Causes and Treatment of Fungal Nail Infections

Do you think you've got a fungal nail infection? There are many factors that can lead to the development of a fungal nail infection. There are also several treatment options. 

What is a fungal infection?

A fungal infection is a microbial infection that feeds off keratin. Keratin is a type of protein that makes up hair, skin and nails. When nail keratin is infected by a fungal infection it can be very difficult to get rid of.

There are several type of fungal infection that can occur:​

• Dermatophytes such as Trichophyton rubrum (T rubrum), T. interdigitale. The infectionis also known as tinea unguium.

• Yeasts such as Candida albicans.

• Molds especially Scopulariopsis brevicaulis and Fusarium species.

*External risk factors that increase the risk of developing a fungal infection include; participation in physical activity, increased exposure to wet work, ill fitting shoes, commercial swimming pools, working with chemicals, walking barefoot, and nail biting.

Trauma to the nail plate: this could include bruising or blistering under the nail plate, kicking or knocking the nail that causes the nail plate to lift from the nail bed. As soon as the nail bed integrity is damaged, a fungal infection has the opportunity to develop. 

Manicures and Pedicures: While not all salons are the same, getting manicures and pedicures are a major risk factor for developing a fungal nail infection. Infections can be passed from person to person via basins, instruments, brushes, physical contact and nail polishes. If equipment is not correctly sterilised (disinfecting is NOT good enough) the risk of spreading an infection from person to person is very high. 

Nail polish: Nail polish is the worst culprit in my opinion. Preserving chemicals used in nail polish damages the surface of the nail plate, combine that with using harsh chemicals to remove nail polish the nail plate doesn't stand a chance once an infection gets in. Additionally once a brush used on an infected nail is put back into the bottle, you have a hive of infection ready to spread to anyone else using that same colour. 

Footwear and hosiery: Finally footwear and hosiery play an important role in preventing, but also spreading fungal infections. Sharing shoes and socks and wearing dirty or damp shoes and socks increases the chance of catching and spreading fungal infections. 

What can you do?

Clinical testing: there are several clinical tests that can be done to determine if you have a fungal infection. However, false negative rates for cultures are around 30% - even when tests are done correctly; therefore a negative result can not exclude infection and should be repeated if clinical suspicion is high.

Natural/ Herbal Remedies: tea tree oil, apple cider vinegar, coconut oil have relatively low success rates. Tea tree oil and apple cider vinegar alter the pH around the nail plate and create inhospitable environments for fungal infections to develop. Unfortunately these do not kill fungal infections. Coconut oil contains caprylic acid that damages fungal cell walls and is a great preventative of tinea and moisturiser for nail areas.   

Oral anti fungal: Terbinafine and Fluconazole are the most common anti fungals prescribed by GP's. When taking oral anti fungal treatments liver function tests should be done regularly. 

Topical: Paint on treatments such as APO Ciclopirox, Lamisil, Resolve, Canesten, Rejuvenail, Restoranail, Mycota, Loceryl and Exilor have varying rates of success. Topical applications are great when the product comes directly in contact with superficial infections, but as soon as the infection gets under the nail plate the success rates are very low with topical applications. Treatment with topical applications should be continued for the complete duration while growing out a nail infection, this can range from 3 months to 18 months or even longer. 

Laser: Hot laser, cold laser and UV laser. The cold laser and UV laser use light therapy to increase blood flow, healing and growth in the toe area and topical solutions are required. Hot lasers (diode laser and pulsed dye lasers) denature fungal cell membranes and denatures enzymes that result in fungal cell death. Laser treatment is incredibly safe and does not damage healthy tissue. Research indicates an 80% success rate with just 1 hot laser treatment. If you are worried about laser treatment hurting or burning, I can tell you that it only gets as hot as you can handle. 

Here are some happy toes and fingers that have been fixed with Laser treatment

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finger

RM 11 months

SL Success

*Eisman Samantha, Sinclair Rodney. Fungal nail infection: diagnosis and management. BMJ 2014; 348 :g1800