Fungal Nail Infection

Introduction

  • Fungal nail infection, or onychomycosis, is a common condition affecting the toenails or fingernails.
  • It is caused by dermatophytes, yeast, or non-dermatophyte molds.
  • Characterized by nail discoloration, thickening, and brittleness, it can cause discomfort or embarrassment.
  • Effective treatment often requires a combination of topical and oral therapies, as well as good hygiene practices.

Causes of Fungal Nail Infection

  1. Dermatophyte Infections
    • Most common cause: Trichophyton rubrum and Trichophyton mentagrophytes.
  2. Yeast Infections
    • Candida species, more common in fingernails.
  3. Non-Dermatophyte Molds
    • Scopulariopsis and Fusarium species.
  4. Risk Factors
    • Warm, moist environments.
    • Nail trauma or poor circulation.
    • Wearing tight footwear or synthetic socks.
    • Immune suppression (e.g., diabetes, HIV/AIDS).

Symptoms of Fungal Nail Infection

  1. Visual Changes
    • Nail discoloration: White, yellow, brown, or black.
    • Nail thickening and distortion.
  2. Structural Changes
    • Brittle, crumbly, or ragged nails.
    • Separation of the nail from the nail bed (onycholysis).
  3. Other Symptoms
    • Foul odor.
    • Discomfort or pain, especially with shoes or during walking.

Complications of Fungal Nail Infection

  • Spread to Surrounding Skin: May cause athlete’s foot or cellulitis.
  • Pain and Mobility Issues: Especially in severe cases affecting toenails.
  • Secondary Bacterial Infections: Increased risk in diabetic patients.

Diagnosis of Fungal Nail Infection

  1. Clinical Examination
    • Visual inspection of the nail for typical features.
  2. Microscopy and Culture
    • Nail clippings or scrapings examined under a microscope or cultured for fungal growth.
  3. Histopathology
    • PAS (Periodic Acid-Schiff) staining for fungal elements in nail tissue.

Treatment Options for Fungal Nail Infection

1. Topical Treatments

MedicationBrand NameManufacturerCost Range
AmorolfineLocerylGalderma$20–$50 per bottle
CiclopiroxPenlacSanofi$25–$40 per bottle
EfinaconazoleJubliaValeant Pharmaceuticals$100–$150 per bottle
TavaboroleKerydinAnacor/Bayer$100–$200 per bottle
  • Applied daily for 6–12 months.
  • Effective for mild to moderate infections.

2. Oral Treatments

MedicationBrand NameManufacturerCost Range
TerbinafineLamisilNovartis$10–$50 per course
ItraconazoleSporanoxJanssen$50–$150 per course
FluconazoleDiflucanPfizer$10–$30 per course
  • Terbinafine: 250 mg daily for 6–12 weeks (toenails) or 6 weeks (fingernails).
  • Itraconazole: Pulse dosing: 200 mg twice daily for 1 week/month for 2–3 months.

3. Combination Therapy

  • Combining oral and topical therapies for resistant or severe infections.

4. Non-Pharmacological Interventions

  • Nail Debridement
    • Removal of thickened or damaged nail portions.
  • Laser Therapy
    • Targets fungal elements with heat; effectiveness varies.

Monitoring Parameters

  • Monitor nail growth and appearance during treatment.
  • Assess for side effects of oral antifungals (e.g., liver enzyme elevation).
  • Regular follow-ups every 2–3 months for long-term cases.

Patient Counseling Points

  • Educate on the long duration of treatment (6–12 months).
  • Advise wearing breathable footwear and cotton socks to prevent moisture buildup.
  • Emphasize regular nail trimming and hygiene.
  • Avoid sharing nail clippers or footwear to prevent spread.
  • Reinforce the importance of completing the full course of treatment to avoid recurrence.

Use in Children

  • Oral antifungals like terbinafine are used with dose adjustments based on weight.

Use in Pregnancy

  • Topical treatments are preferred; oral antifungals are avoided unless absolutely necessary.

Use in Elderly

  • Ensure liver function monitoring for oral antifungals; consider topical treatments if systemic risks are high.

FAQs About Fungal Nail Infection

Q1: What causes fungal nail infections?

  • Dermatophytes, yeast, or molds that thrive in warm, moist environments.

Q2: How long does it take to treat a fungal nail infection?

  • Typically 6–12 months, depending on the severity and treatment type.

Q3: Can fungal nail infections be prevented?

  • Yes, by keeping feet dry, wearing breathable footwear, and avoiding shared personal items.

Q4: Are over-the-counter treatments effective?

  • OTC topical treatments may help mild cases but are less effective than prescription options.

Q5: Do fungal nail infections go away on their own?

  • Rarely; treatment is usually required for resolution.

Q6: Can fungal nail infections spread to others?

  • Yes, through direct contact or shared items like towels or nail clippers.

Q7: Is laser therapy effective for fungal nail infections?

  • It may be effective for some patients but is often costly and less proven than medications.

Q8: What are the side effects of oral antifungals?

  • Possible side effects include liver dysfunction, rash, and gastrointestinal upset.

Q9: Can I wear nail polish during treatment?

  • Avoid nail polish, as it can trap moisture and reduce medication effectiveness.

Q10: Are fungal nail infections common in diabetics?

  • Yes, diabetics are at higher risk due to poor circulation and immune response.

Q11: How can I tell if the infection is improving?

  • Look for healthy nail growth at the base and reduced discoloration.

Q12: Can fungal nail infections recur?

  • Yes, recurrence is common without proper prevention and maintenance.

Q13: Is there a natural remedy for fungal nail infections?

  • Tea tree oil may have antifungal properties, but effectiveness is limited compared to medications.

Q14: Can children get fungal nail infections?

  • Yes, though less common; treatment may require tailored approaches.

Q15: When should I see a doctor for a fungal nail infection?

  • If over-the-counter treatments fail or the infection causes pain or severe nail damage.