Onychomycosis is an infection of the nail by fungi that include dermatophytes, non-dermatophyte molds and yeasts. The nails become thick, yellow, opaque, brittle and dystrophic.  This can become painful over time and often spreads from nail to nail or skin.  Onychomycosis can be very difficult to manage and when it worsens it can become painful and limit one’s ability to walk or wear shoes.  The incidence of onychomycosis has been increasing since the Vietnam War likely due to increased awareness.

There are other dermatological diseases that can have a similar appearance so I recommend a biopsy of the nail plate for diagnosis before choosing a treatment. This condition can be very difficult to treat and is typically addressed with either topical medications or oral prescriptions.  Topical treatments typically consist of an antifungal medication in medias that attempt to penetrate the tough nail.  I have found these approaches to be fairly unsuccessful and I only use them at patient request, in mild cases or if health issues limit the ability to choose oral antifungal medications.  In my experience the best topical treatments include Pen-lac, Formula-3, and Tea tree oil. Patients should be reminded that application must happen daily and for at least one year.  Patient compliance tends to be difficult and cure rate is low.  Oral medication, such as Lamisil, has a much higher cure rate as well as a much higher risk level particularly concerning the liver.  Taking an oral antifungal requires compliance from the patient and follow-up that may require additional blood tests to make sure the medication is being tolerated well.

A proper diagnosis and consideration of treatment options is imperative if the patient is to have success concerning fungal nails.  Please see a podiatrist, dermatologist or primary care physician when trying to decide.  Thorough debridement (reduction of thickness and length) should be part of any treatment regimen.  Feel free to call Sowell Podiatry if you have any questions!

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