USF-COM
Department
of Family Medicine
Patient Education Information on...
Index of
Patient Education Topics
What Is Nail Fungus Infection?
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Onychomycosis is a fungal infection of the finger or toe nails which is
difficult to cure.
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It occurs in 12 million Americans and many do not even know they have it.
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How Do I Know If I Have It
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Begins as a small separation between the end of the nail and the nail bed.
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Soft yellow material gradually builds up in this separation.
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Nail becomes thick and yellow.
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May appear as white spots or streaks on the nail.
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Usually doesn’t itch and is painless, unless the area becomes infected.
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Eventually, the entire nail separates, resulting in partially destroyed,
yellow nail.
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What Causes
It and Who Is At Risk?
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Typically, caused by an infection with Trichophyton fungus.
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Occurs when the nail is damaged or is continuously exposed to a warm moist
environment. At risk are individuals such as farmers, cooks, dishwashers,
housewives.
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Other risk factors include hot humid weather, poor circulation, and diabetes
mellitus.
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How Do We Test For It?
The doctor can test scrapings of the nail or the material under the nail
for the fungus. The fungus is identified under a microscope or the material
is placed on dish with nutrients to see if fungus grows. This must
be done because other diseases such as psoriasis or lichen planus can mimic
onychomycosis.
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How Do I Treat the Infection?
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Onychomycosis never resolves by itself.
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Treatment is an antifungal drug, which is taken by mouth for several months.
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The following drugs are available:
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Griseofulvin(Fulvicin, Grisactin)-taken 6
months and costs about $350 ~40% effective
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Terbinafine(Lamisil)- taken 3 months and costs
$500-up to 70% effective
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Itraconazole(Sporanox)-taken 3 months and
costs $400-same as above
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Pulse Dosing allows intermittent therapy for 3 months at decreased cost.
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Treatment is lengthy because of the slow growth of the nail. Toenails
grow at 1-3mm per month and fingernails at 2-4mm per month.
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Side effects of these oral drugs include headaches, rash, nausea, vomiting
or stomach upset, and rarely, reversible liver damage or blood disorders.
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In addition, topical antifungal creams are available, but are less successful
when used alone.
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Surgery may be used with the other methods of treatment but this can be
painful and disfiguring. omes infected.
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Eventually, the entire nail separates, resulting in partially destroyed,
yellow nail.
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How Can I Prevent Nail Fungus?
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Keep your nails short, dry, and clean - after bathing, dry your feet well,
especially between your toes.
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Change your socks often- If your feet sweat a lot, switch socks several
times a day. Consider using an antifungal foot spray or powder.
Avoid wearing socks or hose made of polyester or nylon, which don’t absorb
sweat well.
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Don’t pick or poke around your toenails- A small cut in the skin beside
the nail becomes the entry point for fungus.
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Don’t walk barefoot around public pools, showers, and locker rooms.
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What If I Don’t Treat the Nail Fungus?
This may lead to permanent nail loss or nail deformity.
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Internet Sites with More Information:
References:
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Zaias N, Glick B, Rebell G. Diagnosing and treating onychomycosis. J Fam
Pract 1996;42:513-518.
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Elewski BE, Hay RJ. Update on the management of onychomycosis: Highlights
of the third annual international summit on cutaneous antifungal therapy.
Clin Inf Dis 1996;23:305-13.
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Hull PR. Onychomycosis-treatment, relapse, re-infection. Dermatology 1997;194
sup 1:7-9.
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Roberts DT. Oral Terbinafine(Lamisil) in the the treatment of fungal infection
of skin and nails. Dermatology 1997;194 sup 1:37-39.