Fungal nail infection

Alternative names:

infection - fungal (nails); nails - fungal infection; onychomycosis

Treatment:

Topical treatment:
Some toenail infections can be cleared with the persistent use of a prescription antifungal cream or lotion. The medication must be able to penetrate the nail plate (the outer surface of the nail). This is facilitated by filing the nail surface on a weekly basis or using tape or a bandage to cover the medication overnight. The nail is trimmed back to the line marking normal nail growth. Because nails grow slowly, treatment must be continued for 3 to 6 months for fingernails and 6 to 12 months for toenails (the time it takes to grow a new nail).

Systemic (oral) medications:
Griseofulvin has been the standard treatment for many years. The medications prevents fungus from growing but does not penetrate the nail plate. Consequently treatment must be continued until a new nail is produced. Relapse after treatment is also common, occurring approximately 50% of the time.

Treatment is more difficult in older people, perhaps because the blood supply is reduced. Some of the new antifungal medications seem to penetrate the nail plate directly allowing shorter treatment periods and may result in higher cure rates.

Self care:
Keep the area clean and dry. Change shoes and socks frequently. Dry the feet and hands thoroughly after bathing. Powders such as baby powder or talcum may help to keep the area dry.

Avoid damage to the nails or the fingertips. Because the nails grow slowly, damage can cause an injury that lasts for months. Protect the nails from exposure to detergents and chemicals by the use of protective rubber or plastic gloves, preferably with cotton liners.

To minimize the risk of damage to the nails, keep them smooth and properly trimmed. Trim the fingernails weekly. The toenails grow more slowly and may be trimmed when needed, about once a month. Trim nails carefully, using sharp manicure scissors or clippers to trim and an emery board to smooth the edges of the nails. The nails may be softer and easier to trim after bathing. Fingernails should be trimmed with a slightly rounded edge, toenails should be trimmed straight across. Avoid cutting toenails too short to reduce the chance of developing ingrown toenails.

Minimize the use of nail care products. Nail polish remover can weaken and dry the nails. Nail polish may coat and protect the nails slightly. All polishes are basically identical in chemical composition, despite advertising claims to the contrary. Nail strengtheners can discolor or break the nails. Artificial nails may produce reactions under the nail. There is no scientific evidence that gelatin, calcium, or nutritional supplements will improve the nails if the general diet is good.

Do not trim cuticles or use cuticle removers. Cuticle removers are corrosive and may damage the skin around the nail. Trimming the cuticle results in damage to the skin at the base of the nail and allows an entry point for fungi (and bacteria), which can result in infection.

Expectations (prognosis):

Fungal nail infections may be difficult to treat and may become a reservoir for fungal organisms, causing their recurrence 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 paronychia
• recurrent fungal infections of the nails or other parts of the body

Calling your health care provider:

Call your health care provider if you experience persistent fungal nail infections or if the fingers become painful, red, or drain pus.