Sophia Delgado
Fungal nail infections are characterized by discolouration, thickening, and distortion of the nail. They can be treated using antifungal pills, creams, gels, sprays, patches, and nail lacquers. In some cases, the infection may be severe or persistent, and other treatments may not be effective. In such cases, a doctor may recommend removing the infected nail to allow a new, healthy nail to grow in its place. This can be done surgically or non-surgically, and the procedure is usually performed in the doctor's office or clinic. While nail removal can be effective, it is important to note that nails grow slowly, and it may take a year or more for the nail to fully regrow.
| Characteristics | Values |
|---|---|
| Removal methods | Surgical, non-surgical, chemical |
| Treatment before removal | Antifungal pills, creams, gels, lacquers, natural remedies |
| Nail regrowth time | 6 months for fingernails, 12-18 months for toenails |
| Post-removal treatment | Antifungal creams, gels, sprays, patches |
| Removal location | Doctor's office or clinic |
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What You'll Learn
Surgical and non-surgical removal methods
Fungal nail infections can be treated through surgical and non-surgical methods. Non-surgical treatments are typically the first course of action and can include:
- Antifungal pills, such as itraconazole (Sporanox) and terbinafine (Lamisil), which are taken for 6 to 12 weeks. These medications are highly effective but must be carefully monitored by a doctor due to potential side effects and interactions with other medications.
- Antifungal nail polish, which is painted onto the affected toenail daily. While less effective than pills, they may be used in conjunction with other treatments.
- Antifungal creams, gels, sprays, and patches, which are available without a prescription.
- Natural remedies, such as mentholated salve, snakeroot extract, tea tree oil, Listerine, vinegar, eucalyptus oil, and baking soda.
If non-surgical treatments are ineffective or the infection is severe, a doctor may recommend surgical nail removal. This can be done by applying a strong chemical to the nail or through a minor surgical procedure. During the procedure, the doctor will loosen the skin around the nail and remove it from the toe. This method is rarely performed and is typically a last resort if other treatments have failed or if the patient is experiencing significant pain. The new nail usually grows back within a year, although it may take longer.
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Antifungal pills and creams
Antifungal Pills
Antifungal pills are usually prescribed for severe fungal nail infections or when other treatments have failed. Pills typically need to be taken for several weeks or months, and sometimes for up to six months. They are more effective than topical treatments but tend to have more side effects. Examples of antifungal pills include itraconazole (Sporanox) and terbinafine (Lamisil). Itraconazole is FDA-approved to treat nail fungus in adults and can be used for both toenails and fingernails. However, it is not suitable for pregnant women or those with heart failure. Terbinafine is also prescribed to treat nail fungus in adults and is taken daily for six weeks for fingernails and 12 weeks for toenails. Liver damage is a rare but possible side effect of terbinafine, so liver function tests are required before and during treatment.
Antifungal Creams
Antifungal creams are available over the counter at drugstores and pharmacies without a prescription. They are typically used for mild toenail fungus and may take months to work. Examples of antifungal creams include clotrimazole (Lotrimin) and terbinafine (Lamisil). While terbinafine cream is available over the counter, the terbinafine pill requires a prescription. One study found that tea tree oil, applied twice a day for six months, was as effective as clotrimazole cream in treating toenail fungus. Another treatment option involves using a urea-based cream to soften the nail for removal, followed by the application of a bifonazole cream to treat the underlying skin.
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Natural remedies
A fungal nail infection, also known as onychomycosis or tinea unguium, causes the nail to become discoloured, thickened, distorted, and brittle. While it is not a serious infection, it can take a long time to treat.
There are several natural remedies that can be used to treat fungal nail infections. However, it is important to note that the effectiveness of these remedies may vary, and in some cases, medical treatment may be necessary. Here are some natural remedies that you can try:
Baking Soda
Baking soda may be effective in treating toenail fungus due to its ability to absorb moisture and its potential fungistatic properties, which prevent the growth of fungi. A small study found that treating nail samples with baking soda stopped fungal growth in 79% of cases. However, there is limited scientific evidence to support its use, and it may not be effective in preventing infections.
Vicks VapoRub
Vicks VapoRub is a topical ointment that contains camphor and eucalyptus oil, which have antifungal properties. A 2011 study found that it had a positive clinical effect in treating toenail fungus, and these findings were confirmed by a 2016 study. To use this treatment, apply a small amount of the ointment to the affected area at least once a day.
Tea Tree Oil
Tea tree oil is a natural antifungal agent that may be effective in treating toenail fungus. While there is limited research on its effectiveness specifically for nail fungus, it is often recommended as a safe and effective treatment.
Foot Care and Hygiene
Practising good foot care and hygiene can help prevent the spread of toenail fungus and may aid in its treatment. Keep your nails short, dry, and clean. Use separate nail clippers for infected and healthy nails. Wear well-fitting, breathable shoes, and clean cotton socks, changing them daily. If you use communal showers, wear clean shower shoes.
It is important to note that while these natural remedies may provide some relief, they may not completely cure the fungal nail infection. If there are no improvements or complications occur, it is recommended to consult a doctor or podiatrist and consider medical treatments such as antifungal medications or, in severe cases, surgery.
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Microscopic diagnosis
A fungal nail infection, or onychomycosis, is a common nail disorder that causes the nail to become thick, discoloured, and brittle. It is typically caused by dermatophytes, non-dermatophyte moulds, or yeast. While it is not a serious infection, it can take a long time to treat.
To diagnose onychomycosis, confirmatory mycologic testing is essential. Direct potassium hydroxide (KOH) testing is a simple, quick, and inexpensive technique for identifying fungal organisms. It involves retrieving a specimen from the nail bed and underneath the nail plate, dissolving it in KOH, and then visualising it under a microscope to detect the presence of fungal septate hyphae. This method has 61% sensitivity and 95% specificity.
Fungal culture is another diagnostic technique that involves culturing a specimen from the nail in SDA with and without cycloheximide to prevent the growth of non-dermatophyte moulds (NDMs). Fungal culture has 99% specificity, but its sensitivity is variable, ranging from 29-82%. The sensitivity of fungal culture also depends on the expertise of the testing centre, and results can take several weeks to months.
Histopathological assessment involves examining the microscopic features of nail clippings. The nail clippings are embedded in paraffin blocks and stained with haematoxylin-eosin, periodic acid-Schiff, or Grocott methenamine silver to visualise fungal hyphae. This method is easy and sensitive.
Other techniques such as confocal microscopy, optical coherence tomography, infrared thermography, flow cytometry, immunochromatography, and mass spectrometry are currently being explored but are rarely used.
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Preventing re-infection
Fungal nail infections can be unsightly and difficult to treat. Once the infection has been addressed and the nail has been removed, it is important to take steps to prevent re-infection. Here are some ways to do that:
Keep your hands and feet clean and dry: Fungi thrive in warm, moist environments, so keeping your hands and feet clean and dry can help prevent fungal growth. Wash your hands and feet regularly and dry them thoroughly, especially between the toes.
Wear appropriate footwear: Avoid walking barefoot, especially in public places like locker rooms or pool decks. Wear shoes or sandals that allow your feet to breathe and change your socks when they become sweaty.
Practice good nail hygiene: Keep your nails trimmed short and cut your toenails straight across. Avoid cutting your nails too short or down the sides, as this can lead to ingrown nails and provide an entry point for fungi.
Disinfect your surroundings: Disinfect your bathroom tiles and any other surfaces that may come into contact with your hands or feet, such as gym equipment or yoga mats. Use a disinfectant spray or wipe, or a diluted bleach solution.
Choose the right socks and shoes: Wear socks made of breathable materials, such as cotton or wool, and avoid tight-fitting shoes that can make your feet sweat more. Change your shoes regularly to allow them to air out and dry completely.
Treat any underlying conditions: Fungal nail infections can be more common in people with certain underlying conditions, such as diabetes. Managing your health conditions effectively can help reduce your risk of fungal nail infections.
By following these steps and maintaining good hand and foot hygiene, you can significantly reduce the chances of re-infection and enjoy healthy, fungus-free nails.
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Frequently asked questions
A fungal nail infection causes the nail to become discoloured, thickened, distorted, and brittle. It usually starts at the edge of the nail and can spread to the rest of the nail. It can affect both toenails and fingernails.
Treatment options include topical antifungal medications such as creams, gels, and lacquers, as well as oral antifungal pills. In some cases, nail removal may be recommended, which can be done surgically or non-surgically.
Nail removal may be considered if other treatments have not been successful or if the patient is experiencing significant pain. It is typically a last resort option when the infection is severe or deep.
For non-surgical nail removal, a doctor applies a urea ointment to the nail, softening it over several days before removing the infected portion. Surgical nail removal involves administering local anaesthesia, loosening the skin around the nail, and removing it from the toe.
Nail regrowth can take a significant amount of time, with fingernails taking 6 months or longer and toenails typically taking 12 to 18 months to fully regrow.
