Your fingernails and toenails are composed of keratin and adherent connective tissue, the same stuff that your hair is made of. Nail grows at an average rate of 0.1 mm/day (1/2 inch every 100 days). Finger nails require 3 to 6 months to re-grow completely while toe nails require 12 to 18 months. Onychomycosis is a fungal infection of the nails, 80% of the infections are caused by dermatophytes (Trichophyton rubrum), that causes lots of other skin fungal infections.
Diagnosis is based on clinical exam and history, microscopy, and culture.
- OTC nail lacquers (Fungi-Nail®) treat fungus around the nail, they don’t penetrate the nail plate. Don’t recommend them due to minimal efficacy; is only for athlete’s feet.
- Rx products provide best treatment option.
- Advise patients about possible recurrence.
Treat for 6 weeks for fingernails and 12 weeks for toenails.
- Terbinafine (Lamisil®) (Rx) – fewest drug interactions; most efficacy: cure rate: (46%). Side effects include headache, gastrointestinal disturbance (diarrhea and/or dyspepsia), rash and elevated liver enzymes
- Itraconazole (Sporanox®)(Rx) –drug:drug interactions. cure rate (23%pulse). Side effects, skin rash, high triglycerides, cardiac side effects and gastrointestinal effects (nausea, bloating, and diarrhea)
- Fluconazole (Diflucan®) (Rx) cure rate:28% dosed at 150mg once a week, less drug interactions than itraconazole. Frequent relapse, due to poor retention in the nail.
- Ciclopirox (Penlac®) (Rx) nail lacquer complete cure rate (7%)
- Efinaconazole (Jublia®) (Rx) nail lacquercomplete cure rate (17%)
- Tavaborole (Kerydin®) (Rx)nail lacquer cure rate (<10%)
- Small study of 18 participants, where fifteen of the 18 participants (83%) showed a positive treatment effect. Source: J Am Board Fam Med. 2011 Jan-Feb;24(1):69-74. doi: 10.3122/jabfm.2011.01.100124
- 5 of 18 (27.8%) had a clinical cure at 48 weeks;
- 10 of 18 (55.6%) had partial clearance
- 3 of 18 (16.7%) showed no change.
Since our enemy Trychophyton rurum is everywhere, re-infection is a possibility if measures are not taken to make the feet an inhospitable environment for this fungus. Fungus breed where it is warm, dark and moist. Here are some points:
- 1 in 5 “cures” will relapse (20%) within 2 years
- Keep feet clean and dry
- Change socks often
- Antifungal product for feet and shoes.
- Sports shoes that fit well will reduce microtrauma to the nail plate. Wear sandals when possible.
- Using communal showers leads to fungal infection, so these should be avoided
- Care with hygiene is needed to reduce cross-infection between family members
- Throw out old “creek shoes”.
- Emollients can be used to avoid cracks in the skin that allow fungus to enter.
Certain-Dri®—Prevention of nail fungus
- Contains aluminum chloride-12%. This product stops the feet from sweating, creating the moist environment for the fungus to grow.
- Water-based and unscented which makes it gentler on skin
- Should not wash off after bathing or showering, if application instructions are followed. Use twice a week.
Your Thompson Pharmacist is the best source for foot care products both in the front of the store and in the prescription department.
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