Fungal Nail Infection
What is a Fungal Toenail Infection?
Onychomycosis is a fungal infection which causes the toenails to become thickened, discolored and brittle. It is a common condition and is thought to affect 10 percent of the general population.
Fungal infections have a tendency to affect toenails more than fingernails due to their slower rate of growth, reduced blood supply and being confined to footwear.
Risk Factors
People who tend to be more at risk of developing a fungal nail infection include:
- Older aged adults (over 65 years)
- Diabetics
- Immunocompromised patients
- Athletes
Associated medical conditions (comorbidities):
- Tinea pedis (athletes foot)
- Psoriasis
- Circulation disorders
- Smoking
- Obesity
Predisposing individual factors:
- Sweating
- Nail trauma
- Gyms and communal swimming pools
- Chronic inflammation of the skin around the nails
Causes
- Onychomycosis can be due to infection with dermatophytes or non-dermatophytes such as moulds and yeasts.
- Dermatophyte fungi are the ringworm fungi (tinea) and these account for over 75% of cases.
- Non-dermatophytes are basically moulds and yeasts and occur in about 10% of cases.
Clinical signs
Features that are observed include:
- Scaling under the nail
- Jagged and crumbling of the free end of the nail plate
- Discolouration of the nail, eg, yellow, white, grey, or green discolouration
- Ridging, crumbling, and sometimes eventual complete nail plate destruction
- Scaling on the plantar skin and web spaces due to associated tinea pedis
Credit: https://dermnetnz.org/
Diagnosis
Fungal nail infections can often be diagnosed clinically. However, in certain cases, clippings will be taken and sent away for microscopic examination and fungal culture testing. This is usually recommended when we are unsure of the diagnosis.
Treatment
Mild infections affecting < 50% of one or two nails may respond to topical therapies and routine nail care such as Vicks Vaporub or over-the-counter (OTC) treatments purchased from a pharmacy.
Common nail tinctures that can be purchased OTC include:
Typically, these treatments will take a minimum of at least 6-12 months and will require regular nail debridement.
It is often recommneded that nail tinctures should be combined with other topical antifungal therapies such as terbinafine hydrochloride. This is becuase these types of fungal infections are often present in the skin as well as the toenails.
If there is total nail involvement or if multiple toenails are involved then the following treatment options may be advised:
- Oral antifungal medication, however, you will be required to be on this treatment for several months. This medication is not suitable for everyone due to drug interactions and potential liver injury.
- Removal of the nail. In certain cases the toenail will need to be removed for testing purposes and to help facilitate a new nail.
- Cold Laser. Is a safe and painless treatment (non-theramal) that increases blood flow to the area which aids the immune response to toenail infections
- Hot Laser. A thermal laser which uses an infrared beam to target and heat up fungal spores until they can no longer survive. Patients may experience pain with this treatment.