The Facts About Nail Fungus

Toenail fungus is an infection that lives underneath the nail, in the skin of the nail bed. Toenail fungus is more than a cosmetic concern. 

What is Toenail Fungus?

Toenail fungus is an infection that lives underneath the nail, in the skin of the nail bed. Toenail fungus is more than a cosmetic concern.  Toe nail fungus is a condition your doctor may refer to as Onychomycosis, other nails include dermatophytosis of the nail or Tine Unguium.

Onychomycosis is an infection of the nail caused by fungi such as dermatophytes, non-dermatophyte moulds and yeasts (mainly Candida species). Of these 80% of the toenail infections are caused by dermatophytes (Trichophyton rubrum).

Some contributing factors that can increase the risk of developing toenail fungus include: Wearing closed-toe shoes. Getting pedicures with improperly sanitized tool. Having a chronic illness, such as diabetes or HIV. Having a deformed nail or a nail disease

It is important to be evaluated by a podiatrist or dermatologist to appropriately diagnose nail changes. Other systemic conditions can mimic onychomycosis. If the physician is unable to make the clinical diagnosis a sample of the nail is sent for further evaluation.

Treatment Options for Nail Fungus:

Several things make it especially challenging to treat toenail fungus. The thickness of the nail can pose a barrier between treatment and the fungus under the nail. Additionally, the time it takes for a healthy nail to grow back varies from person to person. Even after the fungus has been eliminated, nail regrowth can sometimes take a year or longer.

Nail grows at an average rate of 0.1 mm/day (1 cm every 100days). Finger nails require 3 to 6 months to re-grow completely while toe nails require 12 to 18 months. The actual growth rate depends upon the age, season, exercise level and hereditary factor.

Treatments for fungal nails include oral medication, topical anti-fungal agents and laser therapy.

Oral Lamisil (Terbinafine) is the most effective systemic therapy. There have been cure rates reported from 57.8% to 73% when taking the medication once daily for 3 months. Whether or not this treatment is right for you should be determined by your doctor.

Topical preparations in the form of lacquers applied on the nail plate are a valuable tool in the treatment of onychomycosis, however, monotherapy  success is limited.

In randomized studies carried out in the US on 460 patients with mild to moderate onychomycosis (20–65% nail involvement) showed a high safety profileand effectiveness of Ciclopirox monotherapy. The agent was applied daily on all toenails, including the healthy ones. After 48 weeks of treatment, negative culture and negative direct examination were achieved in 29% of patients compared to 11% in the placebo.

Topical Julblia (efinaconazole) is clear solution not a lacquer applied to the nails once daily.  This has been proven to be the most effective topical treatment. Clear nail (0% affected target toenail) was achieved in 19.7% of patients at week 52, meaning clinical signs of the fungus had been treated.  Further more treatment success leaving only less than 10% of the affected toenail was seen in 42.6% of the patients.

Laser therapy has been proven to increase the effectiveness of topical agents and achieve similar or even greater success than oral medications.

The cure rate of 71.88% in the laser and nail lacquer combined-therapy group at 16 weeks was significantly higher than the 20.31% in the nail lacquer monotherapy group. This result confirmed the effectiveness of combination therapy.

In addition, when compared with results in a meta-analysis of  oral medication [systemic antifungal therapy] for onychomycosis, the cure rate of the laser and nail lacquer combined-therapy in this study was similar to the 60%~76% for systemic antifungal therapies such as terbinafine and itraconazole.

Many patients ask about removing the toe nails. Although nail surgery is useful in some cases of onychomycosis, it is a painful and disfiguring process and should be limited to one or only a few nails if used at all.

Recurrence is also a common problem with onychomycosis.  Topical agents may be useful in preventing the relapse of chronic tinea pedis, which often accompanies onychomycosis. An at home anti-fungal regimen is important to help prevent recurrence. Ask your podiatrist for tips at your next visit or stay tuned for up coming blogs on the subject.

Don’t wait any longer to treat your toe nail fungus.  Visit one of our podiatrists and start your treatment today!