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Dr Helen Webberley MBChB MRCGP MFSRH
GMC no 3657058
Fungal nail infections and athlete’s foot
The medical expression for fungal nail infection is onychomycosis.
Chronic fungal nail infections are very common with an incidence of around 15% of all patients in the US and Europe. There is an increasing incidence with age 19% of over 60s being troubled and only 0.7% of under 19s.
It is also much more common in men than in women.
Other risk factors include diabetes, poor peripheral circulation, disturbed immune system and there may also be a hereditary element making some families more at risk.
Where does it occur?
Onychomycosis occurs much more commonly in feet than in hands and by far the most common source of the infection is from athlete’s foot.
Athlete’s foot (tinea pedis) is a chronic fungal infection of the outer layers of the skin and usually occurring between the toes and in particular between the 4th and 5th toe.
It causes scaling, fissuring and weeping of the skin between the toes which is further exacerbated by an intense itch leading to scratching (often at night whist asleep), further damaging the skin.
If left untreated, it frequently causes infection of the toenails with the fungi feeding off the keratin present in nails. It is probably the scratching that leads to onychomycosis of the finger nails.
The infection causes discolouration of the nails, separation of the nail from the nail bed (onycholysis) and thickening and disfigurement of the nail’s appearance (onychodystrophy). Sometimes the nail bed can be permanently damaged by the infection leading to the above appearances even when the infection has been eradicated.
The infection is usually caused by the dermatophytes of the fungus Trichophyton rubrum although Epidermophyton and Microsporum can also be involved.
Chronic onychomycosis doesn’t usually cause much in the way of complications but cosmetically the nails often appear unsightly.
In patients with diabetes, athlete’s foot can lead to secondary bacterial infections and in these patients it is important to treat the underlying fungal infection fairly aggressively.
Treatment is usually with systemic antifungals in the form of tablets.
Unfortunately topical therapy with antifungal creams and ointments have been very disappointing probably due to the inability of the antifungal to penetrate the nail.
The development of the oral antifungals, Terbinafine and Itraconazole has revolutionised treating onychomycosis although it needs to be borne in mind that treatment frequently needs to be for at least 12 to 18 months.
If taken properly 85% eradication rates can be achieved. It is important to remember that occasionally these drugs can cause liver damage and interact with other drugs which may be relevant in the elderly patient on multiple medications.
Other treatments include;
- Surgery to remove the infected nails
- Photodynamic therapy
- Iontophoresis (passing electrical currents through nails to improve drug penetration)
- Laser therapy
although many of these treatments are confined to the private cosmetic market.
For further information about any of this or how to obtain treatment, please ask here.
Dr.Helen Webberley in the news!
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