Fungus Infections of the Nails
What are fungal infections of the nails?
Fungal infections of the nails are common. The fungus grows in the nail bed, where the nail meets the skin. The fungus grows slowly and does not spread to internal organs. The main concern is the nail discoloration (usually yellow) and change in nail texture and growth. Nails can become crumbly, break easily, and grow irregularly. But because other nail conditions can mimic fungal infection, most doctors will confirm the diagnosis by sending a nail clipping for laboratory evaluation — especially if treatment is being considered.
Fungal infections are not commonly contagious or spread easily between people. The fungus grows in people whose bodies “allow” the fungus to become established without mounting an immune response to suppress the fungus. We know of no ways to boost your immune system to make fungal infections less likely. You may be able to prevent fungus infections by:
Keeping your feet dry, avoiding constant moisture
Avoid non porous, closed shoes made of synthetic materials
Wearing absorbent socks
Wearing water proof sandals when in public showers
What can be done about fungal nail infection?
Because the fungus grows slowly, it is hard to eliminate. The anti fungal medications that eliminate the fungus are strong, must be taken by mouth, and must be taken conscientiously for months in order to be effective. Each drug has potential side effects on other body organs (especially the liver, skin, or bone marrow). To monitor for side effects, periodic blood testing must be obtained, usually monthly, during the time you take the medication. Any symptoms suggesting organ damage should be reported immediately to your physician, such as: unusual fatigue, severe loss of appetite, nausea, yellow eyes, dark urine, pale stool, skin rashes, bleeding, enlarged lymph glands, or signs of infection.
Unfortunately, anti fungal creams applied directly to the nail cannot penetrate the nail bed to kill the fungus at its source, so they are not usually effective.
How effective are the medications at curing the fungus?
The anti fungal medications usually suppress the nail infection when taken as directed. Unfortunately, they cannot guarantee permanent cure. At least 1 in 5 patients (20%) and probably more will have a recurrence of the original nail infection at some time, and re-treatment with medication would be necessary.
Should I take medication to treat my fungal nail infection?
Doctors usually recommend treating fungal nail infections only when such infections cause secondary problems, like pain, recurring ingrown toenails, or secondary bacterial infections of the nails or skin. If the nail infection causes no symptoms, then doctors often will discourage treatment because of the potential side effects, the need to monitor the blood throughout therapy, and the high recurrence rate. Patients with liver or heart disease generally should not take these medications.
Some insurance companies require documentation of secondary problems beyond the mere presence of the fungal infection before they will cover the costs of the anti fungal medications.
Acknowledgment and Thanks
Palo Alto Medical Foundation
What is Nail Fungus?
Also known as: Onychomycosis or Tinea Unguium
Nail fungus is made up of tiny organisms (Tinea Unguium) that can infect fingernails and toenails. The nails of our fingers and toes are very effective barriers. This barrier makes it quite difficult for a superficial infection to invade the nail. Once an infection has set up residence however, the same barrier that was so effective in protecting us against infection now works against us, making it difficult to treat the infection.
More than 35 million people in the United States get this fungus. The fungus lives underneath the nail. The nail provides a safe place for the fungus and protects it while it grows, since fungus like dark and damp places. This is why it’s hard to reach and stop nail fungus.
Nail polish and plastic or acrylic nails can trap moisture and fungi. Most often, nail fungus appears in the toenails because socks and shoes keep the toenails dark, warm, and moist. The toenails are 6 to 7 times more likely to be infected than fingernails. Fungi often cause the area around the base (and the sides) of the nail to become red and irritated. At first, the edges or base of the nail is affected. As it spreads, the nail and nail bed show changes. There is often mild discomfort, itchiness, or even pain around the cuticles (flesh surrounding the nails). Bleeding or detachment of the cuticles may occur. The nail can become discolored-yellow-green, dark yellow-brown, and sometimes white spots are seen. The nails thicken and develop abnormal grooves, lines, and tiny punched out holes.
Is it Contagious?
Yes, it can be. The organisms can sometimes spread from one person to another because these critters can live where the air is often moist and people’s feet are bare. This can happen in places like shower stalls, bathrooms, or locker rooms or it can be passed around on a nail file or emery board. So, don’t share them. Nail fungus may also spread from one of your nails to other nails.
How Do You Treat Nail Fungus?
The best treatment of course is prevention. Keep your nails cut straight across. If nails are hard to cut, soften by soaking in salt water (use 1 teaspoon per gallon of water and then dry well). Keep feet dry and well ventilated. Be careful with artificial nails and be selective about choosing your manicurist. Ask about how they sterilize their instruments. See a podiatrist or your health care provider if you see signs of fungus.
Topical creams applied directly to the infected site are often used for less serious infections. Visit the foot care section of your local drug store chain. Creams include Lotrimin, Monistat, Nizoral, Tinactin, and Lamisil. If the topical treatments fail, more potent medications can be taken orally if your health care provider thinks it is necessary. Oral medications may have side effects, so tell your health care provider about any other medications, including birth control like the pill or Depo-Provera, if you are prescribed an oral medication for fungus.
The nails can reveal a lot about the body’s internal health. Healthy nails are often a sign of good health, while bad nails are often a tip off to more serious problems. A high protein diet may help your nails grow stronger and healthier.