Onychomycosis

About Your Diagnosis

Onychomycosis is an infection of the nails with fungal organisms. It is seen more frequently as individuals’ age. It occurs very frequently in elderly individuals who have poor circulation and in diabetics. The disorder is also seen more frequently in the toenails than in the fingernails. Usually a fungal infection of the feet (athlete’s foot) is present along with the fungal infection of the toenails.

The diagnosis of this infection is made by the appearance of the nails, and also by scraping the nail and looking at the scrapings under the microscope. Cultures can also be done but are not usually necessary.

The fungi that most frequently cause this infection are called dermatophytes. These fungi are present all around us. It is not possible to pinpoint the manner in which the infection was acquired. Trauma to the nail makes the nail more likely to become infected. Broken skin on the feet makes it easier to acquire the athlete’s foot that often precedes the infection of the nails. The warm moist conditions that the feet are exposed to may partly explain why the toenails are more frequently infected than the fingernails.

Living With Your Diagnosis

Onychomycosis can vary in severity and in the depth of the infection of the nail. One or many nails may be involved. A very superficial infection is called superficial white onychomycosis and can be treated with medication applied to the nails. Other types of infection involve the nail bed to various degrees. The nails are usually thickened and may appear white, yellow, or even brownish. They also grow more slowly. There is an infection of the nails from another type of fungus called a yeast or Candida organism. This infection causes more inflammation than the skin fungi (dermatophytes).

Treatment

Fortunately two new drugs have recently been released that make curing this condition more likely than it was a few years ago.

Except for the superficial white form of the disorder, treatments with creams and lotions applied to the nails have little effect. Older treatment of this infection was with griseofulvin and required treatment for a year, especially for the toenails. There were also frequent relapses. If griseofulvin was not effective, then ketoconazole (Nizoral) was used.

 The two newly available drugs are terbinafine HCl (Lamisil) and itraconazole (Sporanox). Treatment with both of these drugs is usually for 12 weeks for toenail involvement, although it takes much longer for the damaged nail to be replaced with healthy nail. Treatment of the fingernails takes about 6 weeks.

There are several regimens for the use of these drugs, and you and your doctor will decide which is best for you. The most common side effects with terbinafine HCl are headache, diarrhea, and heartburn or dyspepsia.

Cimetadine (Tagamet) should not be taken with this drug.

The most common side effects with itraconazole are nausea, vomiting, and diarrhea. Liver function tests may also become abnormal, and your doctor will want to check these several times while you are taking the drug. This drug must be taken with a full meal to be fully absorbed. Your physician should know all the other drugs you are taking when this drug (itraconazole) is prescribed because there are potentially serious side effects, especially with heart drugs, blood thinners, cholesterol-lowering drugs, and some drugs taken for anxiety.

The DOs

• There is no specific food or diet that will help this condition. If you are diabetic, good control of the diabetes can make a less favorable climate for the fungus to grow. You also should keep your feet dry. You should wear shoes and socks that will let the air circulate and absorb moisture.
• If you are diabetic and/or elderly and have trouble with trimming your toenails, a podiatrist will be very helpful and could help prevent serious problems with your feet.

The DON’Ts

• Your physician may recommend that toenail fungus not be treated, especially if you are taking multiple other drugs. The older treatments took so long and there were so many relapses with treatment of the toenails that it often wasn’t worthwhile. However, these newer drugs make a cure much more likely.

When to Call Your Doctor

• You should call your doctor if you seem to be having a reaction to the medication that your doctor prescribed for you. Your doctor may also want to do occasional laboratory tests to check your liver or kidney function if you are taking certain of the medicines long-term. If the toes or fingers crack around the nails, become red and tender, or drain, you also need to see your doctor. Sometimes you will lose your nail. It will regrow but it may be somewhat deformed.