Fungal Nails (cont.)
Allison Harvey, MD, FACEP
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
In this Article
How are fungal nails diagnosed?
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Physical exam alone has been shown to be an unreliable method of diagnosing fungal nails. There are so many conditions that can make nails look damaged, that even doctors have a difficult time. Therefore, laboratory testing is almost always indicated. A nail sample is obtained either by clipping the toenail or by drilling a hole in the nail. That piece of nail is sent to a lab where it can by stained, cultured, or tested by PCR (the best test but new and not widely available) to identify the presence of fungus. Staining and culturing can take up to four weeks to get a result, but PCR, if available, can be done in about one day. Most of the medications used to treat nail fungus have side effects, so you want to make sure of what you are treating.
How is nail fungus treated?
Keeping nails trimmed and filed can help to reduce that amount of fungus in the nails and is highly recommended. A podiatrist or dermatologist may shave the top layer of the nail off or even remove part of the nail.
Creams and other topical medications are usually not effective against nail fungus. This is because nails are too hard for external applications to penetrate. However, a new medicated nail lacquer, ciclopirox (Penlac) topical solution 8%, has been approved to treat finger or toenail fungus that does not involve the white portion of the nail (lunula) in people with normal immune systems. It only works about 7% of the time. There is some evidence that using an antifungal nail lacquer containing amorlfine can prevent reinfection after a cure, with a success rate of about 70%.
Oral antifungal therapy works about 50%-75% of the time. It can take nine to 12 months to see if it has worked or not, because that is how long it takes for the nail to grow out. Even when therapy works, the fungus may come back about 20%-50% of the time.
Oral medications that are effective against nail fungus include:
There are several innovative treatments that are still being tested, but show good results so far:
Vinegar is a commonly recommended home remedy. Its effectiveness has not been proven or disproven in a medical study. Some people apply various oils and other tonics to their nails as well.
Reviewed by Melissa Conrad Stöppler, MD on 12/6/2011
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