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Fungal Nails


Causes, Signs and Symptoms of Fungal Nails


Most nail fungus is caused by micro organisms known as dermatophytes but sometimes can be caused by yeasts and molds.


Fungus favours warm, dark and moist environments and its growth in inhibited by light.  Closed shoes and nail varnish therefore encourage fungal growth.  Other risk factors are age (length of exposure), poor circulation, sweaty feet, humid work conditions (eg chefs), skin conditions such as eczema and psoriasis, occlusive footwear, nail damage, diabetes, weak immunity and walking barefoot in public areas.


Typically the fungus can look like white powdery patches or spots or stripes within the nail in colours varying from cream, through yellow, orange or brown.  Dark patches on nails always need investigating as pigmentation in a nail could indicate skin cancer.  Over time the nail may become crumbly and thickened which makes cutting awkward and as they thicken they may become permanently damaged and even painful.


Big toenails and little toe nails are most commonly affected due to pressure damage from footwear.  The infection can then spread to other nails and the skin.  Fungal nails can pose risks to diabetic patients and those with immune system suppression such as those with leukaemia, AIDs or recipients of donated organs.


An experienced podiatrist can usually diagnose nail fungus by clinical examination but sometimes a culture is required to confirm what microbe is causing the infection.  This involves taking a few scrapings for culture and microscopic examination.


Treatment of Fungal Nails


There are no easy quick fix treatments for well established nail infections.   By far the most effective treatments are oral medication in the form of tablets.  The best ones are terbinafine and itroconazole but these medications are prescription only and expensive to administer - currently you can only obtain them from your GP (though this may change in the future with independent prescribing).  Typically you need to take these tablets for about 12 weeks but during this period patients will not witness any change to the damaged nail because the infected nail plate must grow out.  Only after the 12 weeks has passed will patients be able to see clear healthy nail appearing at the base of the nail.  Occasionally a longer course of medication will be given but usually only after liver function tests.


It is important to treat your shoes at the same time to avoid reinfection - your shoes will contain fungal spores waiting to germinate in the correct conditions!  Not all patients are suitable for oral antifungal treatments - patients with congestive heart failure, renal or liver disease will nt be able to take these medicines.


Some clinics also offer laser or photodynamic therapy but this can be expensive and not necessarily more effective than other treatments.


Topical antifungals have improved in recent years but you will need to treat your nails for at least 9 months to a year and it works best if you get your nails regularly pared down my your podiatrist so that penetration into the nail is optimised.  Again footwear treatment with antifungal powder is an essential part of this treatment strategy.  Leah at betterNOW can provide this service and dispense a the P-medicine (prescription strength) medication Amorolfine.


If you don't like the idea of using medicines there is some anecdotal evidence that applying Vicks Vapour Rub improves the appearance of fungal nails and daily soaks in vinegar (1 part vinegar : 2 parts warm water) has also been reported to be beneficial (there is no clinical evidence to prove these claims however).




Prevention of fungal nails


Reinfection is very common so learning how to avoid reinfection is an important part of any treatment programme.  To increase the risk of not becoming reinfected:


Keep nails short and clean

Natural fibre socks absorb more moisture than synthetic and if your have sweaty feet this can increase foot humidity

Air your feet regularly

Alternate shoes

Avoid picking at infected nails and wash your hands after handling your feet

Only patronise reputable beauty salons that practice hygienic techniques and who sterilise their equipment

Avoid all kinds of nail polish especially dark colours




If you want to learn more about fungal infections there is a short article on athletes foot in another section on this website.


Leah, our Podiatrist, is happy to discuss and treat any fungal foot problems, please go to our contact page.


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