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more about Onychomycosis

Tinea unguium

  • It is a fungal infection of the nails that causes the nails to be thick and brittle.  The infection involves one or more (but usually not all) nails.  Infected fingernails can usually be successfully treated, but the toenails may be more difficult to treat.  Treatment is usually with anti-fungus pills.

  • Usually, there are no symptoms. It is often a cosmetic problem.
  • Occasionally, it can cause pain or discomfort.
  • The nail usually is brittle, thickened, dull, and easily breakable.
  • Sometimes, the surrounding skin can become infected and cause Cellulitis (inflammation).

  • Onychomycosis is due to a fungal infection of the nail.
  • Occasionally, fungal infection of the palms or feet can lead to the nails becoming infected.

  • Examination -- the doctor usually easily recognizes the typical appearance of the infected nail.
  • The doctor may also scrape the nail and examine it under the microscope.
  • Sometimes, a culture of the nail may be needed to make the diagnosis.

  • Onychomycosis is difficult to treat because one has to take medicines for a very long time, and often the problem comes back after stopping the medication.
  • The medicines do not get into the nail very well, which is one of the reasons that medication has to be taken for such a long time.
  • Onychomycosis of the fingernail responds well to treatment.
  • Usually anti-fungus creams are not effective.  However, if the nail is not too thick and the infection not severe, then a gel (Naftifine) or a lotion (Ciclopirox) may work after 4 to 6 months.
  • Usually, though, oral anti-fungus medicines are needed to successfully treat these infections.  However, unlike fungal infections of the hands and toenails, once treated fingernail infections often do not come back.
  • Choices include:
    1. Ultramicrosize Griseofulvin for 6 months
    2. Itraconazole -- 200 mg a day for 3 months or 400 mg a day for the first week of each month for 2 months
    3. Fluconazole -- 150 mg once a week for 6 months.
    4. Terbinafine -- 250 mg a day for 6 weeks
  • Onychomycosis of the toenails is much harder to treat and may not always succeed.
  • The gel and lotion listed above for fingernail infections can be tried, but usually does not work as well for toenail infections.
  • Oral anti-fungus medicines are usually needed.  Even with these medicines, only about 60% of toenail infections clear up.  Also, even after successful treatment, toenail infections have a high chance of coming back.
  • Choices include:
    1. Itraconazole -- 200 mg a day for 3 months or 400 mg a day for the first week of each month for 3 months.
    2. Terbinafine -- 250 mg a day for 3 months is usually the treatment of choice.
  • Griseofulvin and Fluconazole are not very good choices for toenail infections.
  • If there is any Tinea Pedis (Athlete's Foot) present, this needs to be treated for the patient's entire life to try to reduce the chance another nail infection.
  • Sometimes, if the infection does not clear up, then the toenail may have to be removed.  Once the toenail is removed, the doctor may prescribe an anti-fungus lotion to prevent the new nail from becoming infected.

  • General measures used to prevent fungal infections are important.  Keep the skin dry.  Moist skin encourages fungal infections.
  • Dry all areas of the skin after a bath or after heavy sweating, especially between the toes.
  • Wear loose fitting clothing.
  • Change socks frequently -- this is especially important for those who have a tendency to perspire a lot.
  • Try to wear open-toed shoes or sandals.
  • Use talc or other drying powders to keep dry the areas that perspire a lot, especially the feet.  You can even use over-the-counter anti-fungus powders.
  • People using steroid creams, taking steroid pills, or those with diabetes have a higher chance of developing fungal infections and need to be especially careful.
  • It may also help to wear slippers or sandals when using community showers.

  • Special Information
    1. Medicines used to treat fungus infections of the nail often adversely interact with other medicines. Make sure to let the doctor know all the medicines that you are taking, so that he can make sure there will not be any problems.
    2. Toenail infections have a very high tendency to recur. It is often a life-long problem, requiring repeated treatment, despite the best precautions. Sometimes, it just doesn't pay to keep treating it, and the best we can do is to learn to live with it.

more about Onychomycosis

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