Onychomycosis: a treatment challenge

I’ll share a podiatry secret. Fungal toenails aren’t a great conversation starter!

As soon as I mention to a patient that they may have a fungal infection you can see the sheer horror in their eyes. It’s a difficult topic to approach both in conversation and treatment.

So what is a Onychomycosis (a fungal nail infection) and how do we treat it?

Onychomycosis is a fungal infection that affects toenails and fingernails. It is caused by a fungus known as a dermatophyte or sometimes by the yeast Candida.

This condition is widespread, affecting up to 14% of the population.

Fungal infections are more commonly seen in toenails rather than in fingernails. This is because toenails spend a lot of time in shoes (a warm, dark, and moist fungus-friendly environment).

Onychomycosis can be contracted through contact with contaminated objects, such as shoes, socks, shower floors, and nail care equipment.

Features & Appearance

Onychomycosis begins as a white or yellow-brown spot under the nail.

The nail becomes increasingly discoloured, thick, and crumbly as the fungal infection develops. In some cases, the toenail can separate from the nail bed.

Generally, fungal infections are not painful. However, if the toenail becomes too thickened, it can cause pain or discomfort.

Risk Factors

Anyone can contract a fungal nail infection. However, it is more common in certain circumstances, including:

• in older individuals,

• in people with weakened immune systems,

• in people with circulation issues,

• in people with diabetes,

• when there is trauma or injury to the toenail,

• when you constantly use nail polish/shellac, or

• where you have a fungal infection on another part of your body.

Diagnosis and Treatment

It’s important that you have your nail condition diagnosed correctly. Some nail conditions may look like onychomycosis, but actually aren’t fungal in nature. Your podiatrist will examine your toenails and in some cases may take a nail sample for pathology testing.

Fungal nail infections are a challenge to cure; and treatment is most successful when started early.

The gold standard treatment is oral anti-fungal medication. However, not everyone can take these drugs.

Topical anti-fungal paints/sprays that you apply directly to the toenail are another option. But, this technique can take up to a year for the fungal infection to clear.

Apple cider vinegar is a popular natural remedy due to its anti-fungal properties, while laser therapy is an emerging option for stubborn infections.

It is best to speak with your podiatrist about the best treatment options for you and your nail(s).

Even after treatment, fungal nail infections can, unfortunately, come back again.

Prevention

You can do many things to prevent onychomycosis and cross-contamination at home: