What is Onychomycosis?
Nail fungus is a fungal infection in one or more of your nails. An infection with nail fungus may begin as a white or yellow spot under the tip of your fingernail or toenail. As the nail fungus spreads deeper into your nail, it may cause your nail to discolor, thicken and develop crumbling edges -- an unsightly and potentially painful problem.

An infection with nail fungus may be difficult to treat, and it may recur. But medications are available to help clear up nail fungus.

Symptoms

There are different classifications of nail fungus -- depending on type of fungus and manifestation -- which may have somewhat different signs and symptoms. In general, however, you may have a nail fungal infection -- also called onychomycosis (on-i-ko-mi-KO-sis) -- if one or more of your nails are:

1)Thickened
2)Brittle, crumbly or ragged
3)Distorted in shape
4)Dull, with no luster or shine
5)A dark color, caused by debris building up under your nail

Infected nails also may separate from the nail bed, a condition called onycholysis. You may feel pain in your toes or fingertips and detect a slightly foul odor.

Causes

Nail fungal infections are typically caused by a fungus that belongs to a group of fungi called dermatophytes. But yeasts and molds also can be responsible for nail fungal infections.

What are fungi?

Fungi are microscopic organisms that do not need sunlight to survive. Some fungi have beneficial uses, while others cause illness and infection.

All of these microscopic organisms:

1)Live in warm, moist environments, including swimming pools and showers

2)Can invade your skin through tiny visible or invisible cuts or through a small separation between your nail and nail bed

3)Cause problems only if your nails are continually exposed to warmth and moisture -- conditions perfect for the growth and spread of fungi

Toenails vs. finger nails

Nail fungus occurs more in toenails than in fingernails.

Toenails often are confined in a dark, warm, moist environment inside your shoes -- where fungi can thrive.

Diminished blood circulation to the toes as compared with the fingers makes it harder for your immune system to detect and eliminate the infection.

Western Medicine Treatment

Nail fungus can be difficult to treat, and repeat infections are common. Over-the-counter antifungal nail creams and ointments are available, but they are not very effective. If you have athletes foot as well as nail fungus, you should treat the athletes foot with topical medication and keep your feet clean and dry.

Oral medications

To treat nail fungus, your doctor may prescribe an oral antifungal medication. Studies have shown the most effective treatments to be terbinafine (Lamisil) and itraconazole (Sporanox). Your doctor is likely to recommend oral medication if you:

1)Have diabetes or other risk factors for cellulitis
2)Have a history of cellulitis
3)Are experiencing pain or discomfort from your nail infection

These medications help a new nail grow free of infection, slowly replacing the infected portion of your nail. You typically take these medications for six to 12 weeks, but you will not see the end result of treatment until the nail grows back completely. It may take four months or longer to eliminate an infection. Recurrent infections are possible, especially if you continue to expose your nails to warm, moist conditions. Antifungal drugs may cause side effects ranging from skin rashes to liver damage. Doctors may not recommend them for people with liver disease or congestive heart failure or for those taking certain medications.

Other treatment options

Your doctor may also suggest these nail fungus treatments:

1)Antifungal lacquer. If you have a mild to moderate infection of nail fungus, your doctor may prefer to prescribe an antifungal nail polish called ciclopirox (Penlac). You paint it on your infected nails and surrounding skin once a day. After seven days, you wipe the piled-on layers clean with alcohol and begin fresh applications. Daily use of Penlac for about one year has been shown to help clear up some nail fungal infections.

2)Topical medications. Your doctor may also opt for other topical antifungal medications. You may be advised to use these creams with an over-the-counter lotion containing urea to help speed up absorption. Topical medications usually do not cure nail fungus, but they may be used with oral medications. Your doctor may file the surface of your nail (debridement) to lessen the amount of infected nail to treat and possibly make the topical medication more effective.

3)Surgery. If your nail infection is severe or extremely painful, your doctor may suggest removing your nail. A new nail will usually grow in its place, though it will come in slowly and may take as long as a year to grow back completely. Sometimes surgery is used in combination with ciclopirox to treat the nail bed.

4)Treating nail fungus with a laser or photodynamic therapy -- intense light irradiates the nail after it has been treated with an acid -- may also be successful. However, this new treatment may not be available everywhere.

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