Fungal Nails and other Thick and Discolored Toenails
Alternative names
Nails - fungal infection; Onychomycosis;
Figure 1 - Potential nail fungus
Definition
Fungal nail infection is an infection of the nails by a fungus.
Causes, incidence, and risk factors
The body normally hosts a variety of microorganisms, including bacteria and fungi. Some of these are useful to the body. Others may multiply rapidly and form infections. Fungi can live on the dead tissues of the hair, nails, and outer skin layers and are also the cause of
Athlete’s Foot.
Fungal nail infections are most often seen in adults. They often follow
fungal infection of the feet. Fungal nail infections may be difficult to
treat and may recur often. Toenails are affected more often than
fingernails.
People who frequent public swimming pools, gyms, or shower rooms -- and
people who perspire a great deal -- commonly have mold-like infections,
because the fungi that cause them thrive in warm, moist areas.
The risk of getting a fungal infection is increased by closed-in
footwear, prolonged moist skin, and minor skin or nail injuries.
Symptoms
Nail changes on one or more nails (usually toenails):
- Brittleness
- Discoloration
- Loss of luster and shine
- Thickening
- Distortion of nail shape
- Crumbling of the nail
- Debris being trapped under the nail
- Loosening (detaching) of the nail.
Signs and tests
Your doctor will suspect a fungal infection based on the appearance of the nails. The diagnosis can be confirmed by scraping the nail for a culture, or a microscopic examination to identify the type of fungus.
Treatment
Over-the-counter creams and ointments are generally are not very
effective at completely eliminating the fungus, but according to some
studies1, 2 some over-the-counter treatments can help the nail look
better and reduce symptoms.
What you can do on your
own
We have tried a number of products over the years and have prepared a
step-by-step program to help you treat your fungal nails at home.
We do not guarantee a cure of the fungal nails – don’t trust anyone who
guarantees a cure. We have, however, had relatively good success with
this program and think it is the best home remedy for fungal nails
currently available.
What we can do for you in our office
For more definitive treatment
make an appointment to see us in our
Seattle office. We will likely take a sample of the nail (no pain
involved – just a little clipping) to send for a lab test to see if the
nail has a fungal infection and if so, what kind of fungus. This
information will help us decide the most appropriate treatment for your
condition. We’ll review in detail with you the available prescription
treatments for fungal nails including details on the advantages and
disadvantages of each. Once your lab tests are back, we’ll provide
information on the treatment most likely to provide the best outcome.
Prescription anti-fungal medicines taken by mouth may help clear the
fungus in about 50% of patients. However, such medicines can cause side
effects or may interfere with other health medicines the patient is
taking.
In some cases, the nail may be removed by the doctor. Nails grow slowly,
so even if treatment is successful, a new, clearer nail may take up to a
year to grow in.
Expectations (prognosis)
Fungal nail infections may be difficult to treat and may become a
reservoir for fungal organisms, causing them to return in the skin or
nails. The fungal nail infection is cured by the growth of new,
non-infected nails. Even with successful treatment, a relapse is common.
Complications
• Permanent damage to the nails
• Secondary skin infections, including infections associated with
ingrown nails.
• Recurrent fungal infections of the nails or other parts of the body
Making an Appointment
Make an appointment to see us in our Seattle office if you are not happy
with the results of the home treatment explained above, if you
experience persistent fungal nail infections, or if the fingers become
painful, red, or drain pus.
Prevention
Good general health and hygiene help to prevent fungal infections. Keep
the skin clean and dry. Take proper care of the nails (see treatment).
Wash and dry the hands thoroughly after contact with any fungal
infection.
It is possible to pick up a nail infection in a nail salon. If you ever
go to a nail salon or otherwise have pedicures, you can help prevent
infection by taking your own instruments. We recommend the
Dr. Siegel’s
Savvy Nail Kit or the
SOS Safe Salon Pedicure kit. In addition, take
your own tub liners, such as the
Dr. Siegel’s Savvy Nail Tub Liners.
What Do Studies Show About the Effectiveness of Oral Medication for Fungal Nails?
Definitions:
- Mycological cure (100% resolution of fungus from nail
sample):
defined as patient's nail sample does not show fungus under a
microscope and does not grow fungus in a laboratory medium.
Mycological cure does not evaluate visual appearance of nail.
- Effective treatment - defined as mycological cure and
>5mm of unaffected nail growth (thus clinically still signs of
fungus)
- Mycological cure plus clinical cure (no laboratory or visual signs of nail
fungus)
The Lamisil studies showed the following:
- 70% Mycological cure (no laboratory signs of fungus).
- 59% Effective Treatment (no laboratory signs of fungus
and >5mm of unaffected nail growth).
- 38% Mycological cure plus Clinical cure (no laboratory or
visual signs of nail fungus).
Laser Fungal Nail Treatment
Click here for information on
laser toenail treatment.
References:
1. Syed, TA; Treatment of toenail onychomycosis with 2% butenafine and
5% Melaleuca alternifolia (tea tree) oil in cream. Trop Med Int Health.
1999 Apr;4(4):284-7
2. Buck DS; Comparison of two topical preparations for the treatment of
onychomycosis: Melaleuca alternifolia (tea tree) oil and clotrimazole.
Dermatology, 2001
Healthy feet allow for regular exercise and a
happy healthy feet. If you have nail problems not
relieved by the suggestions above, make an appointment to see us in our
Seattle office. We can provide you with conservative treatment options
that will relieve your pain.
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Douglas Hale, DPM & Lawrence Huppin, DPM
Foot and Ankle Center of Washington, Seattle
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