What are fungal nails?
A fungal nail infection can occur in fingernails or toenails. In the toenail it usually occurs as a result of having Athletes foot that has been left untreated. Athletes foot is a fungal infection that resides on the sole of the foot and between the toes, if not managed it can eventually spread to the nails. The nails can become discoloured, thickened, have a strong odour and become uncomfortable. The shape and thickness of the nail can change making them difficult to trim and causing discomfort when placing pressure on them.
What is the cause?
The fungi responsible for the infection are called Dermatophytes, they live on our skin without causing any problems. However, in a warm dark moist area, such as our shoes, the Dermatophytes can multiply and lead to infection. Not keeping the feet clean and dry can also increase the risk of infection. Nails that have had trauma and been damaged in some way are more prone to fungal infection. It is a common infection and is more prevelant with men than women and more frequently seen in the over 50s.
What can help prevent the infection?
Keeping the feet clean and dry. Managing Athletes foot with topical preparations when necessary. Changing socks daily, and wearing natural materials to allow the feet to breath. Allowing the feet to air when possible and using surgical spirit or witch hazel between the toes can help cleanse control the moisture. Avoid sharing towels with others.
It is important to know that fungal nail infection is only resposible for 40-50% of problem nails and that there are a number of other causes of dystrophic nails, such as , psoriasis, poor circulation, trauma amongst others.
In many cases a diagnosis is made on the clinical appearance only, however, it is shown that in over 30% of cases there is an incorrect diagnosis. Therefore, ethically a diagnosis should be established in order to make a correct treatment plan and avoid inappropriate and costly treatments.
The present UK guidelines from the British Association of Dermatologists and NICE guidelines highly recommend that suspected fungal nails should be confirmed before treatment commences, particularly if oral medication is to be used.
The most common ways to test for fungal nails are visual diagnosis in clinic, or laboratory testing, where a sample of nail is sent to a lab to establish the presence or absence of fungal infection. However, the downsides to these tests are they are not reliable. As mentioned before, visual examination can resuit in a wrong diagnosis. Laboratory testing has a high false negative result of around 30%, and takes time to get the results back from the lab.
A BREAK THROUGH IN FUNGAL NAIL TESTING
A new more reliable test is now available that can be undertaken in clinic which provides an accurate and clear result in under 5 minutes, the test is 98% sensitive to fungal elements in the sample.
As discussed before fungal nail infection can cause morbidity and effects quality of life. Controlling fungal infections on the skin is important to the success of treating the fungal nails, as the infection usually start on the skin first. There are various treatments available with varying success rates. Oral medications, topical preparations are available, however there is a desire to reduce the risk of toxicity using oral medications and this treatment must be considered carefully before commencing. Topical treatments for nails can be considered but require good compliance and can take 6-12 months to clear the infection. Pharmacies supply Lacquers and nail paint, and Amorolfine is thought to be the most effective, although it is suggested to have a success rate of around only 50%. Other chemical agents such as urea 40% applied to the nail have been shown to be effective in clearing the infection. Nail reduction before anti fungal nail treatment improves the cure rate and its is recommended to seek help from an HCPC registered Podiatrist in this case. Here at Central Podiatry we can carry out an in clinic fungal nail test to confirm the presence of fungal elements and determine the most suitable treatment plan.
For a consultation please contact us via our contact page on the website https://www.centralpodiatry.co.uk or call us on 01327 700033. We look forward to assisting you.