nail fungus

With the right treatment, you should be able to get rid of a nail infection caused by fungus, even if you’ve had it for years or it’s very bad. But you may have to be patient. It could take months to clear up.

Diagram of Toenail Fungus

Key points about treating fungal nail infections

• To get rid of a fungal nail infection, you will probably have to take treatment, sometimes for up to six months.
• Fingernail infections tend to clear up quicker than toenail infections. You may need to take medication for only six weeks for a fingernail infection.
• Some Prespcription Medication can sometimes damage your liver (though this is rare) and you may have a test to check if your liver is healthy before starting treatment.
• Normally doctors recommend pills for this condition, but there are also treatments you can put on an infected nail. If the problem is mild, you might be given a nail varnish or use tea tree oil that kills the fungal infection.
• If your infection is severe or keeps coming back, your doctor might recommend removing part or all of your nail. But this treatment is rarely used.
• If your nail infection doesn’t bother you, you may wish to leave it alone.

Does the term Onychomycosis (on-ee-koh-my-ko-sis) sound bad to you? Wait till you see it. But better make sure they won’t be on your own nails or you might not want to see your fingers for a time. To give you an overview, Onychomycosis is the scientific name for nail fungal infection. This type of nail abnormality is caused by the bacterium called dermatophyte or tinea unguium, of which sources include yeasts and molds. This bacterium is also the source of such skin infections as athlete’s foot, jock itch, and the common ringworm.

Onychomycosis is 50 per cent more common than other nail disorders. It consists of several subtypes: Distal Subungual Onychomycosis (this takes place when the fungus affects the nailbed); White Superficial Onychomycosis (happens when the fungus forms "white islands" on the outer layers of the nail bed); Proximal Subungual Onychomycosis (if the fungus seeps through the proximal nail fold); Candidal Onychomycosis (is caused by the bacterium candida, when the nails are overexposed in water); Total Dystrophic Onychomycosis (when the nail plate is completely ruined).

Normally, men are more prone to nail fungal infection than women. Nail fungi can actually infect anyone but those with diabetes or leukemia should take extra care, the same goes for adults especially ages 60 and above. Having declining immune system and troubled blood circulation is what makes them more vulnerable.

This infection is characterized by the thickening and discoloration (yellow, white, or black of the nails. Minor pain is felt in the infected area while the nail slowly detaches from its plate. This kind of fungus easily spawns in warm and moist areas, thus, always finding settlement under our toenails and seldom on the fingernails.

How does the nail get contaminated? Nail fungal infection are anaerobic microorganisms, which means that they thrive in warm and wet areas. The little supply of oxygen keeps them surviving making our nails the safest place for them to breed. They feed on the keratin substance of the nails and slowly destroy them.

Usually, walking barefoot in public swimming pools, communal shower rooms, and gyms gives them access to your toenails, while overexposing your hands to water and harmful chemicals allow the bacteria to grow in your fingernails. To cure the infection, consult a specialist at the early stages of growth. There are common oral and topical treatments that doctors commonly prescribe such as Lamisil, Penlac, Tinactin, and lacquer, among others.

If you are a fan of alternative medicines, vinegar works well as anti-fungal remedy. Soaking the infected part in vinegar for 15-20 minutes twice daily until the infection heals kills the bacteria because of its strong acid contact. Applying Vicks VapoRub on the area is also a popular treatment.

Meanwhile, the rules for preventing nail fungal infection are easy. Three simple ways: Keep your hands and feet dry and apply foot powder on your feet if you must; never walk barefoot in wet, public places; and most importantly, maintain good hygiene. Then, you are guaranteed to be fungi-proof but for awhile.

Treatment of onychomycosis is challenging because the infection is embedded within the nail and is difficult to reach. As a result full removal of symptoms is very slow and may take a year or more.

Pharmacological

Most treatments are either systemic antifungal medications such as terbinafine and itraconazole, or topical such as nail paints containing ciclopirox or amorolfine. There is also evidence for combining systemic and topical treatments.

For superficial white onychomycosis systemic rather than topical antifungal therapy is advised.

Relative effectiveness of treatments

In July 2007 a meta-study reported on clinical trials for topical treatments of fungal nail infections. The study included 6 randomised controlled trials dating up to March 2005.^[15] The main findings are:

• There is some evidence that ciclopiroxolamine and butenafine are both effective but both need to be applied daily for prolonged periods (at least 1 year).
• There is evidence that topical ciclopiroxolamine has poor cure rates and that amorolfine might be substantially more effective.
• Further research into the effectiveness of antifungal agents for nail infections is required.

A 2002 study compared the efficacy and safety of terbinafine in comparison with placebo, itraconazole and griseofulvin in treating fungal infections of the nails. The main findings were that for reduced fungus terbinafine was found to be significantly better than itraconazole and griseofulvin, and terbinafine was better tolerated than itraconazole.

• A small study in 2004 showed that ciclopirox nail paint was more effective when combined with topical urea cream.
• A study of 504 patients in 2007 found that aggressive debridement of the nail combined with oral terbinafine significantly reduced symptom frequency over terbinafine alone.
• A 2007 randomised clinical trial with 249 patients show that a combination of amorolfine nail lacquer and oral terbinafine enhances clinical efficacy and is more cost-effective than terbinafine alone.

Drug pipeline

Most drug development activities are focused on

• the discovery of new antifungals
• novel delivery methods to promote access of existing antifungal drugs into the infected nail plate

Active clinical trials investigating Onychomycosis:

Phase III

• A medicinal nail lacquer, NM100060 from NexMed, contains terbinafine as the active ingredient and a permeation enhancer which facilitates the delivery of the drug into the nail bed where the fungus resides. Commercial sale of the product is expected to begin no earlier than in 2010.
• A comparison of delivery methods for Itraconzole.
• Safety and tolerability of topical Terbinafine.

Phase II

• A topical treatment, AN-2690, is being developed by Schering-Plough Corp and Anacor Pharmaceuticals. It is active against Trichophyton species.
• Posaconazole, taken orally.
• A topical treatment, NB-002, is being developed by NanoBio Corporation.It has completed Phase II trails.

A non-pharmalogical approach with encouraging preliminary results is ultraviolet germicidal irradiation which has been shown to deactivate dermatophytes both in vitro and ex vivo.

Natural remedies

As with many diseases, there are also some scientifically unverified folk or alternative medicine remedies.

• Australian tea tree oil.There is insufficient information to make recommendations for or against the use of tea tree oil for onychomycosis.
• Grapefruit seed extract as a natural antimicrobial is not demonstrated. Its effectiveness is scientifically unverified. Multiple studies indicate that the universal antimicrobial activity is due to contamination with synthetic preservatives that were unlikely to be made from the seeds of the grapefruit.

The causative pathogens of onychomycosis include dermatophytes, Candida, and non-dermatophytic moulds. Dermatophytes are the fungi most commonly responsible for onychomycosis in the temperate western countries; meanwhile, Candida and non-dermatophytic moulds are more frequently involved in the tropics and subtropics with a hot and humid climate.

Dermatophytes

Trichophyton rubrum is the most common dermatophyte involved in onychomycosis. Other dermatophytes that may be involved are Trichophyton interdigitale, Epidermophyton floccosum, Trichophyton violaceum, Microsporum gypseum, Trichophyton tonsurans, Trichophyton soudanense (considered by some to be an African variant of T. rubrum rather than a full-fledged separate species) and the cattle ringworm fungus Trichophyton verrucosum. A common outdated name that may still be reported by medical laboratories is Trichophyton mentagrophytes for T. interdigitale. The name T. mentagrophytes is now restricted to the agent of favus skin infection of the mouse; though this fungus may be transmitted from mice and their danders to humans, it generally infects skin and not nails.

Other

Other causative pathogens include Candida and non-dermatophytic moulds, in particular members of the mould genera Scytalidium (name recently changed to Neoscytalidium), Scopulariopsis, and Aspergillus. Candida mainly cause fingernail onychomycosis in people whose hands are often submerged in water. Scytalidium mainly affects people in the tropics, though it persists if they later move to areas of temperate climate.

Other moulds more commonly affect people older than 60 years, and their presence in the nail reflects a slight weakening in the nail’s ability to defend itself against fungal invasion.

Onychomycosis means fungal infection of the nail. It is the most common disease of the nails and constitutes about a half of all nail abnormalities.

This condition may affect toenails or fingernails, but toenail infections are particularly common. The prevalence of onychomycosis is about 6-8% in the adult population. Onychomycosis caused by dermatophytes is also known as tinea unguium (tinea of the nails).

Symptoms

The nail plate can have a thickened, yellow, or cloudy appearance. The nails can become rough and crumbly, or can separate from the nail bed. There is usually no pain or other bodily symptoms, unless the disease is severe.

Dermatophytids are fungus-free skin lesions that sometimes form as a result of a fungus infection in another part of the body. This could take the form of a rash or itch in an area of the body that is not infected with the fungus. Dermatophytids can be thought of as an allergic reaction to the fungus.

Patients with onychomycosis may experience significant psychosocial problems due to the appearance of the nail. This is particularly increased when fingernails are affected.