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Nail Fungus

Nail fungus is a very common problem. It usually involves toenails, but fingernails can be involved as well. The affected nail usually becomes thickened and discolored, and there may be debris under the end of the nail. A clipping of the nail may be obtained to confirm the diagnosis. Initially the problem may be cosmetic, but if untreated, pain and disfigurement can result.

Cause

Factors associated with a higher risk of developing nail fungus include: advanced age, weakened immune system, living in a warm climate, wearing occlusive shoes and using communal showers (such as at a gym). For many people, a fungal infection of the skin of the feet develops first, which then spreads to the toenails.

Treatment

  • Topical treatments: these are applied directly to the nail and are more likely to work if the infection is mild (involving less than 50% of the nail plate). Topicals include: efinaconazole (Jublia), tavaborole (Kerydin), ciclopirox and amorolfine. Daily application and a long duration of treatment are required for these medications to be effective.
  • Oral treatments: these include terbinifine, fluconazole and itraconazole. These can be more effective than topical medications, especially when treating severe cases of onychomycosis. However, they are more likely to interact with other medications and cause side effects. Rarely, serious side effects including liver damage or decreased blood counts can occur. Blood work is usually monitored before and during treatment.
  • Laser treatment: several lasers have been used to treat nail fungus, but data on the efficacy of this treatment is still limited.
  • Surgery: occasionally the nail can be removed surgically, however, the infection can involve the new nail as it grows.
  • Combination treatments: different treatments (for example topical + oral or surgical + oral) may occasionally be used together.
  • Other treatments: some data suggests that other therapies including tea tree oil (Melaleuca alternifolia), mentholated ointments (Vicks Vaporub) and bleach baths may help eliminate fungus.

It is best to keep the involved nails trimmed short with any of the above treatments, and it takes time for a new healthy nail to grow. Fingernails take approximately 6 months to grow out completely, and toenails may take a year or long