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Green Nails

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Green Nails, Chloronychia, Pseudomonas Nail Infection, Green Nail Syndrome

  • Pathophysiology
  1. Pseudomonas pyocyanea or Pseudomonas aeruginosa infection
  2. Infection occurs after local Trauma lifts the nail from the nail bed, allowing entry of Pseudomonas
  • Risk Factors
  1. Workers in warm, moist environments
    1. Dishwashers
    2. Barbers
    3. Nail Salon Technicians
    4. Bakers
    5. Janitors
    6. Homemakers
  2. Chronic Paronychia
  3. Onycholysis
  4. Onychomycosis
  5. Artificial nails or nail polishes (possible)
  6. Immunocompromised State
  • Signs
  1. Blue-green biofilm on the nail surface
  • Labs
  1. Clinical diagnosis is pathognomonic and no additional testing is needed
  2. Consider nail culture or biopsy if unclear diagnosis
  • Management
  1. Best treatment protocol is unclear
  2. General Measures
    1. Nail care (trim nails and keep dry)
    2. Avoid repeat Trauma to the area
  3. Home treatments
    1. Finger or toe soaks in dilute white vinegar (1:1 vinegar to water)
    2. Dilute bleech soaks (1 teaspoon bleach per gallon water) have also been used
  4. Topical Antibiotics applied to nail bed twice daily (over 4 to 6 weeks)
    1. Topical Gentamicin
    2. Topical Fluoroquinolone
  5. Oral Antibiotics (severe infections or Immunocompromised state)
    1. Oral Ciprofloxacin
  6. Other measures
    1. Nail removal
  • References
  1. Jhun, Raam and DeClerck in Herbert (2015) EM:Rap 15(12): 3-4
  2. Fawcett (2004) Am Fam Physician 69(6):1417-24 [PubMed]
  3. Quattlebaum (2021) Am Fam Physician 104(6): 645-6 [PubMed]