Toenail fungus is also known as onychomycosis and is typically caused by dermatophytes, moulds or yeasts infecting the nail bed, matrix and plate of the nail. These fungal infections can present in a number of different ways, affecting your nail shape, colour and overall appearance.
But there’s no need to be alarmed, as although a fungal nail infection can look physically unappealing, it is one of the most prevalent nail conditions. It rarely has pain associated with it and will not have any major impact on your quality of life. In saying that, fungal nail infections are not self healing and should be treated to avoid spread and worsening of the infection.
A fungal nail infection occurs when a fungal infection penetrates your nail. You can acquire this fungi from a number of sources including public swimming pools, unsterilised nail equipment, coming into contact with someone who has a fungal infection, and any other moist environments.
Fungal nail infections are seven times more likely to occur on the toenails than on the fingernails as the inside of a shoe, where it’s dark, warm and moist, is the perfect environment for fungi to thrive.
A fungal nail infection can present itself in many ways. In fact, there are five core patterns of fungal nail infections that are categorised by their physical appearance.
Whilst fungal infections can usually be categorized into these 5 different types, it is not uncommon for people to have mixed patterned fungal infections. Due to these various patterns, a fungal nail infection can often be mistaken for other nail conditions or simply a discoloured and thickened toenail.
Fungal nail infections can be acquired at all ages and ethnicities however are more often present in men rather than women and in adults more so than children.
Although being common in such a diverse group, there are certain risk factors that heighten your chance of acquiring it. These include:
Clinical appearance of the nail will usually alert your podiatrist to the presence of a fungal infection. They will be assessing or looking for:
Even though these features are common for fungal infections, it must not be mistaken for other nail conditions such as a psoriatic nail condition, which have very similar appearance!
Our qualified podiatrists will perform a physical examination and if required, use diafactory tinea unguium diagnostic testing which has a 95-99% accuracy of all common dermatophytes. Therefore we can then confidently diagnose your fungal infection and begin treatment.
It is important to consult your podiatrist for advice and preferred treatment plans as there are multiple factors that must be considered before starting a treatment pathway to resolve your fungal infection. These can include the type of fungal present, predisposition to antifungal drugs, comorbidities, drug interactions whether with medication or adverse effects, diet, age, compliance and cost.
Photodynamic Antimicrobial Therapy (PACT) is a safe and reliable treatment pathway for fungal nails. This treatment uses light interaction with photosensitive agents to penetrate the microorganism's cell wall. PACT kills off these cells without causing harm to the healthy tissues and usually only takes 3 sessions.
A study conducted by Figueriredo et al. 2016 showed a 100% success rate in mild to moderate fungal infections and a 63.5% success rate for severe infections.
Review 4-12 weeks after last PACT treatment to review the progress of the fungal nail infection and to
ensure healthy nail is growing out.
2. Oral Medications
Systemic or oral treatments can be used for all types of fungal infections. These oral medications are prescription medication and it is important to discuss your complete medical history and the common adverse reactions and side effects with your GP first. Doctors commonly order a blood test to check liver function and it will be monitored every 12 weeks for those at risk of adverse effects such as liver disease.
Oral treatments can be taken for months until results are achieved in respect to the individuals liver and
heart function and/or their resistance to the medication or adverse drug effects. This form of treatment has approximately an 85% success
rate, however there can be many side effects ranging from; dizziness, headaches and skin rashes etc.
3. Topical Nail Paints
Local or topical treatments are over-the-counter medications and include ciclopirox nail lacquer, amorolfine nail lacquer (Loceryl) and Canesten. Topical treatments can be used as long as there is no involvement of the nail matrix. The dosal nail is filed down and painted with the chosen lacquer, which allows the active ingredient to diffuse into the unhealthy nail.
The efficacy rate is approximately 8-10% and can take upwards of 6 to 24 months to treat or notice a visible change at all.
In addition to this, it is recommended that you have podiatry treatments approximately every six (6) weeks during this time, so we can use sterile instruments (that limit the risk of cross contamination and re-infection) and mechanically de-bride the nail back so the topical agents are more effective.
Although a fungal infection may seem daunting, with these simple tips we can all stay fresh and fungal free.
Additionally, if you get a pedicure at a nail salon, remember to ask the staff how they disinfect their equipment and how often they do it.
If you notice a change in your nail, consult your podiatrist as we want to start treatment straight away before the infection spreads to other nails or people.