Fungus enters the fingernail or toenail through the adjoining skin, causing the nail to become discoloured, brittle or thick. Getting rid of a fungal infection of the nail is difficult. Numerous remedies are touted, including alternative treatments and over-the-counter creams and ointments, but their effectiveness is open to question. Treatment by prescription oral drugs gives the best result, but it can be lengthy and has potential side effects.
Fungi prefer a warm, dark area of the body, which is why they are usually found in the armpit, foot, or groin. When a fungus attacks a nail, it eats into the keratin, the hard part of fingernails, toenails, and hair.
The most vulnerable area of a fungus is its cell membrane. That is the target of topical creams and ointments, over-the-counter medications, oral medicines and injections. Most people with infected fingernails get rid of it by frequently washing with specialised antifungal creams and soaps.
An overproduction of keratin, the hard protein substance found in nails and hair, is a sign of fungus and can cause a nail to become detached.
Nails can also become dull, losing their shine. A fungus can enter the tip of the nail and progress toward the root, causing the nail to turn yellow, brown or even purple. If black or white patches appear under the nail, it is likely infected. A yellow powder under a brittle nail is the sign of advanced infection.
An infected nail can also become thick, painful and tender because of layers of fungi growing under it. Brittle, chipped, flaky and smelly nails are other signs of an infection.
The infection can also cause small bumps under the nails (possibly a sign of pus).
How fungus spreads
Tight footwear, exercise that results in sweaty feet and trauma to the toenails can bring on an infection. Nail fungus can also spread through communal showers or can be caused by an immune system weakened by diabetes or aids.
Not all problems with fingernails or toenails are caused by fungus. Psoriasis and eczema can also cause discoloured, brittle nails. About half of the people with discoloured or thickened toenails and fingernails have some kind of fungal infection.
Basic dos and don'ts
If you develop fingernail fungus, expose your fingernails to the sun. Fungi hate sunlight.
Don’t wear nail polish until you get rid of the fungus.
Use rubber gloves to wash dishes.
Keep your hands and feet dry.
Diagnosing a fungus
To identify the fungus, a physician will take a sample of the infection. The Trichophyton fungus is responsible for most infections. In giving a KOH (potassium hydroxide) test, the physician will drip a few drops of potassium hydroxide on an infected sample before examining it under a microscope. The physician can also take a fungal sample for a culture, but the exact fungus might not be identified for three weeks to a month.
Some home remedies are said to work. Vinegar has antiseptic and antifungal properties. You can soak your nails in a few drops of vinegar or in a mixture of half-vinegar, half-bleach for half an hour. Other treatments believed to work are tea tree oil, oregano oil, mouthwash, and Vicks VapoRub.
Neem, a plant from India, is known to have antibacterial and antifungal properties. If you find an ointment containing neem, use it on the infected area.
Numerous over-the-counter medical creams and ointments are available to combat nail fungus, but none have proven to work well enough to exclude all other treatments. The main advantage of over-the-counter remedies is that they don’t have side effects. You can use them safely if you follow directions.
Treatment with prescription oral drugs is a long-term ordeal. The patient may have to take a drug for several months, and the three medications currently prescribed by physicians interact with numerous drugs and have significant side effects. The medications become part of the nail, so they are present even after the patient has stopped taking them. Pregnant women should not take these medications, and patients who do take them should have their blood cells and liver monitored regularly.
Terbinafine (Lamisil) is 70 to 90 per cent effective for treating nail fungus when used correctly. Terbinafine interacts with caffeine, cimetidine and some other drugs. The dosage for fingernail infections is 250 mg daily for six weeks. Toe infections require 12 weeks.
Intraconzalole (Sporanox) is effective 70 to 80 per cent of the time. It, too, interacts with many medications. It’s taken in 200 mg doses once a day with a meal for six weeks for a fingernail fungus and for three months for toenail infections. Taken with pulses, peas, beans or other legumes, the dosage is 200 mg twice daily for one week every month, and the treatment is repeated for two to three months.
A third drug, fluconazole (Diflucan), is an effective oral antifungal medication (72 to 89 per cent). Because it stays in the body for long periods, it is taken in weekly doses of 450 mg for four to nine months.
A nail lacquer, ciclopirox (marketed as Penlac), is not always effective, but many people can’t take oral antifungal medications, so ciclopirox may be their only option.