Nail fungus is a fungal infection of the nail bed and the plate under the nail surface and is characterized by thickening of the toenail with yellowish discoloration, deformity and splitting. Gradually, the toenail becomes rough and may separate from the nail bed. In medical language, nail fungus is known as “Onychomycosis” or “Nail Ringworm”. Toenail fungus can press on shoes, causing irritation and pain. It can also cause social, psychological, and employment-related problems. Toenail fungus is caused by three main groups of bacteria: dermatophytes, yeasts, and various non-dermatophyte molds. About 90% of toenail fungal infections are caused by dermatophytes.

Toenail fungus is difficult to treat because the infection is embedded in the hard-to-reach nail. The toenail receives little blood and grows slowly. Therefore, medications and topical applications used in the treatment of toenail fungus will only reach the infected area in small amounts, which will not be enough to cure the infection. Because of this, the infection in your nail responds slowly to treatment, and it may take more than a year for the symptoms to disappear completely. Treatment of toenail fungus includes various treatment options such as pharmacological treatment, laser therapy and surgical treatment.



Pharmacological Treatment

This line of treatment includes oral and topical antifungals. Newer oral antifungal medications such as Itraconazole, Terbinafine have revolutionized the treatment of toenail fungus. Oral antifungal medications are given for 3 months as standard treatment for toenail fungus. Terbinafine is administered daily for 3 months, while Itraconazole is usually prescribed in pulsed doses. Pulse doses mean one week per month for 3 months.

These antifungal drugs produce fewer side effects with few contraindications such as congestive heart failure and liver diseases. Itraconazole should be avoided with certain medications, as it interacts with several antibiotics, such as erythromycin and some asthma medications. About 50% to 75% of cases respond very well to oral antifungal therapy, and toenail fungus may recur in 20% to 25% of cases.

Oral antifungal therapy combined with topical and surgical treatments can reduce the duration and side effects of oral therapy. For superficial toenail fungal infections, topical antifungal agents containing ciclopirox, olamine and amorolfine are recommended. These topical agents are available in the form of nail paints that can be applied to the affected nail.

Laser Treatment

Noveon type laser is used in the treatment of toenail fungus. This laser is also used in some cataract surgeries.

Surgical Treatment

In the surgical treatment method, nail fungus is removed with surgery or chemical drugs. In chemical cleaning, approximately 40-50% urea compound is used to remove the infected nail. It is a painless procedure that is beneficial in patients with very thick toenails. Surgical removal of Infected toenail and plaque alone is not possible as it is not effective. Additional oral antifungal medications may be helpful. Combining oral and topical antifungal treatments with surgery increases the effectiveness of surgical treatment.

Prevention

Prevention of nail fungus is very important because it is common for toenail fungal infections to recur. Do not wear wet socks, keep your nails dry and do not wear tight shoes. Trim regularly to keep the toenail short, and don’t dig into corners when trimming the nail. Athlete’s foot must be treated otherwise it can cause toenail fungus.

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