Fungal nail infections are often a persistent, frustrating, and difficult to treat problem. Left untreated, an infected nail can discolor, thicken, warp, and infect neighboring nails, as well as causing an unpleasant odor. Fortunately, new developments an medications have made it possible to reliably cure fungal nail infections. Fingernails and toenails can be infected by one of three species of fungi, called epidermophyton, trichophyton, and microsporum. Although these three distinct fungi can all cause nail infections, the results and appearance of the infected nail are similar.
One treatment for the infected nail is “debridement,” a process in which part of the infected nail is filed away. This can lessen the amount of infected nail which needs to be treated, by either topical or oral medications.
Topical medications for an infected nail include lacquers and creams containing antifungal compounds. Although some are available over the counter, stronger formulations are generally available by prescription. One drug common used in the topical treatment of persistent nail fungus is ciclopirox.
Although topical treatments applied directly to the nail or surrounding skin have some efficacy in treating persistent nail fungus, the effects are often times limited as these medications do not penetrate effectively into the affected nail and surrounding skin. Consequently, persistent nail fungus can often require a course of oral anti-fungal medications. Three drugs, terbinafine, itraconazole, and fluconazole are available by prescription, and are effective for the treatment of persistent nail infections. They require a relatively short course of treatment for efficacy. Although the portion of the nail which is already infected is unlikely to revert to a healthy appearance, treatment with these oral medications ensures that new nail material, when it grows from the nail bed, remains free of fungal infections. Although terbinafine, itraconazole, and fluconazole are effective for the treatment of persistent nail infections, their use is limited by their high cost, and the fact that they have interactions with many other prescription and nonprescription medications.
As a result, there was recently introduced a new medication called griseofulvin. Like terminafine or intraconazole, it is an oral medication which can be used to treat a wide variety of fungal infections including ringworm, jock itch, athlee’t's foot, and fungal infections of the fingernails and toenails. It requires a longer course of treatment, but causes relatively mild side effects, has low toxicity, and relatively few drug interactions. Like the other oral medications, griseofulvin usually cannot “reverse” the appearance of an already infected nail, but instead ensures that newly grown nail material is healthy in appearance. Because of these limitations of the medications just described, treating persistent fungal nail infections remains a slow process. Cosmetic improvement generally requires the regrowth of new, uninfected nail material, and may take as long as six to eight weeks.
Finally, in cases of extreme nail infection, the physician may recommend surgery to completely remove the infected nail. In consultation with a surgeon, the old nail is removed, and a new nail is allowed to grow in its place. This procedure has significant downsides, and may require up to a year for the complete regrowth of a new and uninfected nail. However, it may be the treatment of choice if the infection does not respond to topical and oral medications.