Natural Ways to Treat Fungal Toenails
Conservative treatment of onychomycosis is the first-line choice for management. A fungal culture of nail clippings can be done to confirm the diagnosis but may take up to 1 month for growth and identification. There is good evidence that oral terbinafine, 250 mg daily for 3 months, is the most effective oral treatment for fungally infected toenails (Crawford et al., 2002). Even with terbinafine, failure rates can reach 50 . When onychomycosis causes dystrophic nails resulting in pain or toe dysfunction, a complete nail plate avulsion can be performed, with high patient satisfaction (see Ingrown Nail).
Onychomycosis is an invasion of the nails by any fungus. Four clinical subtypes are noted. Distal subungual presents as discolorations of the free edge of the nail with hyperkeratosis leading to a subungual accumulation of friable keratinaceous debris. White superficial consists of sharply outlined white areas on the nail plate which leave the surface friable. Proximal subungual presents as discolorations which start proximally at the nail fold. Candidal onychomycosis encompasses the entire nail plate, leaving the surface rough and friable.
Onychomycosis is a chronic infection that rarely remits spontaneously. Adequate treatment is essential to prevent spread to other sites, secondary bacterial infections, cellulitis, or gangrene. Due to the chronic nature and impenetrability of nails, topical agents have low efficacy rates for treating onychomycosis. Oral agents that can penetrate the nail matrix and nail base, such as itraconazole and terbinafine, are more effective than ciclopirox lacquer. Itraconazole and terbinafine demonstrate mycologic-al cure rates of 62 39 and 76 ,40 respectively, while ciclopirox has a cure rate of 29 to 36 41 Itraconazole can be administered continuously (200 mg orally daily) or as pulse therapy (200 mg orally twice daily for 1 week per month). Terbinafine is administered orally 250 mg per day as continuous therapy. Whether administered continuously or as pulse therapy, oral treatment for toenail infections should continue for at least 3 months, while treatment for fingernail infections should...
Types of onychomycosis Candida onychomycosis Further reading Fungi may invade the nails in four different ways, leading to four separate types of onychomycosis with specific clinical features, prognosis and response to treatment. The type of nail invasion depends on the fungus responsible and the host susceptibility. Invasion occurs Table 8.1 Causes of onychomycosis Table 8.1 Causes of onychomycosis 1 Via the distal subungual area and the lateral nail groove, leading to distal lateral subungual onychomycosis (Figure 8.1). 2 Via the undersurface of the proximal nail fold leading to proximal subungual onychomycosis (see Figure 8.10). 3 Via the dorsal surface of the nail plate, producing superficial onychomycosis (see Figure 8.16). 4 Via the nail plate free margin, producing endonyx onychomycosis (see Figure 8.21). TYPES OF ONYCHOMYCOSIS Distal lateral subungual onychomycosis Distal lateral subungual onychomycosis (DLSO) is the most common type of onychomycosis (Figures 8.3, 8.4, 8.5,...
Onychomycosis is a fungal infection that affects the toenails or fingernails. It may involve any component of the nail unit, including the nail matrix, nail bed, or nail plate. Ony-chomycosis may be unsightly but is often asymptomatic. In the worst cases, it causes enough discomfort and disfigurement to produce physical and occupational limitations. Use of topical agents should be limited to cases involving less than half the distal nail plate and patients unable to tolerate systemic treatment. Agents include ciclopirox 8 (Pen-lac), azoles, and allylamines. Topical treatments are poorly effective because of inadequate nail plate penetration. Oral antifungal agents such as terbinafine and itraconazole have replaced older therapies in the treatment of onychomycosis. Oral antifungals offer shorter treatment regimens, higher cure rates, and fewer adverse effects. Removal of the nail plate should be considered an alternative treatment in patients who cannot tolerate oral therapy and are...
A double-blind, randomized, placebo-controlled trial investigated the efficacy of 2 buten-afine hydrochloride cream with added 5 Melaleuca alternifolia essential oil in 60 patients with toenail onychomycosis. After 16 weeks, 80 of patients in the treatment group were cured, as opposed to none in the control group (Syed et al., 1999). However, butenafine hydrochloride is a potent antimycotic in itself and the results were not compared with this product when used alone.
Ichthyosis Psoriasis Onychomycosis Syphilis, pemphigus, variola Local causes positive, homogeneous, rounded or oval, amorphous masses surrounded by normal squamous cells which are usually separated from each other by empty spaces caused by the fixation process. These clumps, which coalesce and enlarge, have been described in psoriasis of the nail, onychomycosis, eczema and alopecia areata, and also in some hyperkeratotic processes such as subungual warts and pincer nails. The horny excrescences of the nail bed are not very obvious, but the ridged structure may become apparent if the nail plate is cut and shortened.
Mucocutaneous fungal infections are caused by dermatophytes (Microsporum, Epidermophyton, and Trichophyton) and yeasts. About 40 species in the three dermatophyte genera can cause tinea pedis and manus, tinea capitis, tinea corpo-ris, tinea cruris, and onychomycosis. Yeasts of Candida can cause diaper dermatitis, balanitis, vulvovaginitis, and thrush (Fig. 33-40). The yeastlike organism of Malassezia (Pityros-porum) causes tinea versicolor and contributes to seborrhea. Although tinea versicolor has the name tinea in it, it is not a true dermatophyte.
For onychomycosis, relief of symptoms is slow. The infected nail will need months to grow out. The practitioner should advise the patient not to become frustrated by the slow resolution. Despite the slow progress, the antifungal agent is curing the infection. The practitioner should also advise the patient that even after the infection is cured, the nail may not look normal.
The most common treatment consists of oral griseofulvin, fluconazole, luconazole, or terbinafine. Candidal infections require oral ketoconazole. Toenail onychomycosis is very difficult to eradicate. Onychomycosis. Invasion of the nail bed by fungus. (Photo contributor Lawrence B. Stack, MD.)
Thick nails caused by diseases such as psoriasis, pityriasis rubra pilaris and pachyonychia congenita can be abraded. Hyperkeratosis is prone to be associated with onychomycosis of the toes. Nail abrasion helps to expose the nail bed to antifungal chemicals, especially in elderly people in whom systemic treatment is not advisable. Abrasion is a good way to improve the contour of an abnormal nail, for example in onychogryphosis. In selected cases of ingrowing toe nail, repeated thinning of the nail plate may be a useful conservative method in association with appropriate definitive treatment.
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