Nail Disorder Treatment in Clovis & Fresno, CA
Nails are more than cosmetic — they are a window into your overall health. Changes in nail color, texture, shape, or growth can indicate fungal infections, skin diseases, nutritional deficiencies, or systemic conditions that deserve professional evaluation. At Dehesa Dermatology, board-certified dermatologist Dr. Luis A. Dehesa evaluates and treats the full spectrum of nail disorders for patients throughout Clovis, Fresno, and the Central Valley — from common nail fungus to psoriatic nail disease and beyond.
Common Nail Disorders We Treat
Nail disorders are often overlooked or attributed solely to cosmetic neglect, but many have underlying medical causes that respond well to targeted treatment. At Dehesa Dermatology, we diagnose and manage a wide range of nail conditions:
- Onychomycosis (Nail Fungus): The most common nail disorder, affecting up to 10% of the general population. Causes thickening, discoloration (yellow, brown, or white), brittleness, and separation of the nail from the nail bed (onycholysis). Requires oral antifungal therapy for complete clearance — topical treatments alone are insufficient for established nail fungus. Dr. Dehesa has specific expertise in onychomycosis from his research fellowship at the University of Miami Hospital.
- Psoriatic Nail Disease: Approximately 50% of patients with psoriasis develop nail involvement — characterized by pitting (small depressions in the nail surface), onycholysis, nail thickening, oil drop discoloration, and subungual hyperkeratosis. Psoriatic nail disease may precede skin or joint psoriasis and is an important diagnostic clue for our integrated rheumatology team when joint symptoms are also present.
- Ingrown Toenails (Onychocryptosis): A painful condition in which the nail edge grows into the surrounding skin, causing inflammation, infection, and significant discomfort. Conservative management and nail avulsion are performed at Dehesa Dermatology for appropriate cases.
- Paronychia: Infection of the nail fold — acute paronychia is typically bacterial (Staphylococcus aureus) and presents with painful, red, swollen tissue around the nail; chronic paronychia is often Candida-related and associated with prolonged wet work or immunosuppression.
- Nail Trauma: Subungual hematoma (blood under the nail), nail avulsion, and post-traumatic nail deformity — evaluated and managed with appropriate drainage and nail care.
- Melanonychia (Dark Nail Streak): A longitudinal brown or black streak in the nail. While most cases are benign (nail matrix nevus or ethnic melanonychia), subungual melanoma must be ruled out — particularly when the streak involves the proximal nail fold or is changing. Biopsy when indicated.
- Nail Involvement in Lichen Planus and Alopecia Areata: Both conditions can affect the nails — lichen planus causes nail thinning, ridging, and scarring; alopecia areata may produce pitting and surface changes. Recognized and managed as part of our comprehensive dermatologic care.
- Brittle Nails (Onychoschizia): Horizontal splitting of the nail tip, associated with repeated wet-dry cycling, nutritional deficiencies, and thyroid disease — evaluated with appropriate laboratory workup when indicated.
Nail Disorder Diagnosis at Dehesa Dermatology
Accurate nail diagnosis requires clinical expertise, dermoscopy, and in many cases laboratory confirmation. For suspected nail fungus, nail clippings are submitted for culture and periodic acid-Schiff (PAS) staining to confirm the diagnosis and identify the causative organism before prescribing oral antifungal therapy. For dark nail streaks, dermoscopy of the nail and nail fold is performed, with biopsy reserved for clinically suspicious lesions. For psoriatic nail disease, correlation with skin and joint findings guides treatment selection from our broad range of psoriasis treatment options including systemic and biologic therapies.
Treatment Options
- Oral Antifungals: Terbinafine and itraconazole for onychomycosis — the most effective treatment for established nail fungus.
- Topical Antifungals: Ciclopirox lacquer and efinaconazole for mild or early nail fungus, or as adjuvant therapy with oral treatment.
- Intralesional Corticosteroid Injections: For psoriatic nail disease and nail lichen planus.
- Systemic Biologics: For psoriatic nail disease severe enough to warrant systemic therapy — managed as part of the comprehensive psoriasis treatment plan.
- Nail Avulsion and Drainage: For ingrown toenails and acute paronychia requiring surgical management.
- Nail Biopsy: For suspicious nail lesions requiring tissue diagnosis.
Frequently Asked Questions About Nail Disorders
How do I know if my nail problem is fungal or something else?
Nail fungus is one of the most commonly misdiagnosed nail conditions — many nail changes attributed to fungus are actually caused by trauma, psoriasis, lichen planus, or other conditions. Accurate diagnosis requires laboratory confirmation, including nail clipping analysis. At Dehesa Dermatology, Dr. Dehesa performs a clinical evaluation combined with laboratory testing to confirm your diagnosis before prescribing treatment. This prevents unnecessary courses of oral antifungals for non-fungal nail disease.
How long does nail fungus treatment take?
Oral terbinafine for toenail fungus is taken for 12 weeks, but complete nail clearing takes 9 to 12 months as the treated nail grows out. Fingernail fungus clears more quickly — typically within 6 months after a 6-week course of treatment. Regular follow-up at Dehesa Dermatology confirms treatment response and allows us to address any recurrence promptly.
Can psoriasis affect the nails?
Yes — nail involvement occurs in approximately 50% of psoriasis patients. Psoriatic nail disease causes pitting, onycholysis, nail thickening, oil drop discoloration, and subungual buildup. It can be painful and functionally impairing, and often correlates with psoriatic arthritis risk. At Dehesa Dermatology, nail psoriasis is managed as part of your comprehensive psoriasis care, and our on-site rheumatology team evaluates patients with nail psoriasis for associated joint disease.
Is a dark streak in my nail concerning?
A dark longitudinal streak in the nail (melanonychia) should always be evaluated by a dermatologist. While most cases are benign — particularly in individuals with darker skin tones where ethnic melanonychia is common — subungual melanoma can present as a dark nail streak and must be ruled out. Warning signs include a streak wider than 3mm, irregular borders within the streak, extension of pigment onto the surrounding skin (Hutchinson’s sign), or recent change in appearance. Call (559) 951-9000 to schedule a prompt evaluation at Dehesa Dermatology.
What causes brittle, splitting nails?
Brittle nails are most commonly caused by repeated wet-dry cycling — frequent hand washing, dishwashing, or swimming without glove protection. Other contributing factors include nutritional deficiencies (particularly biotin and iron), thyroid disease, and certain medications. At Dehesa Dermatology, we evaluate brittle nails with a clinical history and targeted laboratory workup to identify and address any underlying systemic cause.
Do you treat ingrown toenails at Dehesa Dermatology?
Yes. We evaluate and treat ingrown toenails including conservative management, partial nail avulsion, and matrixectomy for recurrent cases. If you have a painful, infected ingrown toenail, call (559) 951-9000 to schedule a prompt evaluation at Dehesa Dermatology.
Does Dehesa Dermatology treat nail disorders for patients from Fresno?
Yes. We treat nail disorders of all types for patients from Fresno, Clovis, and throughout the Central Valley. Our office is at 978 N Temperance Ave in Clovis, just minutes from Fresno via Highway 168. Call (559) 951-9000 to schedule your nail evaluation.