February 16, 2021: Ten things you need to know about treating your fungal nail
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So many people have fungal nails and become increasingly frustrated by the lack of progress using commonly available over the counter treatments. So how do you go about treating your fungal nail?
In this blog we will address infection mechanism and treatment and listed below are ten important things you should know about treating your fungal nail.
1. Generally but not always infection of a nail follows damage.
Treating your fungal nail can be a right pain in the foot.
Nail fungus is an opportunist and normally (but not always) infects following damage to a nail – which is why it often doesn’t spread to the next door healthy nails.
This is why runners often have multiple fungal nail infections because of the damage done to nails by ill fitting and poorly laced running shoes especially when running downhill.
2. You have may caught your fungus from someone else.
The dermophyte responsible for athlete’s foot is naturally occurring on most feet. It is when it reproduces unchecked that we experience the familiar itching, redness and macerated tissue between the toes and changes to the nails.
The fungus may initially been ‘caught’ or transferred to the foot from a communal surface such as a changing room floor, a hotel bathroom, a swimming pool surround, a family member and so on.
Having acquired the fungal spore(s) it can be carried in footwear for sometime without becoming active waiting for conditions for activation and propagation to present themselves.
3. Fungus loves shoes.
The warm, dark and moist conditions found inside your shoe when your foot is in it is an ideal environment for a fungus.
Athletes foot is often already present. If you see an infection between the toes it is likely that you already have it on the sole of your foot. And it doesn’t always itch.
4. Fundamental to any fungal treatment is sanitising footwear.
Think about it.
Our footwear is the only article of clothing that we wear day in day out and never clean apart from the occasional polish. Certainly not the inside.
Footwear must be treated at the same time as a fungal infection for comprehensive eradication or re-infection will follow.
5. Don’t just treat your nails.
In addition to treatment of the skin and nails of the foot, anti-fungal spray such as Daktarin Spray should be used every time you change shoes.
Wrapping your shoes in a plastic bag and putting them in the freezer for 24hrs will kill most micro-organisms and give you a head start.
Fungal spores don’t survive above 37degreesC and so wearing socks once and washing them in a 40degreeC wash will sanitise them.
6. Nail fungus is very difficult to eradicate with over the counter products.
First and foremost when a Podiatrist is going to apply an otc (over the counter) product they will remove all of the fungal nail as a starting point.
This will be done far more comprehensively than you will be able to achieve at home and is usually painless as the nail being removed is already lose and not attached to the nail bed.
This allows direct application of the product into the site of the infection.
7. Not all the discolouration you see is ‘live’ fungus.
A fungal nail infection is like a forest fire – it is easy to see where it has been but it is only active at the leading edge and the ‘leading edge’ of a fungal infection is usually quite a way up underneath the nail towards the matrix – i.e. where it grows from.
This is one of the reasons that fungal nail tests can come back negative – because the fungal nail clipped from the edge is dead and therefore nothing is produced by a culture.
Clippings need to be taken from high up the nail and include skin scrapings from the same place too. Get your Podiatrist to do it for you.
8. So, what can you do?
So. Having cleared the dead fungal nail away and exposed the site of the infection there is a plethora of products on the market that make various promises which should see them referred to trading standards under the trades description act as unsustainable.
Generally you have fungi-stats such as amorolfine and products which change the pH of the nail – in theory a fungus can’t grow in an acidic environment.
Neither and none appear to be better than any other, clinical evidence of efficacy is patchy and even if they are successful could take several years of assiduous application.
9. What about tablets?
Oral medication is an option and usually (but not always) successful. You will need to speak to your GP about this and they are frequently reluctant to go down that route as there can be side effects. Terbinafine Hydrochloride or lamisil tablets appear the most effective.
If you would like to read more about oral medication and possible side effects – click here.
‘Google’ the subject and educate yourself ahead of a visit to your GP so you can have an informed discussion. You will see liver damage mentioned repeatedly but this is a rare side effect (1 in 50,000 to 1 in 120,000, and if you feel unwell or fail a liver function test then stop taking them!
You will need to be on them for four to six months until a reasonable amount of new nail grows. You can then stop as the remaining fungal nail will be dead and will just grow out.
10. .…….and afterwards?
Two things you should bear in mind if you do get rid of the infection.
getting rid of it does not confer immunity and you could get it again in the future
nail fungus is an opportunist and normally infects a damaged nail so if in the future you damage the nail that is the time to be most vigilant for re-infection.
Finally, it is generally accepted that lasers are very expensive and results are inconsistent although you will see much on the web to the contrary.
For more information or to make an appointment with one of our Podiatrists, please: