Continuing his popular Medical Matters Column, this week Dr Roarty of Scally McDaid Roarty Medical Practice looks at the problem of Fungal Nail Infections.
Fungal infections of the nails are quite common particularly in older people and younger swimmers and athletes who may share showers. It more commonly affects toenails and is often caused by the spread of a fungal skin infection eg Athlete’s foot.
Fingernail infections can occur from scratching itchy toes which have a fungal infection, or if you wash your hands a lot in hot water, damaging the protective skin at the base of the nail.
Damage to a toenail or an underlying medical condition such as Diabetes, general ill health or problems with the immune system may also predispose to this infection. Smoking is also a risk factor
This is usually a painless condition where the nail looks thickened and discoloured. Sometimes the nail may come away from the underlying nail bed and either crumble away or totally dislodge. The skin surrounding the nail may also become inflamed and scaly.
What tests are required?
Your doctor may arrange for nail clippings to be sent to the lab to confirm the diagnosis and distinguish from other conditions which may look similar.
What is the treatment?
If the infection is mild or not causing any problems, some patients may opt for no treatment as treatment has a cure rate of between 60-80 % and it may not necessarily restore the appearance of the nail to exactly as it was before. However, if the symptoms are troublesome or bothering you, or you have diabetes, vascular disease or an underlying problem with your immune system it may be recommended to go ahead with treatment.
Antifungal tablets are often prescribed and your doctor may request you to take a blood test first. They are taken for a few months but generally, an improvement is noted after about a month. If not, discuss with your doctor as there may be other underlying problems.
Antifungal nail paint is also used as an alternative but is sometimes not as effective as oral medication. If these options have failed, nail removal under local anaesthetic can be considered along with anti-fungal treatment.
As treatment with medication progresses you will see the healthy nail growing from the base again and the damaged nail growing out and slowly being clipped away. It may take a number of months to be completely cured and fingernails tend to grow and therefore clear quicker. It is important to not stop taking the medication without discussing with your doctor.
It is also important to keep your nails trimmed regularly and file down any thickened nail. Do not share scissors or nail clippers and try to avoid injury to the nails. If toenails are affected it is important to wear properly fitted shoes. You should treat athletes foot promptly as this may cause a reinfection of your toenails otherwise.
The above information is intended as advice only and should you have any concerns please contact your own Doctor.
Dr Ciarán Roarty MB, BCh BAO MICGP DRCOG Grad. Cert. Obst. Ultrasound
is a full-time GP at Scally McDaid Roarty Medical Practice, Scally Place, Letterkenny, Tel 0749164111