Fungal nail infections have several names. They are known as tinea unguium, onychomycosis, and ringworm of the nails. A fungal infection, which is in the keratin layer of the skin of the feet, is called athlete’s foot (dermatophyte fungi). Your nails also consist of hard keratin. The fungi from the athlete’s foot can invade the nails too. This is the commonest cause of fungal nail infections. Other causes are moulds (e.g. Scopulariopsis) and yeasts (e.g. Candida). Toenail infections are commoner than fungal fingernail infections. Both infections are common in the elderly people. Fungal nail infections can spread among family members.
At the beginning, there will be no symptoms (asymptomatic). Gradually, nails become thicker and painful, when they press. Therefore, it is difficult to trim them. Usually, fungal infections begin from the free edge of the nail and spread to the base along the side. Eventually, the whole nail may be infected. The infected nails become thicker, crumbly, and white or yellow in colour. Sometimes, there may be white streaks or patches on the affected nail surface.
Most of the nail conditions look like fungal nail infections (e. g. Some bacterial nail infections and nail changes in psoriasis). Your physician will take a sample of the affected area of your nail and ask to do a microscopic investigation or a culture test to detect the fungus.
Usually, fungal nail infections can be cured. If your infected nails are uncomfortable or embarrassing, it is better to get treatments. After eradicating the fungus, affected nails usually become normal. If the nails were abnormal in shape and colour, before they got the infection, particular nails will not regain the normal state. Mould and yeast infections are very resistant to treatments.
Usually, oral medications are more effective than topical treatments. Topical medications might be best, if the fungal infection is at an initial stage (on the free edge or superficial areas of one or two nails). Tioconazole nail solution and amorolfine nail lacquer are most commonly used topical preparations. If the fungal nail infections are widespread and at the deeper parts of the nails, a topical medication itself will not be enough to eradicate the fungus. Therefore, regular removal of affected nail parts with filing or clippers should be done. If oral medications are used in combination with these treatments, the chance of cure will be higher. You may need to take treatments for four to twelve months before a response is seen.
Commonly used oral anti-fungal drugs are griseofulvin, terbinafine, and itraconazole. Griseofulvin is the only one medication of the three licensed for paediatric use. It has been used for a long time. Griseofulvin is well absorbed with fatty meals. It should be used for about six to nine months for fingernail infections and up to 18 months for toenails. Even if you use griseofulvin properly, about one-fourth of fingernail infections and two third of fungal toenail infections will remain. Recurrences of infection are common with griseofulvin.
Terbinafine and itraconazole are much more effective and quicker than griseofulvin. They eradicate fungal infections 80 to 90 % from fingernails, and about 70 % from toenails. Terbinafine is very effective for the athlete’s foot (dermatophyte fungi). It should be taken daily for about six weeks for fingernails and 12 weeks for toenails.
Itraconazole is less effective than terbinafine, but it is also good for dermatophyte fungi and yeasts. Itraconazole can be given for one week per one month. Two of these weekly treatment courses (taken 21 days apart) are effective for fungal fingernail infections. Three treatment courses should be taken for toenail infections.
It will take six months to one year the affected nails to become normal after finishing the treatment. Toenail infections are somewhat resistant to treatment than fingernails.
Sometimes, affected nails become very thick, and they cannot be managed with medications alone. Therefore, they have to be surgically removed under local anaesthesia.
What can you do?
- Keep the nails clean and dry.
- Keep the nails short.
- Use one nail clipper for the affected nails and another one for the normal nails.
- Treat fungal infections on the skin as well.
- Keep the feet dry.
- Use breathable shoes.
- Use dry and clean cotton socks.
- Change socks daily.
- Do not walk barefoot around public showers, locker rooms, and pools.
- These should not be limited during your treatment. Do them regularly to avoid recurrences of the infection.
(Photo courtesy: Medguy)