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
- Dermatophyte Infections
- Most common cause: Trichophyton rubrum and Trichophyton mentagrophytes.
- Yeast Infections
- Candida species, more common in fingernails.
- Non-Dermatophyte Molds
- Scopulariopsis and Fusarium species.
- 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
- Visual Changes
- Nail discoloration: White, yellow, brown, or black.
- Nail thickening and distortion.
- Structural Changes
- Brittle, crumbly, or ragged nails.
- Separation of the nail from the nail bed (onycholysis).
- 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
- Clinical Examination
- Visual inspection of the nail for typical features.
- Microscopy and Culture
- Nail clippings or scrapings examined under a microscope or cultured for fungal growth.
- Histopathology
- PAS (Periodic Acid-Schiff) staining for fungal elements in nail tissue.
Treatment Options for Fungal Nail Infection
1. Topical Treatments
Medication | Brand Name | Manufacturer | Cost Range |
---|---|---|---|
Amorolfine | Loceryl | Galderma | $20–$50 per bottle |
Ciclopirox | Penlac | Sanofi | $25–$40 per bottle |
Efinaconazole | Jublia | Valeant Pharmaceuticals | $100–$150 per bottle |
Tavaborole | Kerydin | Anacor/Bayer | $100–$200 per bottle |
- Applied daily for 6–12 months.
- Effective for mild to moderate infections.
2. Oral Treatments
Medication | Brand Name | Manufacturer | Cost Range |
---|---|---|---|
Terbinafine | Lamisil | Novartis | $10–$50 per course |
Itraconazole | Sporanox | Janssen | $50–$150 per course |
Fluconazole | Diflucan | Pfizer | $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.