Summary – infection of the nail plate with fungus, usually a dermatophyte, commonly trichophyton rubrum. Infrequently the infection can be caused by yeasts or non-dermatophyte moulds. Onychomycosis is more difficult to treat than tinea pedis although the infecting organism is the same, due to the slow growth of the nail plate compared to skin.
Patients often experience only social discomfort with onychomycosis, not wanting to show the toenails in public. Pain can be associated with the condition when thickening or defomity of the nail plate occurs. There are two main types of onychomycosis: distal subungal and superficial types. In both cases, the condition responds well to topical treatment when less than half of the nail surface area is affected, and the dermatophytoma does not contact the nail fold or sulci.
Treatment can be topical – twice daily application of terbinafine hydrochloride cream/spray, or 1064nm laser treatment with podiatrist, or in severe cases, oral medication is required.
Fungicide is only half the battle. Eliminating the warm, moist environment makes a significant impact on the long term success of treatments. As does debulking of gryphotic nails, to decrease infectious load.
Literature – Treatment of onychomycosis becomes important in people living with diabetes and other auto-immune conditions, or people at risk of ulceration or infection. Always refer people with diabetes and onychomycosis to a podiatrist to assess for peripheral neuropathy and management of mycosis.
Diagnostic tip – Cultures are only required if oral medication is recommended for treatment of severe infection (where there is more than ½ of the nail surface area affected, or the dermatophytoma touches the sulci or nail fold). Topical treatments can be tried for up to 6 weeks before oral medication is required.
Testing or imagery – Nail clipping for culture can be taken when oral medication is recommended for treatment of severe infections.
Referrals – Refer to Podiatrist for education, management and treatment.
Summary – Fungal infection of the toenail.
How does this occur? – Trauma to the toenail, can be micro- or macro-trauma, in the presence of fungal spore. Often associated with sweaty feet.
How can this be helped? – There are non invasive treatment methods available – cream, laser therapy, and oral medication is sometimes appropriate. Managing sweaty feet and eliminating fungal spores from your shoes, socks, laundry and bathroom can significantly decrease the rate of reinfection.
Who can help? – Your podiatrist can help with treatment, nail cutting and shaping, tips to decrease chance of reinfection. Your GP can help if cultures are required and medication needs to be considered.
