Fungal nail infections are common in adults and medically harmless. They are largely a cosmetic problem but those who are self-conscious about their feet will feel that it’s important to be treated.
Symptoms of nail infections:
The nail becomes thickened and discoloured (usually yellow or brown) and may become so
thick that wearing shoes becomes uncomfortable. There may also be a bad-smelling debris under the nail. Eventually the nail may crumble, come away from the nail bed and fall off.
Diagnosing fungal nail infections:
There are many different types of fungus that can cause toe nail infections and also infect the skin of the foot causing athlete’s foot. So to be sure that you’re treating the right one you should visit your doctor so that s/he can take scrapings or clippings that can be sent to the lab for analysis. The right treatment will be based on these findings.
This step is important as there are a few other things that can cause thickened toenails other than a fungal nail infection, such as psoriasis, lichen planus, contact dermatitis and some bacterial infections.
What causes fungal nail infections?
Fungal nail infections are often caused by a combination of the following:
- Tight or poorly fitting shoes
- Layers of nail varnish
- Chronic infection with athlete’s foot
- Having a long-term/chronic condition such as diabetes or HIV will lower immunity to infection
- Poor peripheral circulation
And other risk factors for toenail fungus include:
- Increasing age
- Being male
- Nail trauma
- Poor hygiene
- Hyperhidrosis (sweating more than average)
- Long term exposure of the nails to water.
Treatment for fungal nail infections:
There are 2 types of treatment – oral (tablets) and topical (creams/lotions/powders on the skin).
Treatment by either topical or oral methods is usually over weeks (in the case of finger nail infections) or months for toe nail fungus. This is another reason to make sure that the diagnosis is right.
Older oral treatments such as griseofulvin (trade name Grifulvin V)work quite well but need long treatment courses and there is a greater chance of the fungus coming back.
Terbinafine (Lamisil) is a newer oral treatment and is given as a 250mg tablet once a day for 12 weeks to treat toe nail fungus.
It can also be given as ‘pulse therapy’ where you take a short, high dose for one week, followed by 3 weeks without the drug and repeat for 2 further months.
Blood tests need to be taken to check liver function and full blood count before treatment and 4 weeks into it.
Itraconazole (Sporanox) is usually given in pulses as described above. Its regimen is usually one 200mg tablet each day for 1 week each month for 3 months. Sporanox can interact with other medications so it’s important that your doctor knows about all the drugs you’re taking. The same blood tests also need to be taken too.
Topical treatments are of limited value as a toenail fungus cure because the problem is in the nail and the nail bed. They are sometimes prescribed alongside an oral treatment and are important in treating any co-existing fungal skin infections (like athlete’s foot).
Ciclopirox (Penlac) is one of the more effective topical treatments (available on prescription) and it is used once a day, usually at night.
If the problem is mild or localised a nail lacquer (prescription or from the pharmacy) may be of use.
Toenail Fungus Home Remedies:
Many at-home remedies have been tried over the years and while some work for some people. They are all topical remedies and therefore may not be able to penetrate the nail to get to the problem. No medical trials have been carried out on these over-the-counter items but there is little harm in trying them, especially if you can’t or don’t want to take the prescribed alternatives.
They include –
- Listerine. Soaking the nails in Listerine for 10 minutes each night may help as it contains thymol, ethanol, eucalyptol, and benzoic acid. It is known to kill bacteria and has recently been shown to have antifungal properties.
- Vinegar is acetic acid and can be used to soak the nails for 20 minutes a day. Use one part vinegar and two parts water and continue until symptoms are better (ie the nail grow in without the discolouration) or the skin around the nail becomes irritated.
- Vicks Vaporub. It’s thought that the oils plus the petroleum jelly in Vicks dissolves and softens the nail when it’s used repeatedly over time. This allows ingredients like menthol to penetrate the nail and kill the fungal infection. Use it at night and cover with a 100% cotton glove or sock. This allows the skin to breathe as otherwise the moisture from a hot foot or hand will let the fungus breed.
- Tea Tree oil has been shown to be successful in some people. Use 100% tea tree oil oever the skin and nails.
Preventing re-infection of a fungal nail infection:
- Wear comfortable, well fitting shoes.
- Wear clean cotton socks every day or clean pantyhose. Wash hosiery in a hot wash to kill any fungal spores.
- Wear shower shoes or flipflops in communal changing areas.
- Don’t share towels or wash cloths.
- Wash and dry your feet thoroughly every day.
- Keep toenails trimmed.
- Avoid using layers of nail varnish.