Fungal Nail Infections (Onychomycosis)

Fungal infections of the fingernails or toenails are very common in women with brown skin particularly those who frequent nail salons. Nail infections are contagious and because of that they develop from public showers, saunas, spas, nail salons, sporting activities as well as from footwear. Infections are caused by both fungus (Trichophytum rubrum or mentagraphytes) as well as yeast (Candida). Fungal and yeast nail infections have several different presentations or appearances which are listed below:

  • Distal and lateral subungual onychomycosis in which the nail thickens, starting at the tip or the sides of the nail. The thickened nail then turns to an opaque or yellow color.
  • Superficial white onychomycosis has white patches that appear on the surface of the nail.
  • Distal (furthest part of the nail) onycholysis in which the nail lifts off the nail bed starting under the tip of the nail.
  • Proximal (cuticle end) nail fold onycholysis in which there is separation of all or part of a nail from its bed.
  • Chronic paronychia involves swelling, redness, and tenderness of the nail cuticle area.

If you think that you may have a nail infection, your dermatologist will be able to perform testing for conformation. This usually involves obtaining a small amount of the nail plate to send for culture.

Treatment
Since fungal nail infections are not life threatening and are often more of a cosmetic problem, you and your doctor may decide against treatment. Treatment options include both topical and oral medications. Although oral medications are generally more effective as compared to topical treatment, topical therapy avoids potential side effects associated with oral medications. Hence, topical agents are the first line treatment for early nail fungal infections.

  • Ciclopirox Nail Lacquer (Penlac) is an anti-fungal nail polish that is painted onto the infected nail daily for two weeks at a time. The residue is removed and the lacquer is applied again daily for a total of 6-9 months or more.
  • Terbinafine (Lamisil) or Itraconazole (Sporonox) pills are taken daily and are prescribed for 3 months to treat infected toenails and 6 weeks for fingernails. With either of these prescription medications, at the end of treatment, the nails will not appear improved. However, as the nails grow out they will grow out normally. Nails grow slowly, so it may require 6-9 months for fingernails and 12-18 months for toenails, to see a completely healthy toenail. Side effects have been reported with the use of these medications and may involve liver inflammation and altered taste to name a few. Your doctor, who will decide if this medication is appropriate for you, may test your liver function before and after one month of treatment with oral medications.

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