Nail fungus is the fungal infection of the nail bed and the plate under the surface of the nail, and it is characterized by thickening of toenail along with yellowish discoloration, disfiguring, and splitting. Gradually, the toenail becomes rough and can get separated from the nail bed. In medical terms, nail fungus is known as “Onychomycosis” or “Ringworm of the Nail”. Toenail fungus can press against shoes causing irritation and pain. Also, it can cause social, psychological, and employment related problems. Toenail fungus is caused by three main groups of organisms which include dermatophytes, yeasts, and non-dermatophyte molds. Approximately 90% of the toenail fungal infections are caused by dermatophytes. Around 8% of the cases are due to yeast [Candia albicans] infections and non-dermatophyte molds cause the infection in 2% of the cases.
The fungus treatment for toenails is challenging because the infection is embedded within the nail which is difficult to reach. The toenail receives little blood supply and grows slowly. Therefore, medications and topical applications used in the treatment for toenail fungus will reach the infected site in little quantity which will not be sufficient to cure the infection. Hence, the infection responds slowly to the treatment and may take a year or more for complete removal of the symptoms. Treatment for toenail fungus includes various treatment options such as pharmacological treatment, laser treatment, and surgical treatment.
This line of treatment includes oral and topical anti-fungal medications. Newer oral anti-fungal drugs such as Itraconazole, Terbinafine have revolutionized the treatment for toenail fungus. As a standard line of treatment for toenail fungus, oral anti-fungal drugs are administered for 3 months. Terbinafine is administered daily for 3 months whereas Itraconazole is often prescribed in pulse doses. Pulse doses means it is administered one week in a month for 3 months.
These anti-fungal drugs produce fewer side effects with few contraindications such as congestive cardiac failure and liver diseases. Itraconazole should be avoided along with certain drugs because it interacts with few antibiotics such as Erythromycin and certain asthma drugs. About 50% to 75% of the cases respond very well to the oral anti-fungal therapy and in 20 to 25% of the cases toenail fungus can recur.
Oral anti-fungal therapy combined with topical and surgical treatments can reduce the duration and side effects of the oral therapy. In superficial toenail fungal infections, topical anti-fungal agents are advised which include ciclopirox, olamine and amorolfine. These topical agents are available in the form of nail paints which can be applied to the affected nail.
A noveon type laser is used in the treatment for toenail fungus. This laser is also used for some types of cataract surgery.
In surgical treatment, nail fungus is removed surgically or chemically. In chemical removal, about 40-50% urea compound is used to remove infected nail. It is a painless procedure which is useful in patients with very thick toenail. Surgical removal of the infected toenail plate alone is not effective. Additional oral anti-fungal medications can be helpful. Combining oral and topical anti-fungal therapies with surgery increases the effectiveness of the surgical treatment.
Prevention of nail fungus is very important because the recurrence of toenail fungal infections is common. Do not wear wet socks, keep the nails dry, and do not wear tight shoes. Cut the toenail regularly to keep it short and while cutting the toenail do not dig into the corners. Athlete’s foot should be treated otherwise it may cause toenail fungus.