Fungal Nail Infection-Treatment

Treatment of nail fungal infections is very difficult and results are not satisfying. There are many products available over the counter including creams, lotions, powders and liquids but none of them are effective.

Topical creams: In simple, these products do not work for nail infections. Topical medications usually don't provide a cure, but may be used in conjunction with oral medications. One can paint the nail with a topical medication for an entire lifetime and still the infection will persist. They are just not worth the expense and aggravation.

Oral medications

To get rid of the nail infection, you need to take oral anti fungal medication. The three most commonly prescribed anti fungal drugs are:

- itraconazole (Sporanox)

- Fluconazole (Diflucan)

- Terbinafine (Lamisil)

These oral drugs have to be taken for a long time. In mild cases they help clear the fungus but in the severe cases, the drugs do not do much, except stop the redness and nail thickening.

Most individuals see some results at the end of 3-4 months. If the nail is deformed, the medications do not help reverse the deformity and recurrence is a problem if the drug is stopped. Fungal nail infections can recur if the nail is again re-exposed to the warm humid conditions.

The mean time to overall success after oral medications is about 10-12 months and relapses are common.

The antifungal drugs are not without side effects and can cause a variety of adverse reactions like:

- constipation, gastritis

- depression

- insomnia (trouble sleeping)

- tinnitus (ringing noise in the ear)

- menstrual disorder

- gynecomastia (breast growth in males)

- male breast pain

- allergic reactions including rash, pruritus, urticaria, angioedema and in rare instances, anaphylaxis

- reports of elevated liver enzymes and rare hepatitis

Other treatment options:

Antifungal nail polish: For the mildest variety of nail infection, a nail polish with an antifungal ointment called ciclopirox (Penlac) can be tried. The nails are painted everyday and may help erase the superficial nail layer. Even after one year, less than 10% of individuals have any significant benefit

Surgery: If the nail is deformed and if oral medications have been tried for more than 6-12 months, it is unlikely that the infection will be cured. In such cases, surgery to remove the nail is the best treatment. The surgery is a minor procedure and can be done under local anesthesia. The entire nail is removed. There is minimal pain after the procedure. The new nail bed should be kept clean and dry. The resulting nail will be smoother and disease free and grow back completely within 12 months.

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