Managing common nail disorders in active patients and athletes.

Sports-related acute nail trauma can cause subungual hematoma and pain, which can be alleviated by fluid evacuation; the differential diagnosis includes subungual melanoma. A careful history will help distinguish splinter hemorrhages related to systemic disease from those caused by trauma. Chronic trauma can damage the nail matrix, leading to longitudinal splits or ridging, pigmentary changes, pterygium, or dystrophy. Mildly ingrown toenails can be treated with cotton placed under the lateral nail edges and proper trimming; severe cases may require surgery. Treatment of acute paronychia includes systemic antibiotics, while chronic paronychia may require topical or systemic antifungal agents.