Fungal nail infections, known as onchomycosis, are the most common nail disorder and can affect both fingernails and toes. A nail fungal infection can be difficult to eradicate, resulting in thickening and discoloration of nails, eventually causing splitting or disfiguration. If left alone, a nail fungal infection only becomes worse. Nail infections are unsightly and can be irritating or even painful. They become more frequent with aging, but diabetes or any sort of immune suppression can put you at higher risk.
The nail grows from the nail matrix, which is where nail cells multiply and eventually harden, forming nail material. This process is known as keratinization. Your nail matrix begins below the nail fold, where your cuticle meets the nail. It extends into the area known as the lunula, which is the white half-moon shape region at the base of the nail. The cuticle, which refers to the thickened skin covering the junction of skin and nail, is an important defense against matrix infection. The nail, also known as the nail plate, covers the nail bed, which is the soft tissue beneath the nail.
Different types of nail infections
Any of these areas can become infected, resulting in one of the five patterns of fungal nail infection. Fungus can spread from the skin, invading the underside of the nail. It can also directly invade the nail surface and spread to the nail bed. The least common type of onchomycosis occurs when fungi invade the cuticle of the nail and nail fold, eventually penetrating the nail itself.
Fungal infection can also spread directly from the nail to the skin, with invasion of the nail plate, instead of the nail bed. Finally, yeast infections of the nail, another type of fungal infection, can cause oncholysis, which refers to separation of the nail and nail bed. Any of these fungal nail infections can progress to involve the entire nail, nail plate, and nail bed. This is a final common pathway and it is known as total dystrophic onchomycosis.
There are three primary types of organism that can infect the nail unit, including yeast and dermatophytes. Fungal nail infections are diagnosed by their appearance, but it’s important to confirm the type of infection before you begin treatment. The most effective treatments can take months and there are some risks associated with antifungal medications. It’s important to allow your physician to scrape a sample of your nail to examine under a microscope to “nail down” the diagnosis. In some cases, a fungal culture will be grown in the laboratory to determine the best type of treatment for your nail infection.
Fungal nail infections are sometimes difficult to treat because the nails do not have a robust blood supply. Even with treatment, the rate of recurrence is high. Antifungal agents include topical medications, which are applied to the skin and nail area to eradicate infection. Topical antifungal treatments usually do not provide a cure. The nail is a hard surface and topical treatments generally do not penetrate the nail adequately to completely eradicate fungus. A topical agent should not be used if more than half of the nail is involved, unless you can’t tolerate a systemic agent taken by mouth. Topical medications include Nizoral cream, Lamisil cream, Tinactin, clotrimazole, and Penlac, which is applied like nail polish. If you have a stubborn or extensive nail infection, your physician may decide that you can achieve better treatment with a combination of both an oral medication and a topical medication.
Oral antifungal medications include Lamisil tablets, Diflucan, and itraconazole, which is sold as Sporanox. In most cases, treatment should last about three months. However, if you have liver disease or heart failure, you are not a candidate for treatment with some of these oral medications.
Surgical removal of the nail itself generally does not work well to treat a fungal infection unless you combine it will oral medication and/or a topical antifungal treatment. The nail can also be removed using a chemical compound, urea. However, laser treatment can be effective because the laser beam penetrates the nail tissue to disrupt fungal organisms and can kill them. Patients may require more than one treatment, but it does appear as effective as medication.
Prevention is key
Prevention of nail fungus will save you a lot of trouble. Nail infections are contagious, so be cautious about any contact with individuals who have nail infections. Fungal transmission can also occur in public showers and locker rooms or can be passed through manicure/pedicure equipment. It’s important to wear shower shoes when you are using a public shower at the gym and to ensure that your manicurist sterilizes instruments after each use. Keeping your feet clean and dry will also be helpful to reduce the risk of a nail infection. If your feet have a tendency to perspire, try some socks that can wick away the moisture, which provides an ideal environment for fungi to thrive.
If you have a nail infection, it shouldn’t be ignored. Call use today for a consultation. Even with medical treatment, a nail infection can be a long battle. You may require several courses of treatment and nail infections often recur. However, the longer your nail infection is left untreated, the greater the risk of permanent discoloration or damage to the nail bed and matrix. Call today for an appointment to determine the best possible options for your treatment.