Fungal nail infections

Onychomycosis aka fungal nail infection 

Fungal nail infections known medically as Onychomycosis, most commonly spread from fungal skin infections such as athletes foot (Tinea Pedis). Or can occur from normal bacteria that lives on your skin and may work its way under a damaged nail plate.  

For fungal infection to occur a portal of entry must be established; The nail plate is sealed tightly to the nail bed- this seal must be broken in order for bacteria to enter.  The nail bed provides bacteria with sugary warm blood to survive while your shoe and sock provides a warm, dark moist environment for the fungus to thrive- just like a mushroom in a mushroom house.

Fungus beneath the nail plate prevents the nail from attaching to the nail bed which leads to thickening of the nail plate. Infection usually begins at the free edge travelling down the side of the nail. During the early stages of the infection, nails may appear yellowish with white powder like lines, whereas with a more established infection the nail may appear varying shades of brown.

Fungal infections are usually diagnosed on clinical examination however, your GP may decide to take clippings of the nail for laboratory testing- this can takes several weeks and may often produce false negative results as it is difficult to grow fungus in laboratory conditions.

Fungal nails will not resolve themselves. Not all infected nails need treated; if the fungal nail infection is not psychologically distressing or painful then in some cases they may be left alone. However, patients should take steps to prevent the infection spreading to other nails, body parts or family members.

There are various treatments available:

Topical Treatments 

Treatments that are usually painted on the nail such as amorolfine, tioconazole and ciclopirox. These treatments work best in the very early stages of infection as they cannot reach the nail bed. They may be used for months to years with cure rates low; 15-30%.

Oral Treatments

Oral treatments are available from your GP- Terbinafine, Itraconazole, Fluconazole, Griseofulvin.  Some of these treatments may have unwanted side effects and quite often liver function tests must be carried out prior to treatment and during treatment. Oral treatments are more likely to cause side effects than topical.

The British Association of Dermatologists recommend Terbinafine should be considered as first line treatment for athletes foot and fungal nail infections. Research has reported approximately 50% of nail infections are cured with this medication.

Fenestration 

By introducing holes through the nail plate antifungal solution can be applied and reach the point of infection directly to clear infection as they nail plate grows. There is ongoing research on the effectiveness of this treatment. 

At Feet First we have seen some very promising results. See photos