How do I go from this to this?
It is an all too common story, a patient comes to the office (usually female) concerned that spring and summer are fast approaching and they want to wear sandals…but their toenails won’t let them. The male patients sometimes present wearing socks with their sandals in order to hide their nails and many women exclaim that there is not enough nail polish in the world to hide the state of their nails. Fungal nails can be both an embarrassing and problematic condition…but there are things you can do!
Dermatophytic onychomycosis, aka Tinea Unguium (Ringworm of the Nail), is the most common nail abnormality and affects, on average 6-8% of the population. It is a fungal infection and occurs in both the fingernails and toenails; however toenail involvement is by far more common. The condition causes the nails to be discolored, thickened, brittle and cracked.
Initially, the condition is of cosmetic concern to patients and many are dissatisfied with the appearance of their nails. If left untreated the condition can progress causing pain and difficulty in walking. Nail thickening causes increased pressure in shoe wear leading to decreased mobility which can worsen peripheral circulation.
Onychomycosis accounts for 30-50% of nail abnormalities. Other nail abnormalities such as psoriasis or previous traumatic injury can be mistaken as fungal infections; therefore diagnosis should be confirmed with nail sampling. Scrapings or trimmings from the affected nails should be collected prior to initiation of treatment and sent for periodic acid-Schiff staining to confirm fungal involvement.
Once the diagnosis has been made there is a variety of treatment options that can be tried alone or in combination. There is a number of topical treatments available, like prescription strength Penlac or FFN, to name a couple. These options are best when used in combination with other options or for maintenance of cleared infection. Oral medications such as Lamisil (terbinafine) or Sporanox (itraconazole) have been the mainstay of treatment. These medications are taken for 3-4 months and concentrate themselves in the nails, providing continued treatment beyond that time. These medications are processed through the liver so routine blood work should be done while on the medication in order to avoid complications. Newer treatment methods are also available for the patients trying to avoid medication. Various nail lasers are becoming a popular treatment option and are proving to be just as effective as oral medications in the clearing of infection. Regardless of treatment method, full resolution of infection and replacement with clear healthy nail may take 9-12 months.
Prevention is important as effective treatment only clears the infection but does not guarantee there will not be recurrence. Continued use of topical lacquers is recommended. Use of sterilization devices, such as the SteriShoe® have been effective at eradicating residual fungus found in the shoes of affected patients. If you or someone you know suffers from a fungal nail infection call 214-574-9255 for a consultation.