Fungal Nail Infection
Fungal Nail Infection of the nails are also known as onychomycosis. The fungi here is similar to the fungi involved in athlete’s foot and in most cases the infection can begin as athlete’s foot (dermatophyte fungi). In athlete’s foot the fungi live in the keratin that makes up the outer layer of the skin, but they can also invade the hard keratin of which nails are made. Some causes:
> poor foot hygiene
> damage to nails from dropping objects on them
> poor footwear
> contagious so sharing towels/shoes with family members can spread the infection
> poor diet and lifestyle
> poor circulation
> people who smoke
At the start, there are usually no symptoms. Later the nails may become so thick that they hurt when they press on the inside of a shoe due to additional pressure. The infection can spread across the whole nail or just a part down the side or at the top end. The infected areas turn white or yellowish, and become thickened and crumbly. Not all discoloured nails have a fungal nail infection.
Fungal nail infections are sometimes difficult to trim without professional equipment. At David Brown Podiatry we use water spraying drills to reduce the thickness of the nail allowing it to be trimmed, pain free and more effectively. This also ensures the best possible chance for any treatment to penetrate your nail bed where the infection lies.
Many nail problems can look like a fungal nail infection – for example the changes seen in psoriasis, or after a bacterial infection or an old injury. The diagnosis of a fungal infection should be confirmed before treatment starts. In most cases your GP will take a piece from a crumbly area of your nail and send it to the laboratory to check if a fungus can be seen under the microscope or grown in culture. This process can take time and be costly so in some cases your GP or podiatrist will prescribe some form of treatment depending on the appearance of the nail and their clinical knowledge.
> research suggests that the most effective treatment for fungal nail infections are a tablet (such as Terbinafine) from your GP. The usual adult dose is 250 mg once a day for three to six months for toenails as well as painting a lacquer on during this same period. In some cases this medication can interact with other medicines for other conditions so a tablet is not always prescribed. Treatment success rates are between 60-80%
> natural products such as tea tree oil or certain vinegars are sometimes effective
> nail surgery may be necessary if the nail is painful and a continuing problem. At David Brown Podiatry we can perform total or partial nail surgery under local anaesthetic and apply a chemical (phenol) to prevent regrowth of the nail (97% success rate of preventing regrowth). We will work with you through the whole process including dressing appointments until the toe has fully healed
> lead a healthy lifestyle – exercise/ good hygiene and healthy diet
There are a number of exciting new products coming on to the market including laser therapy and clearanail (a drill that drills tiny holes in the nail to allow deep penetration of ointment). Success rates are positive but it is too early to tell if they are more effective than traditional methods.
Any treatment will require patience and consistency on your part to give the nail the best possible chance of recovery. Unfortunately, even when the infection has been cleared, some nails may never gain the same appearance as before the infection.