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Nail fungus: Diagnosis and treatment


How do dermatologists diagnose nail fungus?

To find out if a patient has nail fungus, a dermatologist examines your nails and nearby skin. It’s important to check the skin because the fungus can spread. You may already have a skin infection caused by fungus like athlete’s foot.

To get rid of the infection, you will need to treat all infected areas.

Before giving you the diagnosis, your dermatologist may also take some samples. Collecting a bit of debris from beneath a nail, trimming off part your nail, or scraping off a bit of skin can be very helpful. In a lab, these samples can be examined under a microscope to find out what’s causing the problem.

Are you hiding an infected nail with nail polish?

Be sure to ask your dermatologist if you can wear nail polish while treating nail fungus.

How do dermatologists treat a fungal nail infection?

Treatment usually begins with your dermatologist trimming your infected nail(s), cutting back each infected nail to the place where it attaches to your finger or toe. Your dermatologist may also scrape away debris under the nail. This helps get rid of some fungus.

To completely get rid of the infection, most people also need one or more of the following treatments:

Medicine you apply to the nail: If you have a mild infection, a medicine that you apply to your nails may get rid of the infection. This treatment helps keep new fungus out while the nails grow. Fingernails typically grow out in four to six months. Toenails take longer, usually takes 12 to 18 months.

Probably the most difficult part of this treatment is remembering to use it as often as prescribed. Some treatments must be applied every day. Others you apply once a week. To get the best results, it’s essential that you apply these medicines exactly as directed.

The US Food and Drug Administration (FDA) has approved the following medicines that you apply to the nail to treat nail fungus:

  • Amorolfine

  • Ciclopirox

  • Efinaconazole

  • Tavaborole

Side effects from these medicines are generally mild. Possible side effects include redness and swelling, an ingrown toenail, and stinging or burning when you apply the medicine. In clinical trials, none of these side effects caused patients to stop using the treatment.

Medicine you take: If you need more-aggressive treatment, your dermatologist may prescribe antifungal pills. These have a higher cure rate than medicine you apply to your nails.

Antifungal pills also work more quickly than medicine applied to the nails. Taking antifungal pills for two months can cure an infection under the fingernails. Usually three months of treatment cures a toenail fungal infection.

Antifungal pills, however, can cause side effects. Your dermatologist will watch you closely. You’ll also need to have blood tests every month to check for problems.

The FDA has approved the following systemic (works throughout the body) medicines to treat nail fungus:

  • Fluconazole

  • Griseofulvin

  • Itraconazole

  • Terbinafine

Combination therapy: Sometimes, nail fungus is hard to clear. Studies show that taking antifungal pills and applying medicine to your nails can be more effective than using either treatment alone.

Nail removal: If you have a severe infection or other treatments just don’t work, your dermatologist may recommend removing the nail(s) to get rid of the infection. Your dermatologist will use one of the following techniques to remove the nail:

  • Nonsurgical nail removal (a chemical is applied to the nail)

  • Surgical nail removal

Your dermatologist can perform both types of nail removal in a medical office or a clinic. With either procedure, the nail can grow back. If the infection fails to clear, however, your dermatologist can treat the nail so that it cannot grow back.

Researchers continue to look for safe, effective treatments

While there are many treatment options, none is ideal. Medicine applied to the nails has a low cure rate. Antifungal pills can cause side effects. Nail removal requires wound care.

To improve treatment, researchers are looking for new and better ways to treat nail fungus. One treatment showing promise is the use of lasers and light treatments to clear nail fungus. While promising, more research is needed to know whether this treatment can provide safe and effective treatment for most people.

Researchers are also looking at other potential treatments, including patches, nail lacquers, and gels.

What is the outcome for someone who has nail fungus?

With treatment, many people can get rid of nail fungus. Even when the fungus clears, your nail(s) may look unhealthy until the infected nail grows out. A fingernail grows out in 4 to 6 months and a toenail in 12 to 18 months.

To clear the fungus, it’s important to:

  • Use the treatment exactly as prescribed

  • Apply (or take) the medicine for as long as prescribed

  • Keep all follow-up appointments with your dermatologist

Nail fungus can be stubborn. If you had a severe infection, it’s possible to clear the infection. A healthy looking nail, however, may be unrealistic, but you can expect the nail to look better and feel more comfortable.

Even with clearing, nail fungus can return. You’ll find steps to reduce your risk in Tips: 12 ways to prevent another nail infection.


Image
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Reference
Gold LFS and Rosen T. “Onychomycosis: Diagnosis, treatment, and prevention strategies.” Dermatology News (A CME/CE certified supplement). March 2016:2-15.

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