Nail fungus

[Guest guest]

Posted on Thu, Jun. 24, 2004

http://www.sunherald.com/mld/sunherald/living/8997640.htm

Discolored toenails nothing to be ashamed of

Dear Dr. Sangani:

I am in my late 40s. As long as I remember, I have had ugly-looking

toenails. They are discolored and brittle.

I have been to several cosmetologists, and they have not been able to

help me. I am thinking of going to a foot doctor, but before I go to

him, I just wanted to ask you and make sure I was doing the right

thing. I do not want to be laughed at in his office.

- Afraid of Being Laughed At

Dear Afraid of Being Laughed At:

First of all, the rule of maintaining health is that no question is

stupid and no symptom - however trivial - should be ignored. I am all

in favor of you going to the foot doctor to get your toenails

examined.

While I have your attention, let me enlighten you with one of the

diagnoses from which you may be suffering. There is a good likelihood

that you may be suffering from a fungal infection of the nails called

onychomycosis. The infection usually occurs in the feet first.

You will see fine scaling a little ways up the side of the foot. Many

people think this is dry skin. The big toe is usually the first to

have the nail affected, but all nails are susceptible, and one or

several of the nails may be affected.

Many people have or have had tinea pedis, or athlete's foot, as well.

The disease begins with a whitish, yellowish or brownish

discoloration of the distal corner of the nail, which gradually

spreads to the entire width of the nail plate. The distal portion of

the nail plate breaks away or is picked away by the patient, exposing

the nail bed, which is in fact the site of the fungal infection.

The condition persists indefinitely if left untreated. Onychomycosis

is associated with 50 percent to 60 percent of abnormal appearing

nails. It is important to establish the presence of the fungus before

beginning treatment. The medications are expensive and many insurance

companies require a positive diagnosis before they will authorize

reimbursement for medication.

KOH examination of scrapings from the nail bed are the best means of

confirming the diagnoses in patients with a clinical picture.

Q: Where does fungus come from?

A: Fungi are all over - in the air, the dust, and the soil. The

belief that you catch fungus from shower floors, locker rooms,

swimming pools and unhygienic people is not so. Hygienic measures

such as spraying socks and footwear sound sensible and perhaps these

measures can even help. Daily washing of the feet and drying between

the toes can help to prevent nail fungus.

Q: Is nail fungus contagious?

A: No.

Q: What is the treatment?

A: Treatment is indicated and antifungals are recommended. The dosage

may be given daily for six to 12 weeks depending on whether the

fingernails or toenails are involved.

All the azoles can cause liver toxicity and routine monitoring of the

liver function test during therapy is necessary. Patients should be

advised that improvement will continue after oral therapy has

stopped; it may take months to accurately cure. Repeat course of the

therapy can be tried if the patient experiences a recurrence.

A topical antifungal nail lacquer, ciclopirox, has been approved by

the Food and Drug Administration for treatment of mild to moderate

onychomycosis.

Q: What other conditions are mistaken for fungal nails?

A: Lines and ridges are common and may be considered normal. Whitish

or yellowish nails due to onycholysis or separation of the nail from

the nail bed can also be mistaken for the disease. The treatment is

to trim the nail short and it is OK to polish if you want to hide the

color.

Red or black nails due to blood under the nail is usually due to

trauma and goes away by itself. Green nails are caused by pseudomonas

bacteria and no antibiotics are needed. The treatment of a green nail

is to trim the nail short and it is OK to polish it.

Pitted nails may be associated with psoriasis or other skin problems

that affect the nail matrix.

Swelling and redness of the skin around the nail is called

paronychia, a condition that occurs when yeast infects a damaged

cuticle. Applying a topical anti-yeast cream may work.

----------------------------------------------------------------------

----------

Submit questions to Dr. Bharat Sangani at sangani@... or 5601

Sound Bluff Road, Ocean Springs, MS 39564.