Nail Fungus and Accurate Diagnosis

By Jane Farrell

In a news release from the American Academy of Dermatology (http://www.aad.org/), the organization gives an update on the embarrassing but important problem of nail fungus:

Nail fungus can be distressing for patients, especially during the summer sandal season when feet are exposed. While some people who observe nail fungus symptoms may wish to hide their affected nails with polish or run to the store for an over-the-counter anti-fungal treatment, it’s important for these patients to see a board-certified dermatologist before taking any action.

“Although nail fungus is the most common nail disorder that dermatologists treat, not every nail problem is caused by fungus, and there are several other conditions that may look similar, including nail psoriasis and nail trauma,” says board-certified dermatologist Shari Lipner, MD, PhD, FAAD, an assistant professor of dermatology at Weill Cornell Medicine in New York. “If you treat something that’s not a fungus as a fungus, it may not help your problem; in fact, it could make the condition worse.”

“On the other hand, if you do have a fungal infection and let it go unchecked, the symptoms could worsen, possibly causing pain or interfering with your everyday activities,” Lipner adds. “For some patients, nail fungus is not just a cosmetic or aesthetic problem.”

Early signs of nail fungus may include the lifting of the nail off the skin and yellow or white discoloration. As the infection spreads, the nails may become thicker, difficult to cut and increasingly discolored, or they may become thinner, prone to crumbling and splitting.

“If you experience bothersome nail symptoms, see a board-certified dermatologist, who can evaluate your condition and recommend the best available treatment for you,” Lipner says. “It’s especially important to seek treatment for nail conditions if you have underlying medical issues, such as diabetes, poor circulation or a weakened immune system.”

According to Lipner, dermatologists can perform a variety of diagnostic tests to confirm the presence of nail fungus, including a new technique that utilizes molecular biology to identify the exact organisms causing the nail infection. Although this method is not widely used yet, she says, it could provide better diagnoses for more patients in the future.

Once nail fungus has been diagnosed, the condition can be treated with oral or topical medications. While oral medication has high success rates, Lipner says, it may cause significant side effects or interact with other drugs. Although topical treatment is typically not as effective as oral medication, newer topical formulas that have been developed in recent years have shown improved efficacy, she says, and topical treatments may be more feasible for patients with certain underlying medical conditions or those on multiple medications. Because many cases of nail fungus arise from fungal infections of the skin, such as athlete’s foot, applying topical treatments to both the foot and nail simultaneously may lead to improved results, she says.

Oral medications can typically treat fingernail fungus in six weeks and toenail fungus in three months, while topical treatments must be applied for as long as it takes nails to grow out — about four to six months for fingernails and 12 to 18 months for toenails. In stubborn cases, topical and oral medications may be combined to provide the best possible treatment.

While laser procedures are currently approved by the U.S. Food and Drug Administration only for cosmetic improvement of nail fungus, researchers are looking into ways to improve laser treatment and potentially use it to clear the condition, Lipner says. Additionally, she is currently investigating the use of a non-thermal plasma device as an additional treatment option. “While we can’t currently recommend laser and device procedures as first-line treatments for nail fungus, they do hold promise for the future,” she says.

According to Lipner, the best way to deal with nail fungus is to prevent it from occurring in the first place. She suggests taking the following steps to avoid nail fungal infections:

• If you get a manicure or pedicure at a salon, make sure the staff sterilizes its equipment. Don’t shave your legs for at least 24 hours before a pedicure, as this may cause nicks and breaks in the skin that could lead to infection.
• Because fungus can thrive in warm, moist environments, wear breathable socks, and use flip-flops at public pools, gyms, locker rooms and showers.
• If you notice symptoms of a fungal infection in any of your nails (i.e., separation, discoloration, changes in thickness or texture) or your feet (i.e., itchiness, cracked or flaky skin), see a board-certified dermatologist for diagnosis and treatment to prevent the disease from spreading onto other nails or to other members of your household.

“Nail fungus can be an embarrassing problem, but you shouldn’t be embarrassed to discuss it with a board-certified dermatologist, who can help you manage this condition,” Lipner says. “Dermatologists have the expertise to determine what’s causing your nail problem and recommend an appropriate treatment, so see a dermatologist if you have any concerns about your nails.”

About the AAD

The American Academy of Dermatology was founded in 1938. It is the largest, most influential and representative dermatology group in the United States. With a membership of more than 19,000, it represents virtually all practicing dermatologists in the United States, as well as a growing number of international dermatologists. For more information, visit www.aad.org.