Fungal Nail

What are the symptoms of this condition?

Fungal infections of the nails, especially the toenails, are very common and can be unsightly. The appearance of a fungal nail infection can vary. There are four classifications of fungal nail infection, which all look slightly different; the most common is called 'distal lateral subungual onchomycosis' DLSO, in which the underside of the nail appears a green-yellow colour, starting at the top of the nail and working down; the nail becomes thicker, and flaky.

Other types of nail infection can appear as crumbly white 'islands' on the top surface of the nail; or as white areas underneath the nail at the base of the nail, close to the toe. If any of these infections are left untreated, the whole nail may become affected and may become very uncomfortable as it thickens and distorts. The infection will not go away on its own, and could eventually lead to loss of the nail.

What is the cause of the condition?

The nail is usually a very effective barrier, however it's possible for a fungal infection to develop under the nail if you experience athlete's foot (another fungal infection) and do not treat it quickly; an infection may also take hold even if athlete?s foot is not present, as there are bacteria and fungi on the skin all the time. A fingernail infection may develop if you have a toenail infection and scratch the affected area.

Infection is more common in people over 55, those with athlete's foot, smokers, diabetics, poor circulation, and people who have had nail trauma; it's also more common in people who use communal changing rooms or showers regularly.

There are some medical conditions that can cause symptoms that look like a fungal nail infection, such as psoriasis affecting the nails, nail trauma, and eczema. Your doctor will be able to distinguish between these conditions and a fungal nail infection if necessary.

Urine is normally sterile and contains no bacteria; the presence of bacteria in the urine is abnormal, and is one possible cause of cystitis. Bacteria find their way into the bladder and multiply there probably via the urethra, the tube that passes urine out of the bladder. In women, the urethra is considerably shorter than in men; resulting in a shorter distance from the bladder to the outside, which increases the chance of any infection reaching the bladder. This explains the lesser incidence of cystitis amongst men. Also, the position of the female urethra, close to the anus, increases the risk of bacteria from the digestive tract finding their way into the urethra. Commonly, the bacteria found in the urine of cystitis sufferers are bacteria normally found in the digestive tract.

What can I do to treat myself?

Because the nail is such a strong barrier, applying an antifungal cream to the nail (or the area around the nail) is unlikely to make any difference. Treatments for fungal nail infections involve applying special liquids to the surface which penetrate the nail over a period of time; or a course of oral antifungals from the doctor.

If you have diabetes, a problem with your peripheral circulation, or a problem with your immune system, it's best for you to talk to your doctor rather than self-treating.

If you have the symptoms of athlete's foot as well as a fungal nail infection, ideally the athlete?s foot infection should be treated at the same time, with an effective fungicidal preparation such as terbinafine cream (Lamisil AT Cream, also available without a prescription).

Paying attention to hygiene will not help in halting an existing episode of cystitis, but will make another infection less likely.

Click here to see the range of products available from Pharmacy2U for foot and nail care.

There are two preparations available from pharmacies that can treat a fungal nail infection, both of which are applied directly to the nail surface.

Amorolfine nail lacquer ('Curanail')
Curanail has recently been made available from UK pharmacies; before that it was only available on prescription from your doctor.

It comes as a lacquer, which is painted evenly onto the affected nails once a week, after the nail has been filed with the nail file provided. The lacquer evaporates and leaves behind a concentrated film of the active ingredient, which penetrates through the nail during the subsequent week, eventually reaching the nail bed underneath.

It's not a quick process - it usually takes approximately 6 months for fingernails to be treated, and 9-12 months for toenails. It can take up to 3 months for the effect to be visible to the eye. Each bottle should last around 3 months.

Curanail is only available from pharmacies for patients aged 18 and over, for the treatment of 'DLSO' infections, as described above, where the infection starts under the nail, at the top end of the nail. It's not suitable for pregnant women, or for people who have more than 2 infected nails ? if this is the case, talk to your doctor instead.

Click here to see more information about Curanail and to purchase online.

ClearZal BAC
ClearZal BAC nail system is also applied directly to the nail, twice a day, after the nail has been filed. It's based on an antibacterial ingredient and also takes several months to clear away the underlying infection.

Click here to see more information about ClearZal BAC and to purchase online.

What treatments are available from my doctor?

Your doctor can prescribe nail paints, such as the Amorolfine nail lacquer. In addition, you may be prescribed a course of an oral antifungal medicine, such as itraconazole capsules or terbinafine tablets.

Oral antifungal medicines are very effective at treating nail infections, and are usually taken for 6 weeks for fingernail infections, or 12 weeks for toenail infections.

Any other information I should have?

If you are unsure of the best treatment for your nail infection, or if you're not sure that your infection is fungal in nature, talk to your pharmacist or doctor.

Once you have cleared the infection successfully, in many cases the nail will regrow and look normal again; however in some cases there may be some longer lasting nail damage. To prevent a recurrence, watch out for the symptoms of athlete's foot in the future and treat it as quickly as possible using an antifungal cream, and try to avoid injury to the nails.