BACKGROUND

 

A fungal nail infection is an infection that occurs in the nail bed and the nail itself.  The colonisation by the fungi occurs firstly in the nail bed.  The soft keratin in the nail bed is easier to metabolise than the hard compact nail.  The fungi then advance and metabolise the three layers of the nail plate, hence the yellow brown discolouration of the nails which is metabolised keratin (fungus is white, keratin is yellow).  If left untreated the fungus will completely destroy the nail plate. 

 

Fungal nail infection can cause thickening, weakness, distortion and discolouring of the nail.  This can be distressing and cosmetically unpleasant for patients.  Some patients may also experience injury to the surrounding skin or secondary bacterial infection and cellulitis, especially in older people or those with diabetes, circulation issues (peripheral arterial disease) or Raynaud’s phenomenon.

 

Trauma (damage) to the nail can often occur in sport or work-related activity and humidity in footwear can increase the risk of nail infection.  Fungal skin infection (athlete’s foot) is often present also.

 

It is important to be aware that this condition is difficult to eradicate and often recurs; normal nail regrowth and normal appearance may not always be achieved. 

 

SELF-CARE

 

Initial self-care includes keeping nails short and filed down; wearing breathable footwear/socks and spray or powder in shoes; a 60 degrees hot wash of socks (check the label); drying well between toes/using surgical spirit: and treating associated athlete’s foot promptly.  Nail gels and varnishes should be avoided especially when treatment is underway.

 

TREATMENT

 

Topical antifungals (creams, gels, powders, sprays, lacquers) can treat some early, limited, and superficial infections.  Treatment is often needed for at least 12 months.  As mentioned, complete cure rates can be low.  Topical treatment can be used preventatively after successful initial treatment.  Topical antifungals will always work best when the nail has been removed (nail surgery) and the antifungals are then applied.

 

Tablets (oral antifungals) are available for more chronic, widespread and penetrating infections and for those cases where topical treatment alone will not penetrate the nail adequately.  Oral treatments can be discussed with your GP but be advised that they do carry risks and side effects.  Ask your GP for details.

 

The most effective treatment with the highest percentage cure rate is to have the nail removed (nail surgery under local anaesthetic) and then an antifungal applied to the nail bed.  This should always be accompanied by an antifungal to the surrounding skin.  These will most likely be two different products.  In order to get the best possible results you must be compliant with the advice given by your clinician.  Please ask your podiatrist if you are unsure about any of the treatment provided.