The causative pathogens of onychomycosis are all in the fungus kingdom and include dermatophytes, Candida (yeasts), and nondermatophytic molds. Dermatophytes are the fungi most commonly responsible for onychomycosis in the temperate western countries; while Candida and nondermatophytic molds are more frequently involved in the tropics and subtropics with a hot and humid climate.
Many podiatrists now consider this an effective treatment, but because it’s new, there’s not enough concrete data to compare with other treatments. Dr. Hinkes raises another concern: “A clinical cure and a mycological cure are two different things. With the clinical cure, you look at the nail and it looks fine. It’s pink and shiny and smooth and it looks great. But if you sample the nail, you might find that there’s mold or fungus there, so it does not have what we call a mycological cure—mycology is the study of fungi.
Making a few simple lifestyle changes can help prevent a fungal infection of the nails. Taking good care of your nails by keeping them well trimmed and clean is a good way to prevent infections. You should also avoid injuring the skin around your nails. If you’re going to have damp or wet hands for an extended amount of time, you may want to wear rubber gloves.
Fungal nail infections don’t usually lead to serious long-term problems when properly treated, but they may be more serious in certain individuals. This can include people with diabetes or who have a weakened immune system and have trouble fighting off an infection. Even if there is no pain associated with the infection, it is important that you promptly visit your doctor for assessment if you see any abnormal nail changes.
Some methods of prevention include avoiding walking barefoot in public showers, keeping the toenails short, wearing big enough shoes, and changing socks daily. When infected, the feet should be kept dry and clean and wearing sandals may help. Treatment can be either with antifungal medication applied to the skin such as clotrimazole or for persistent infections antifungal medication that are taken by mouth such as terbinafine. The use of the cream is typically recommended for four weeks.
There are several doctors who can provide nail fungus treatment. Your primary care provider, a dermatologist, or a podiatrist can treat nail fungus. Any one of these doctors can provide proper diagnosis and prescribe medications specific to fungal infection. A podiatrist or dermatologist may shave the top layer of the nail off or even remove part of the nail.
Tinea pedis, also known as athlete's foot or foot fungus, can cause recurrence of fungal nails. Therefore, it is important to manage this condition. One can apply over-the-counter (OTC) antifungal medicines such as clotrimazole (Lotrimin) or terbinafine (Lamisil) cream as directed to affected skin. Keeping footwear and socks clean can be helpful. You can also use portable UV light sanitizers to disinfect shoes.
If the fungal infection has spread to the toenails, the nails must also be treated to avoid reinfection of the feet. Often, the nails are initially ignored only to find the athlete's foot keeps recurring. It is important to treat all of the visible fungus at the same time. Effective nail fungus treatment may be more intensive and require prolonged courses (three to four months) of oral antifungal medications.
If you have diabetes or a weakened immune system, treatment is especially important. After getting a fungal nail infection, people who have diabetes have an increased risk of developing sores that do not heal. Sores that do not heal can lead to a serious health problem. It’s important to see a dermatologist (or other doctor) at the first sign of a nail problem. A dermatologist can tell you whether you have a nail infection or something else.