Liam Carter
Green nail syndrome is a bacterial infection that causes the nail to turn green. It is caused by exposure to Pseudomonas aeruginosa, a bacterial organism found in water sources, humans, animals and soil. The bacteria secrete pigments such as pyocyanin and pyoverdin, which cause the nail to turn green. Green nail syndrome is rare in healthy individuals, but can occur in those who are immunocompromised or who frequently immerse their hands in water.
| Characteristics | Values |
|---|---|
| Cause | Exposure to bacterial organisms, particularly Pseudomonas aeruginosa |
| Appearance | Greenish or greenish-black discolouration, with possible green stripes |
| Other names | Green nail syndrome, GNS, Pseudomonas nail infection, chloronychia, chromonychia |
| Risk factors | Prolonged exposure to water or detergents, ungual trauma, immunocompromise |
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What You'll Learn
Green nail syndrome
These bacteria do not normally survive on dry, healthy skin, but can thrive in moist conditions. The seal between the nail and finger acts as a physical barrier to prevent infection, however, hyper-hydration or destruction of the epidermis can impair the barrier, allowing the bacteria to colonise. Patients with green nail syndrome likely have a history of prolonged exposure to water or detergents (soaps), or an ungual trauma. On physical examination, there is characteristic greenish or greenish-black discoloration of the nailfold with proximal chronic paronychia and distolateral onycholysis. A small portion of the nail may be involved or the entire nail itself. Most patients will only have involvement of one nail. On occasion, the nail adjacent to the primarily infected nail will have some secondary evidence of infection.
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Green nail causes
Green nail syndrome is caused by exposure to a bacterial organism, which leads to an opportunistic infection. The most common cause is Pseudomonas aeruginosa, which is frequently found in nature, including in water sources, humans, animals and soil. These bacteria do not normally survive on dry, healthy skin, but can thrive in moist conditions.
The seal between the nail and finger acts as a physical barrier to prevent infection, however, hyper-hydration or destruction of the epidermis can impair the barrier, allowing the bacteria to colonise. The nail turns green due to the bacteria secreting pigments such as pyocyanin and pyoverdin. Green nail syndrome occurs rarely in healthy individuals, but can occur in the immunocompromised or those whose hands are frequently immersed in water or who have had an ungual trauma.
On physical examination, there is a characteristic greenish or greenish-black discolouration of the nailfold with proximal chronic paronychia and distolateral onycholysis. A small portion of the nail may be involved or the entire nail itself. Most patients will only have involvement of one nail. On occasion, the nail adjacent to the primarily infected nail will have some secondary evidence of infection. Green striping of the nail has also been reported.
Chronic fungal infection (onychomycosis) may also be present. Coinfection with Trichophytan rubrum and Pseudomonas is a common occurrence.
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Green nail diagnosis
Green nail syndrome is a rare condition that occurs when the nail is exposed to a bacterial organism, leading to an opportunistic infection. The nail turns green due to the bacteria secreting pigments such as pyocyanin and pyoverdin. The most common cause is Pseudomonas aeruginosa, which is frequently found in nature, including in water sources, humans, animals and soil.
The syndrome is characterised by greenish or greenish-black discolouration of the nailfold with proximal chronic paronychia and distolateral onycholysis. The nail may be tender to the touch and there may be red to reddish-black pigmentation, depending on the age of the blood. In some cases, the nail may be separated from the nail bed (onycholysis) and may have green stripes from repeated infections.
Green nail syndrome is often associated with a history of prolonged exposure to water or detergents (soaps), or an ungual trauma. It can also occur in immunocompromised individuals or those whose hands are frequently immersed in water. However, it rarely occurs in healthy individuals.
Diagnostic studies are typically unnecessary for green nail syndrome.
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Green nail treatment
Green nail syndrome is caused by an infection with Pseudomonas aeruginosa, a bacterial organism that is frequently found in nature, including in water sources, humans, animals and soil. The nail turns green due to the bacteria secreting pigments such as pyocyanin and pyoverdin.
The syndrome is rare in healthy individuals but can occur in those who are immunocompromised, or whose hands are frequently immersed in water or who have had an ungual trauma. Patients with green nail syndrome likely have a history of prolonged exposure to water or detergents (soaps).
On physical examination, there is characteristic greenish or greenish-black discoloration of the nailfold with proximal chronic paronychia and distolateral onycholysis. The nail may be tender to the touch and there may be reddish to reddish-black pigment, depending on the age of the blood. Most patients will only have involvement of one nail, although occasionally the nail adjacent to the primarily infected nail will have some secondary evidence of infection.
To treat green nail syndrome, it is important to address the underlying cause of the infection. This may include reducing exposure to water or detergents, or treating any underlying health conditions that may be compromising the immune system. Antibiotics may also be prescribed to help clear the bacterial infection. In some cases, surgical removal of the nail may be necessary to prevent the spread of the infection.
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Green nail prevention
Green nail syndrome is caused by an infection with the bacteria Pseudomonas aeruginosa. The nail turns green due to the bacteria secreting pigments such as pyocyanin and pyoverdin. The syndrome is rare in healthy individuals but can occur in those who are immunocompromised, or whose hands are frequently immersed in water or detergents (soaps).
To prevent green nail syndrome, avoid prolonged exposure to water or detergents. Keep your hands and nails dry, as the bacteria that cause the infection thrive in moist conditions. If you have an ungual trauma, take extra care to keep the area dry and clean, as this can impair the barrier between the nail and finger, allowing the bacteria to colonise.
If you work with water or detergents, wear gloves to protect your hands and nails from prolonged exposure. If your hands are frequently immersed in water, dry them thoroughly after each immersion and consider using a moisturiser to prevent hyper-hydration of the skin.
Good hand hygiene is also important in preventing green nail syndrome. Wash your hands regularly with soap and water, especially after handling water sources, animals or soil, which can harbour the bacteria that cause the infection. Keep your nails short and clean, as long nails can trap dirt and bacteria, providing a breeding ground for the infection.
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Frequently asked questions
Green nail syndrome is a bacterial infection that causes the nail to turn green.
Green nail syndrome is caused by exposure to a bacterial organism, most commonly Pseudomonas aeruginosa.
The seal between the nail and finger acts as a barrier to prevent infection. However, hyper-hydration or destruction of the epidermis can impair the barrier, allowing the bacteria to colonise.
The nail will have a greenish or greenish-black discolouration, with proximal chronic paronychia and distolateral onycholysis. The nail may also have green stripes.
Green nail syndrome rarely occurs in healthy individuals. Those at risk include those who are immunocompromised, or those whose hands are frequently immersed in water or exposed to detergents or soaps.
