And so it begins. A white or a yellow dot under your nail, eventually causing its discoloration and distortion. Affecting approximately 10% of the American population, nail fungus is an infection that is easy to get and more difficult to cure, given the fact that nails grow slowly and the fungus is stuck under the nail plate. This infection, usually caused by dermatophytes, yeasts or molds, penetrates the strateum corneum of the nail and produces keratinolytic proteases, who make it easier for the infection to spread by entering human cells. This very common condition has quickly spread since the twentieth century, mostly because of world wars and new closed-toed footwear. However, nail fungus can be halted by preventing infection, knowing the causes of nail fungus, and by treating it.
So how does one identify a nail fungus? Thick, brittle, distorted and dark nails can all be indicators of a nail fungus, as well as a friable nail plate. When a nail fungus grows, the nail plate can separate from the nail bed, which is also a reason to visit a healthcare professional. Doctors typically scrape some of the debris from the affected area to send to a laboratory for testing, as to avoid a misdiagnosis (nail fungi can resemble psoriasis and lichen planus, among other conditions).
Although getting a nail fungus is easy to contract, prevention is the best way to maximize your chances of keeping healthy nails. Proper nail care is essential to avoiding an infection; washing your hands and feet regularly cleans the surface of the skin and nails, reducing the chances of a fungus colonizing the area. Getting rid of old shoes as well as wearing socks and shoes that help reduce sweat and humidity can also prevent this undesirable infection. Fungi thrive in moist, warm environments and do not need sunlight to survive, so toenails are more susceptible to fungi.
Depending on the severity of the infection and the type of fungus, doctors may advise different treatments. During the twentieth century, doctors believed that nail fungi needed exclusively superficial treatments, which made the cure rate significantly low. Today, many people try non-prescription methods to get rid of the fungus. Vick’s VapoRub, which can be purchased at the drugstore has been shown to improve some cases of nail fungus (a study of 18 patients showed a 56% improvement in their condition). Another way to manage nail fungus at home is to trim the infected nail and thin it so that any antifungal cream applied to the area can seep into deeper layers of the nail. When applying antifungal cream, it is important to cover the area with a bandage and to wash off the cream in the morning.
In addition, snake root extract and tea tree oil are popular in alternative medicine to treat nail fungus. Snakeroot extract applied on the nail is said to be just as effective as ciclopirox, a more conventional topical solution. However, home remedies and alternative medicine need to be studied more in order to determine the side effects of each product, its efficiency in treating the nail fungus and, if the product seems to treat the fungus, the proper amount to use.
Doctors may recommend the use of medicated nail polish to treat nail fungus. A very common medicated nail polish is Penlac. This treatment requires the application of a layer of the nail polish daily for a week. After 7 days, the patient wipes the nail clean with alcohol and repeats the process. This type of treatment can last for about a year, which can be long for some patients.
Medicated nail cream is another option for treating nail fungus. After cleaning the nail and making sure it is trimmed and thinned, patients rub the cream on the affected area.
A faster way to eliminate the fungus from the nail is to use oral antifungal drugs. Antimycotic agents such as fluconazole, itraconazole, and terbinafine boast of high cure rates and are safe to use (it is important to note that fluconazole has not been approved in the United States for treating onychomycosis). Using such medication helps a new, healthy nail grow by inhibiting ergosterol production of the fungus. This treatment is relatively quicker than creams or home remedies (approximately four months of using antifungal drugs) but it must be noted that the success rate is lower for older adults due to lower blood circulation in the extremities, a weaker immune system etc.
Itraconazole is a capsule whose high affinity for the skin’s keratin makes it stay in the nail longer than fluconazole or terbinafine. While itraconazole can combat dermatophytes, it can also combat non-dermatophytic infections, making it a very effective treatment. Similarly, terbinafine is absorbed quickly and is effective against dermatophytic infections and some molds. Some patients have experienced side effects from these medications, including nausea, headaches, gastro-intestinal upsets and liver damage. Depending on the patient’s medical history and conditions (for example, diabetes), certain medications may not be suitable for them.
A newer treatment for nail fungus is laser treatment. This pain free procedure has a variable duration depending on the severity of the fungus. With a cure rate ranging between 80 and 90%, laser treatments still need FDA approval and more studies are required to assure that this treatment is safe. Once approved, this treatment will be expensive for some people and is not covered by insurance, which can put a dent in one’s wallet.
Finally, if the nail fungus is causing pain or is extremely severe, surgical removal of the nail is an option. Although it can take up to one year for the nail plate to grow back, surgery is a quick fix to a painful problem and is most often treated with ciclopirox. Like every treatment, the patient’s medical history and conditions are assessed.
Nail fungus can be a painful and embarrassing experience for people who have it. The summer months should not be spent exclusively in closed-toed shoes to hide nail fungus; this common infection can be eliminated easily with the treatments mentioned so everyone can wear their flip-flops with pride. Everyone should be able to feel comfortable in their own skin, including their nails.