Fungal Nail Infections: Understanding and Management
Fungal nail infections, or onychomycosis, can cause significant discomfort and more often concerns about the look of the nails. They typically present as thickened, discolored, and brittle nails.
Proper diagnosis and treatment are essential for effective management.
Alternative possible diagnosis and why treatments may not work
Before treating a suspected fungal nail infection, it’s important to consider other possible conditions that can mimic or coexist with fungal infections:
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Nail Psoriasis: Characterized by pitting, ridges, and sometimes a yellow-brown discoloration. Often associated with psoriasis elsewhere on the body.
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Trauma or Injury: Physical damage to the nail can lead to discoloration and thickening, often without fungal involvement.
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Bacterial Infections: Can cause nail swelling and redness, particularly around the cuticle area.
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Lichen Planus: An inflammatory condition that can affect nails, leading to thinning and ridging.
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Aging Changes: Older adults may experience nail thickening and discoloration due to normal aging rather than infection. This is not a treatable condition but may be improved by following the advice below.
Non-Prescription Treatments
Patients can try several non-prescription treatments to manage mild fungal nail infections:
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Topical Antifungal Treatments:
- Amorolfine: Available over the counter - An antifungal nail lacquer applied once or twice a week. It requires careful application directly to the nail and surrounding skin.
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Antifungal Powders or Sprays: These products help keep feet dry and prevent fungal growth but are not an active treatment for the fungal nail disease if present. These are used particularly in shoes. Look for products containing miconazole or clotrimazole.
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Tea Tree Oil: A natural remedy with antifungal properties. It should be diluted with a carrier oil (like coconut oil) and applied to the affected nails twice daily. Results may vary, and can take several months to see improvements.
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Vicks VapoRub: Some patients report benefits from applying Vicks VapoRub, which contains camphor and eucalyptus oil, directly to affected nails twice daily.
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Nail Care:
- Regularly trim and file affected nails to reduce thickness.
- Maintain proper foot hygiene and dry your feet thoroughly after washing.
Prescribable Medications
If non-prescription treatments are ineffective after several weeks or months, your GP may discuss with you stronger medications, including:
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Oral Antifungal Medications:
- Terbinafine: A common oral antifungal treatment for fungal nail infections. It works by inhibiting fungal growth.
Dosage: Typically, a course of terbinafine lasts for 6-12 weeks, depending on the severity and site of infection.
Risks associated with taking terbinafine
- Liver Failure: Terbinafine can affect liver function and, in rare cases, lead to liver failure. Liver function should be monitored through blood tests, especially in patients with pre-existing liver conditions or those taking other medications affecting the liver.
- Side Effects: Other common side effects may include gastrointestinal disturbances (nausea, diarrhea), headache, and skin rashes.
When to Seek Medical Advice
If you suspect a fungal nail infection, consult your GP if:
- The infection is persistent and has not improved with non-prescription treatments after 6-8 weeks.
- You have severe pain or discomfort.
- There are signs of secondary bacterial infection (redness, swelling, or pus).
- You have underlying health conditions (e.g., liver disease, diabetes) that could complicate treatment.
Managing fungal nail infections effectively involves a proper diagnosis and an understanding of available treatment options. Non-prescription treatments can be effective for mild cases, while stronger oral antifungal medications like terbinafine may be necessary for persistent infections. Always discuss with your healthcare provider to determine the best course of action for your specific situation and to monitor for potential side effects