Nail Fungus

Nail fungus is an infection that affects the nails, leading to visible changes and discomfort. Common symptoms include nails turning yellow or black and sometimes appearing splintered. Pain around the affected nail is also frequent. Various antifungal medications are available for treatment, including hydroxypyridone antifungals, tubulin inhibitors, allylamine antifungals, and azole antifungals, each targeting the infection in unique ways.

Causes

• Nail fungus usually begins as a yellow or white spot under the nail tip.

• The primary cause is a variety of fungal organisms, with dermatophytes being the most common as they thrive in keratin, the protein found in nails.

• Other fungi, such as yeasts and molds, can also lead to nail infections.

• The fungus may spread to the nails from other infections, like athlete’s foot.

• Contact with environments that promote fungal growth, such as moist, warm communal areas like gym showers and swimming pools, can contribute to nail fungus.

• Wearing tight, non-breathable shoes creates a favorable environment for fungal development and can increase the risk of infection.

Symptoms

Common symptoms of nail fungus include:

• The appearance of a small white or yellow spot under the nail tip.

• Nails becoming thickened and discolored over time.

• Edges of the nail may begin to crumble, leading to brittleness or raggedness.

• Nails may appear distorted or misshapen.

• Onycholysis, or the nail detaching from the nail bed, can occur.

• There might be an unpleasant odor emanating from the affected nail.

Early recognition of these symptoms is vital. If untreated, the fungal infection could cause pain and discomfort, especially under pressure.

Diagnosis

Diagnosing nail fungus, which often affects toenails, involves visual inspection and laboratory tests. A healthcare provider will inspect for signs like thickening, discoloration, and detachment from the nail bed. To confirm a fungal infection, a sample from beneath the nail is analyzed under a microscope to detect fungal cells. If needed, further tests, such as a culture, may be conducted to specify the fungus type. These diagnostic processes are essential for developing an effective treatment plan.

Treatments

Managing nail fungus, affecting both toenails and fingernails, can be challenging and may require ongoing efforts. Treatment varies depending on the infection's severity and includes topical and oral medications. Topical treatments, like medicated nail polishes and creams, target the fungus directly and necessitate consistent application over months. For persistent infections, oral antifungal medications may be recommended, although monitoring is needed due to potential side effects. Following the treatment regimen as instructed is crucial to preventing recurrence. In extreme cases, surgical nail removal might be considered. Consultation with a healthcare professional is essential to determine the best treatment based on individual health and infection severity.

Medications

• Nail fungus, or onychomycosis, is often treated with prescription medications.

• For mild to moderate cases, topical treatments such as efinaconazole, Tavaborole, or Ciclopirox nail lacquer are recommended. These are applied to the affected nails and require consistent daily use over several months for effectiveness.

• Severe infections may necessitate oral antifungal medications, like terbinafine and Itraconazole, which work throughout the body to eliminate the fungus as new, healthy nails grow. However, they can have side effects and are not suitable during pregnancy or breastfeeding.

• Adhering to healthcare provider advice is crucial for appropriate treatment.

Prevention

To effectively prevent nail fungus:

• Keep nails clean and dry, and wash your hands and feet regularly.

• Trim nails straight across and file thickened areas gently.

• Wear breathable footwear and change socks frequently to minimize moisture.

• Use protective footwear in public spaces like pools and locker rooms.

• Ensure nail salon utensils are sanitized between customers.

• Avoid sharing personal nail tools and keep nails polish-free to prevent moisture trapping.

• Treat athlete’s foot promptly to prevent it from spreading to nails.