Nail Issue - Treatment and Prescriptions

What is Nail Issue?

The main type of nail issue is nail fungus. The medical term for this condition is onychomycosis, and it's a fungal infection of the nail. Although onychomycosis refers to both hand and toe nails, onychomycosis is most commonly seen on toenails. The most common culprit is a type of fungus called dermatophytes, but other fungi can also be involved in the infection. You can have fungus on the nail bed, the top layer of the nail, the skin around the nails, or the skin at the base of the nail. Fungal diseases tend to flourish in warm, damp environments, so it often occurs when people have to wear damp shoes or walk around in moist areas. Nail Fungus doesn’t significantly affect one’s daily activities, but the appearance and odor can inflict daily, personal and social discomfort. It might start out as a white or yellow spot on one of your nails. It could make them brittle, and even produce a foul odor. If left untreated, the fungal infection can even affect multiple nails. Although the onychomycosis is difficult to cure because even if treated, nail fungus often comes back. There are many treatments such as home remedies, over the counter medications, topical prescriptions, and oral prescriptions to combat toenail fungus. However, it is important to note that treatment is a long process and one might not see results for many months or a cure for a year. Getting rid of fungus requires long-term dedication and professional help to significantly increase the likelihood of a cure. Nail Fungus can be diagnosed visually by a dermatologist, but sometimes a nail clipping will be sent to a lab to verify the nature of the disease. There are 4 main types of Toenail Fungus:
  • Distal subungual onychomycosis (DSO)
  • White superficial onychomycosis (WSO)
  • Proximal subungual onychomycosis (PSO)
  • Candida onychomycosis

Photos


Nail fungus affecting the majority of the toes on a patient's foot. Nail fungus on the big toe of a patient. It has a yellow color and sometimes has an odor. Nail fungus on the finger of a patient. It sometimes has an odor with the discoloration of the nail. Nail fungus affecting multiple toes on a man's foot. Nail fungus on the toe. Toenail fungus is a common area for onychomycosis. Onychomycosis Toenail fungus growing on a man's foot.

Symptoms

It can be difficult to tell whether you have nail fungus at first because it can just start as a small white patch on a single nail. Nail fungal infections normally start at the tip of the nail, so this is where you will notice it first. Over time, the fungal infection will spread, and signs of the nail issue will become more obvious. The nails tend to start looking thick, become warped, or feel itchy and they may turn white, yellow, brown, black, or even green. In some cases, the nails may crumble easily, especially along the edges, or fall off entirely. There normally is not a lot of pain, but if the infection spreads deeper into the skin, it can hurt when you put pressure on the nails. Here are the symptoms of the 4 main types of nail fungus:
  • Distal subungual onychomycosis (DSO) – DSO is the most common type of nail fungus, mostly seen on toenails. The nail becomes striated and thickened with a yellow-brown discoloration.
  • Proximal subungual onychomycosis (PSO) – PSO is mostly seen on toenails.The nail has a yellow-white discoloration at the base of the visible nail.
  • White superficial onychomycosis (WSO) – WSO is mostly seen on toenails. It begins with small, white spots on the nail surface and spreads out to the rest of the nail.
  • Candida onychomycosis
  • – This type of nail fungus is commonly seen on the hands. There is yellow, white, green or black discoloration in combination with inflammation of surrounding tissue.
While nail fungus usually does not affect activities of daily life, severe cases of untreated fungus can lead to the following:
  • Nail Loss
  • Nail Distortion
  • Discoloration
  • Thickened or Brittle Nails
  • Odor from the Affected Nails
  • Spread of Infection to Nearby Nails

Causes

Onychomycosis is the result of a fungus infection underneath, inside, or on top of the nail. The fungus can come from the environment, an existing fungal condition such as athlete’s foot, from someone else (though unlikely), or from an already infected nail. Fungus thrives in warm, moist environments which unfortunately means that the inside of your shoes are a great place for it to thrive, though it’s also possible to have it on one’s fingernails. Cracks in nails allow an opening for fungus to get into and grow inside or underneath the nail and make it easier for a fungal infection to grow. For these reasons, the following risk factors increase the likelihood of contracting a fungal nail infection:
  • Old Age
  • Nail injuries
  • Unsterilized manicure tools and footwear
  • Warm, moist environments such as swimming pools, gyms, locker rooms
  • Health issues including a weakened immune system, diabetes, and poor circulation

Treatment

In addition to keeping nails short to prevent further infection, there are several ways to treat nail fungus depending on its severity. While mild cases of nail fungus can yield success with over-the-counter treatments, severe cases likely require oral and topical prescriptions for effective treatment. No treatment is guaranteed to get rid of the fungus completely and there's a chance that the fungus could spread again. The more potent your treatment, the faster your fungus may be treated, and the higher the likelihood that it may not recur. You should seek medical advice from your physician to determine which combination treatments is best to treat your nail fungus. When starting a treatment, it is common to start seeing results only after 6 months of treatment.

Home Remedies

While home remedies have taken on popularity, there are little to no studies confirming the effectiveness of such treatments. In some cases, it might even do more harm than good considering their minimal effectiveness versus the unknown side effects they could have on your body. It’s best to follow the medical advice of a dermatologist because they know what will or will not treat the disease. Here are some popular home remedies that you should be careful with: Baking Soda Tea Tree Oil Ozonized Oil Vinegar Listerine Snakeroot Extract Vicks Vaporub

Over the Counter Medication

While some over the counter (OTC) medications are effective enough to be given as prescriptions, other OTC medications have limited effects on disease. They might help for mild to moderate cases, but they aren’t usually effective on severe ones. If used incorrectly and without guidance, they might even prove to be ineffective and produce unforeseen side effects. However, a dermatologist can tell you whether or not these can be effective for you. Here are some OTC medications that may or may not be included in a treatment plan given by one of our dermatologists:
  • Clotrimazole (Lotrimin AF)
  • Terbinafine (Lamisil Spray)
  • Undecylenic Acid
  • Tolnaftate (Zeasorb)

Prescription

Prescriptions, alongside professional medical advice, are the most effective form of treatment. Home remedies and over the counter treatments take plenty of time, energy, and money, yet are uncertain to work. Our experienced dermatologists take your unique skin, set of symptoms, and medical history into account to take the guessing game out of your road to recovery. Here are some prescriptions your dermatologist might include in your personalized treatment plan: Oral prescriptions that a dermatologist could prescribe to you:
  • Terbinafine (Lamisil)
  • Itraconazole (Sporanox)
  • Fluconazole (Diflucan)
  • Griseofulvin (Gris-Peg)
Topical prescriptions that a dermatologist could prescribe to you:
  • Clotrimazole
  • Ciclopirox
  • Jublia

Post Treatment Prevention

After being seen by our dermatologists, you’ve been equipped with the prescriptions to treat your discomfort. However, disease can be persistent, so you have to be too. A skin care routine and a set of disease-preventing habits recommended by our dermatologists are essential for long term prevention. Here are some popular prevention strategies that could supplement your personalized treatment plan:
  • Sterilize manicure tools
  • Wash hands and feet regularly
  • Treat shoes with antifungal spray or powder
  • Frequently apply antifungal cream or nail polish
  • Wear clean, breathable shoes and change damp socks into dry ones
  • Wear footwear at pools, gyms, locker rooms, and other warm, moist environments

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