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Welcome to NailsFUngus.org - Nail Fungus

In this section you will find articles and videos on nail fungus and nail fungus treatments. Feel free to search for a subject concerning you or just browse around. We have amassed the largest informational database on nail fungus online and are here to help…

Proximal Subungual Onychomycosis (Nail Fungus)

Proximal Subungual Onychomycosis (Nail Fungus)

Least common in people with healthy immune systems but found frequently in people who have compromised immune systems, proximal subungual onychomycosis stands out because the progression of the disease starts at the cuticle and grows out with the nail.

Proximal subungual onychomycosis usually causes the nail to become disfigured, as in other nail fungus infections, but as it starts at the cuticle and works its way up, it is more likely to infect the nail bed early on, causing the nail bed to develop bumps and irregularities. This then may cause the nail plate to become dislodged and fall off, exposing the nail bed to possible further infection.

Similar to distal subungual onychomycosis, the majority of cases of proximal subungual onychomycosis are caused by the same dermatophyte, Trichophyton ruburm. However this particular nail fungus infection can also be caused by a different dermatophyte, Trichophyton  mentagrophytes. Proximal subungual onychomycosis can also be caused by molds. Another defined symptom of proximal subungual onychomycosis is the skin around the nail may become swollen, red and inflamed and may start to ooze pus. This is more commonly seen when the nail fungus infection is caused by molds than by dermatophytes.

Unfortunately, these distinguishing symptoms are what cause proximal subungual onychomycosis to be misdiagnosed as a bacterial infection instead of a fungal infection by some physicians. As antibiotics do not kill fungi, this course of treatment does nothing to stop the infection. An antifungal is required to eradicate molds, yeasts and dermatophytes.

Proximal subungual onychomycosis occurs more often in people who have depressed or deficient immune systems. It is rarely seen in people with good immunity. Immunodepression can be caused by procedures like chemotherapy or in people who are recovering from an autoimmune disease or an organ transplant and have had their immune system deliberately suppressed.

Proximal subungual onychomycosis occurs frequently in people with unhealthy immune systems and even more commonly in people with human immunodeficiency virus or HIV. This is such a common occurrence that if a patient contracts this form of nail fungus infection and no other cause can be found, the doctor will likely suggest an HIV test. Be prepared if you have a fungal nail infection and it is discovered to be proximal subungual onychomycosis, to have your doctor suggest an HIV test. This is a test that requires your consent to perform. And just because you may receive a diagnosis of proximal subungual onychomycosis doesn’t necessarily mean that you have contracted HIV.

The only way to cure proximal subungual onychomycosis is to take an oral antifungal medication. If the nail fungus is caused by dermatophytes Trichophyton rubrum or Trichophyton mentagrophytes then it is likely that your doctor will prescribe terbinafine, also known as Lamisil. The dose is usually one 250 mg pill once a day for six weeks for a fingernail infection and twelve weeks for a toenail infection. A nice thing about Lamisil is that it is usually less expensive than the other current generation antifungals.

Itroconazole, or Sporanox, is used for treatment when the cause of the proximal subungual onychomycosis is unknown because it is effective against both dermatophytes and Candida infections. This tends to be a more expensive treatment method than some of the others.

Fluconazole commercially known as Diflucan, is able to treat proximal subungual onychomycosis but is not used as often as the other available medications. This medication stops the fungal growth and therefore the spread of the disease but does not kill the fungus itself. The difference between these two processes is referred to as fungistatic (stopping growth) and fungicidal (killing growth).

This particular drug tends to slow down the growth so that the immune system can take care of it on its own. As many of the cases of proximal subungual onychomycosis happen in people with previously depressed immune systems, this is not necessarily the best drug choice. Fluconazole (Diflucan) is taken until the symptoms resolve and the infection is gone.

Curing a Nail Fungus Infection with an Acidophilus Beer Soak

Curing a Nail Fungus Infection

with an Acidophilus Beer Soak

A nail fungus infection is unattractive at best, annoying at worst. This is not a disease that is going to kill you. It may affect how you interact with the world if it gets to bad, for instance, if your have a very bad toenail fungus infection, it may become painful to walk, or the nerves in your feet may be mildly affected and you won’t be able to feel the floor very well. However this is not a life threatening condition, especially if it is caught early on.

A fungus, most commonly a dermatophyte, can get onto and underneath your nail and find a happy, warm, moist place to grow. Once the fungus has established itself, it turns your nail white or yellow. This is usually seen originally as a spot, but that spot grows to cover the whole nail over time. It also makes your nails thicker and more brittle, because the fungus is consuming the keratin, the protein that your nails are made of, to grow and protect itself.

So one of the biggest problems with a fungal nail infection is that it is located underneath the nail, in the nail bed. One of the most frequently suggested nail infection home remedies is soaking your feet in a combination of dark beer, vinegar and acidophilus, usually referred to as an acidophilus beer soak.

So Why Acidophilus and Beer?

The theory behind this home remedy is that by soaking your infected nails in this solution for 20-30 minutes, you allow the alcohol in the beer to soften up the nail, thus the acidophilus and vinegar can get into and underneath the nail to kill off the fungal infection.

Here is the process:

•           Use a dark beer, like Guinness Stout. (Any stout will do, most people happen to know and can get this particular brand.)

•           Mix the beer with a ½ cup of white or apple cider vinegar.

•           Add a sachet of acidophilus culture. You can find these at your health food store. You want to find one that is 125 billion organisms. (It should say so on the packaging.)

•           Stir these all together, then soak the infected nails in the solution for 20-30 minutes a day, twice daily.

•           Wash the infected area thoroughly with soap and water afterward, then dry equally thoroughly.

•           Put on clean socks (if it is the beginning of the day) or leave your feet exposed to light and air.

This mixture can be used up to four times before disposing of it, which will keep your costs down. Many people have claimed to cure their nail fungus infection entirely by using this simple home remedy.

Prescription Treatments for Onychomycosis – A Doctor’s Recommendations

Prescription Treatments for Onychomycosis

A Doctor’s Recommendations

Where once onychomycosis was considered solely a cosmetic problem, doctors are treating it with greater concern. Nail fungus is unattractive, yes, but it also affects the infected person’s willingness to interact with others, especially in situations where exposing the infected nail or having other people come into contact with it may make the sufferer uncomfortable.

Beyond the psychological and social repercussions associated with onychomycosis, the basic function of the nail is disrupted. The point of having the nail sheath (the hard part of the nail) is to act as an armor for the soft tissue beneath and to assist in how we sense and interpret the world. A foot that has an infected nail or nails may interfere with normal sensation and even the ability to walk. Add to this the possibility of a nail fungal infection allowing for what is referred to as a ‘superinfection’, the chance that other bacteria and viruses could layer themselves on top of the fungal infection and cause further harm, and it is time to fix the problem.

These are the reasons behind the medical communities more aggressive treatment of onychomycosis. On the patient side of the equation, more people are requesting treatment and mentioning the problem to their doctors earlier to nip it in the bud.

There are two basic categories of treatment for onychomycosis. Oral (by mouth) and topical (applied directly to the infected area) Which treatment your doctor chooses will depend on a variety of factors. If the lunula (white area at the base of your fingernail) is affected by either distal subungual onychomycosis or proximal subungual onychomycosis then the oral medical prescription is the method of eradication. How the patient feels about the entire process is taken into account as well. Therefore it is not uncommon to use both an oral and a topical medication in conjunction. Working the infection from both sides of the body (in and out) can be a very effective treatment.

Choosing the oral prescription medication treatment is not to be considered lightly. One of the main drawbacks of this method of fungus eradication is that all of the antimycotic (antifungal) medications available for the treatment of onychomycosis have the potential to cause liver damage. It is imperative that your doctor test your liver function before beginning a course of these drugs and it is likely that your doctor will continue to monitor your liver during the treatment. If a patient has any history of or current liver problems, an oral medication should not be taken. The patient should monitor themselves as well, telling their doctor if they experience upper abdominal pain, malaise, fatigue, or if they notice jaundice (yellowing skin or yellowing of the eyes), pale colored stools or particularly dark urine.

In the past, Griseofulvin was the only available oral prescription medication to treat onychomycosis. It did work, but not terribly well and usually came with a passel of side effects, particularly when moderate to high doses were recommended. Griseofulvin treatment also took a long time and it was common for the infection to reoccur after the treatment stopped. Fortunately a variety of options have been created since then.

Terbinafine, more commonly known as Lamisil is very effective at fighting onychomycosis caused by dermatophytes, which is the most common cause of the disease. Terbinafine is prescribed as a 250 mg pill taken once a day for six weeks for fingernail infections and for twelve weeks if treating toenails. In some cases, pulse therapy (taking a drug for a certain period of time, then giving the body time off) has been effective. A complete blood count and liver panel should be taken before this treatment is started as well as four weeks into the therapy.

Itroconazole also known as Sporanox is also commonly administered in pulse dosing. The usual treatment schedule is 200 mg by mouth once a day for one week per month over the course of three months. Itraconazole can have negative reactions with several other forms of medication so telling your doctor exactly what you are currently taking before starting treatment is a medical necessity. A liver panel should be taken before this treatment is started and four weeks into the therapy.

Fluconazole, otherwise known as Diflucan is taken once a week in either 150 or 300 mg doses until the symptoms are gone. The treatment may last up to nine months before positive results are seen. Again, this drug may have negative interactions with other medications so tell your doctor what you are currently taking to avoid this. No blood tests are required when taking fluconazole but your doctor may order them anyway.

It is most common to use topical onychomycosis prescriptions in cases that are caught early on and therefore still mild, and in conjunction with an oral medical prescription. An incredibly effective topical prescription is Ciclopirox, commercially known as Penlac. This is an 8% topical solution that is applied to the infected area once a day. While it is a safer delivery method than oral antimycotics, when used alone it only achieved a 5% success rate.

When all other methods have failed, and/or in severe cases of onychomycosis, surgery becomes an options. There are three different methods of surgical nail removal: mechanical, chemical or surgical nail avulsion (removal). The nail can be mechanically or surgically avulsed (torn off) which is done after numbing the area with a local anesthetic as it can be quite painful. This is most common when the nail has already pulled away from the nail bed. A concentrated solution of 50% urea can be used to both eradicate the infection and soften the nail for removal and can be a fairly painless process. Once the nail has been removed, keeping the area clean and dry to prevent further or re-infection is necessary.

References
Ciclopirox (Penlac) prescribing information
Fluconazole (Diflucan) prescribing information
Itraconazole (Sporanox) prescribing information
Terbinafine (Lamisil) prescribing information

Children and Nail Fungus Infections

Children and Nail Fungus Infections

Although it is far less likely than not that a child will contract a nail fungus infection, it does happen. Onychomycosis, or nail fungus, is more commonly an adult disease, but as children spend a great deal of time getting into things they shouldn’t and playing in the dirt, they have as much potential as anyone else to attract the fungus that causes the infection.

For kids, the infection is more of a social affliction than anything. Other children may see the infected nail and want to avoid the person with the nail fungus because they think they’ll get sick. This can be really rough on a child’s self esteem.

And as the nail fungus infection develops, the nail can become painful and even possibly fall off. So treating the infection, or better yet avoiding the infection entirely is the best solution.

The infection tends to show up as whitish or yellowish spots on the nail, then gradually grows to cover the nail surface entirely so that the nail is opaque. The nail will then become thicker and more brittle, possibly flaking or crumbling at the edges. Depending on the type of infection, the nail can disengage from the nail bed and fall off, which can be very painful.

How Can I Prevent My Child From Becoming Infected?

Start by teaching your children good hygiene. Make them wash their hands when they come inside after playing. This will quickly remove any spores they may have picked up outside. Get a soft nail-brush and show them how to scrub underneath their nails as well, as that can be a very common area that nail fungus attack.

Keep your children’s nails trimmed close to the tips of their fingers and toes, as the less exposed nail there is, the less surface is available to the spores to invade.

Put antifungal powder in their shoes overnight so they don’t risk infection from wearing shoes all the time. Wash their socks in bleach to kill off anything that might be lurking in the fibers.

If you do end up with a child contracting a fungal nail infection, simple methods of controlling the disease are:

•           Rubbing Tea Tree Oil on the infected nail and surrounding skin

•           Soaking the infected nail in a solution of vinegar and water twice a day

•           Clean underneath the nails to remove the dirt and then wipe with rubbing alcohol to kill the fungus.

If these solutions don’t have an effect, you can speak with your child’s doctor about other available treatments. Some of these, particularly the oral antifungal medications, do carry the risk of liver damage, so be careful which option you choose, and make sure your child’s health is up to the treatment.

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