some cases, it is indicated as abnormality such as when splinter haemorrhages are caused by onycholysis and it also occurs in patients with nail psoriasis. If splinters occur in multiple nails it is considered as systemic disorder. However, they are not painful due to which most people avoid while aesthetic treatment is required for some people. When splinters occur more frequently and in large numbers it is an indicative of connective tissue disorder. The splinter haemorrhages can per manently disappear when the nail infections resolves. The fungal infection must be treated with systemic or topical antifungal treatment. Antifungal ointments containing cortisone are commonly administered. Patients are advocated o eat food that are natural blood thinner (Haber et al. 2016). Paronychia is the nail disorder characterised by inflammation of the tissue surrounding the nail (Shafritz and Coppage 2014). It includes pus accumulation between the nail matrix and the cuticle resulting in redness, pain, swelling and tenderness in the area. Acute paronychia results from bacterial infection the common agent being Staphylococcus aureus. It can be treated non-surgically. The chronic paronychia results from psoriasis or eczema which is commonly caused by candidal infection and bacterial agents such as Pseudomonasspp. In the chronic condition erythema and oedemaare showed on the proximal and lateral nail folds. The common treatment includes administration of oral antifungal or topical steroids. Regular follow up is required to prevent deep-seated infections. Surgical method involves Swiss roll technique where the non-adherent dressing the nail fold is elevated and reflected proximally. For diabetic patients aggressive treatment approaches used. General management includ e using warm soaks and topical antifungal agents such as miconazole, ketoconazole or fluconazole are administered (Relhan et al. 2014). References Becker, C. and Bershow, A., 2013. Lasers and photodynamic therapy in the treatment of onychomycosis: a review of the literature.Dermatology online journal,19(9). Haber, R., Khoury, R., Kechichian, E. and Tomb, R., 2016. Splinter hemorrhages of the nails: a systematic review of clinical features and associated conditions.International Journal of Dermatology,55(12), pp.1304-1310. Iorizzo, M., 2015. Tips to treat the 5 most common nail disorders: brittle nails, onycholysis, paronychia, psoriasis, onychomycosis.Dermatologic clinics,33(2), pp.175-183. Relhan, V., Goel, K., Bansal, S. and Garg, V.K., 2014. Management of chronic paronychia.Indian journal of dermatology,59(1), p.15. Shafritz, A.B. and Coppage, J.M., 2014. Acute and chronic paronychia of the hand.Journal of the American Academy of Orthopaedic Surgeons,22(3), pp.165-174.