Treating Toe-Nail Fungus
Onychomycosis (fungal toenail infections), may be caused by yeasts, nondermatophyte molds, or superficial dermatophytes that also cause tinea infections of the skin.Onychomycosis may be superficial, affecting only the tip of the nail, or it can involve the entire nail.
How Common Is Onychomycosis?
Onychomycosis accounts for 40% to 50% of all nail problems. It has a prevalence as high as 13%.The risk of onychomycosis in adults is 30 times higher than in children.
Possible causal factors are peripheral vascular disease, traumatic nail abnormalities, polypharmacy, and poor foot hygiene. Certain activities are linked to onychomycosis. Swimming is a risk factor, perhaps because of prolonged exposure of the nails to moisture, with accompanying cuticle and skin maceration. Further, the floors of locker rooms and swimming facilities are usually heavily contaminated with fungi.
Certain medical conditions (e.g., psoriasis, diabetes mellitus, tinea pedis) are risk factors for onchomycosis, as is wearing occlusive or poorly fitting footwear.
Distal/Lateral Subungual Onychomycosis.
The most common variant of onychomycosis. The nail is abnormally colored (white or brown) along the lateral edges of the upper distal areas and may be eroded. Unless aggressively treated, the fungus may spread across the entire nail bed. The nail becomes brittle and may disintegrate and flake away with repeated shoe contact. The nail beneath the abnormal area, experiences thickening with loosening and possible loss of the toe nail.
Diagnosis Treatment for onychomycosis should not be initiated solely based on visual examination, as the most common cause for apparent treatment failure is an incorrect diagnosis. Other nail dystrophies resemble onychomycosis too closely to confirm the presence of fungi. Prior to initiating treatment, the physician may choose to rule out non fungal causes by examining nail scrapings under a microscope.
Complications Because the nail supports and protects the toe and helps the foot work, onychomycosis can affect standing, walking, and exercising. It can cause pain, numbness, and loss of dexterity, as well as morbidity interfering with work and school. Older men (especially those with diabetes or peripheral vascular disease) have an increased risk of cellulites and limb loss.
Treatment Various topical and oral therapies have been used in the past to treat onychomycosis. Whilst some have shown to have a modest clinical success rate, the common adverse affects are headache, gastrointestinal disorders and skin disorders. Abnormal liver function test have also been reported and this oral therapy is not recommended for individuals with liver disease.
A novel non-invasive approach for treatment which involves the application of laser energy to the nail plate with a sub-millisecond Nd:YAG laser has been shown to be an effective alternative. The treatment involves pulsing the laser into the nail bed on 2 separate occasions 6 weeks apart. A warming sensation is felt during the treatment which is tolerated quite well by patients. This is a non-invasive procedure lasting approximately 15 –30 minutes and with no down time.
Recent research indicates that two treatments have been shown to have an efficacy. Efficacy is largely unaffected by the degree of severity of nail involvement. These studies confirm the effectiveness of sub millisecond 1064 nm ND:YAG laser in improving the cosmetic appearance of nails exhibiting mild to severe fungal infections.