Fungal Nails (cont.)

Medical Author:
Medical Editor:

What is the prognosis of fungal nails?

Curing fungal nails can be difficult and treatment can take up to 18 months. Relapse and reinfection are common (40%-70% reinfection rate). Trying to remove or modify your risk factors, if possible, is essential to preventing reinfection. People who have medical illnesses that predispose them to fungal nails can have an even more difficult time eradicating the fungus.

Conclusion

Nail fungus causes only 50%-60% of abnormal-appearing nails. It can be hard to tell the difference between the different causes of discolored nails (even for doctors). Onychomycosis is often not treated. Reasons to receive treatment include

  1. diabetes,
  2. previous leg infection (cellulitis),
  3. if you have pain or discomfort from your nails, or
  4. you would like them treated for cosmetic reasons.

Treatment failures and recurrences are common.

Prevention is the key. The following preventive measures are helpful:

  1. Keep your toenails short, and don't dig into the corners of your nails when cutting toenails.
  2. Keep feet clean, and dry them thoroughly.
  3. Wear dry socks and no tight shoes.
  4. Alternate your exercise shoes.
  5. Don't soak your hands in water or use harsh cleaners.
  6. Treat athlete's foot when it occurs.

Medically reviewed by Norman Levine, MD; American Board of Dermatology

REFERENCES:

Baran, R., R.J. Hay, J.I. Garduno. "Review of antifungal therapy, part II: treatment rationale, including specific patient populations." J Dermatolog Treat. 19.3 (2008): 168-175.

Brillowska-Dabrowska, A., S.S. Nielsen, H.V. Nielsen, and M.C. Arendrup. "Optimized 5-hour multiplex PCR test for the detection of tinea unguium: performance in a routine PCR laboratory." Med Mycol. 48.6 Sept. 2010: 828-831.

de Berker, D. "Clinical practice. Fungal nail disease." N Engl J Med. 360.20 May 14, 2009: 2108-2116.

Gaburri, D., J.M. Chebli, A. Zanine, A.C. Gamonal, and P.D. Gaburri. "Onychomycosis in inflammatory bowel diseases." J Eur Acad Dermatol Venereol. 22.7 JulY 2008: 807-812.

Garcia-Doval, I., et al. "Clinical diagnosis of toenail onychomycosis is possible in some patients: cross-sectional diagnostic study and development of a diagnostic rule." Br J Dermatol. 163.4 Oct. 2010: 743-751.

Ginarte, M., Garcia-Doval, I., et al. "Observer agreement in toenail disorders: implications for diagnosis and clinical research." Br J Dermatol. 160.6 June 2009: 1315-1317.

Gupta, A.K., L.E. Lynch, N. Kogan, and E.A. Cooper. "The use of an intermittent terbinafine regimen for the treatment of dermatophyte toenail onychomycosis." J Eur Acad Dermatol Venereol. 23.3 Mar. 2009: 256-262.

Kondori, N., A.L. Abrahamsson, N. Ataollahy, and C. Wennerås. "Comparison of a new commercial test, Dermatophyte-PCR kit, with conventional methods for rapid detection and identification of Trichophyton rubrum in nail specimens." Med Mycol. 48.7 Nov. 2010: 1005-1008.

Litz, C.E., and R.Z. Cavagnolo. "Polymerase chain reaction in the diagnosis of onychomycosis: a large, single-institute study." Br J Dermatol. 163.3 Sept. 2010: 511-514.

Nair, A.B., S.R. Vaka, S.M. Sammeta, H.D. Kim, P.M. Friden, B. Chakraborty, and S.N. Murthy. "Trans-ungual iontophoretic delivery of terbinafine." J Pharm Sci. 98.5 May 2009: 1788-1796.

Shemer, A., B. Davidovici, M.H. Grunwald, H. Trau, and B. Amichai. "Comparative study of nail sampling techniques in onychomycosis." J Dermatol. 36.7 Jul7 2009: 410-414.

Shemer, A., H. Trau, B. Davidovici, M.H. Grunwald, and B. Amichai. "Onychomycosis in psoriatic patients - rationalization of systemic treatment." Mycoses. 53.4 July 2010: 340-343.

Sigurgeirsson, B., J.H. Olafsson, J.T. Steinsson, N. Kerrouche, and F. Sidou. "Efficacy of amorolfine nail lacquer for the prophylaxis of onychomycosis over 3 years." J Eur Acad Dermatol Venereol. 24.8 Aug. 2010: 910-915.

Smijs, T.G., and S. Pavel. "The susceptibility of dermatophytes to photodynamic treatment with special focus on Trichophyton rubrum." Photochem Photobiol. 87.1 Jan.-Feb. 2011: 2-13.

Sotiriou, E., T. Koussidou-Eremonti, G. Chaidemenos, Z. Apalla, and D. Ioannides. "Photodynamic therapy for distal and lateral subungual toenail onychomycosis caused by Trichophyton rubrum: Preliminary results of a single-centre open trial." Acta Derm Venereol. 90.2 Mar. 2010: 216-217.

Takahata, Y., M. Hiruma, Y. Shiraki, Y. Tokuhisa, T. Sugita, and M. Muto. "Treatment of dermatophyte onychomycosis with three pulses of terbinafine (500 mg day for a week)." Mycoses. 52.1 Jan. 2009: 72-76.

Thomas, J., et al. "Toenail onychomycosis: an important global disease burden." J Clin Pharm Ther. 35.5 Oct. 2010: 497-519.

Walling, H.W. "Subclinical Onychomycosis Is Associated With Tinea Pedis." Br J Dermatol. 161.4 Oct. 2009: 746-749.


Medically Reviewed by a Doctor on 3/26/2014

Patient Comments

Viewers share their comments

Fungal Nails - Treatments Question: What treatment did you use for your fungal nails?
Fungal Nails - Signs and Symptoms Question: What did your nails look like when you had a nail fungus? What were your signs and symptoms?
Fungal Nails - Prevention Question: If you've had a toenail fungus, how do you try to prevent it from recurring?
Fungal Nails - Diagnosis Question: Why did you go to a doctor for your nail fungus? How was the condition diagnosed?