Diagnosis of nail fungal infections

Examination of nails

The first step in beating nail fungus is getting a diagnosis. Your doctor will likely examine your nails first.
Sample testing and analysis
To test for fungi, your doctor may scrape some debris from under your nail for analysis. The debris can be examined under a microscope or cultured in a lab to identify what is causing the infection. Other microorganisms, including yeast and bacteria, also can infect nails.

Treatment of nail fungus infections

The treatment of fungal nail infections is expensive and long-term and it requires taking medicine for several months, sometimes even years. Unfortunately, topical preparations do not effectively treat fungal nail infections. 

Oral Antifungal Medications

There are 3 effective oral antifungal medications - 2 that are FDA approved for fungal nail infections and one that is not FDA approved specifically for nail infections. All 3 medications have significant side effects and interact with many medications. Patients should know that these medications are incorporated into the nail and that’s why-they continue to work even after the medication is discontinued. It is important to remember that none of the oral antifungal medications can be taken during pregnancy.

Terbinafine (Lamisil®, Apo-Terbinafine®)
This is an FDA approved medication for fungal nail infections treatment. Several researches have proven that it is 70% to 90% effective when used as prescribed. The dosage used is 250 mg once a day for 6 weeks for fingernail infections and 12 weeks for toenail infections.

Itraconazole (Sporanox®)
Second FDA approved medicine for fungal nail infections is called Itraconazole. Studies have shown that it is 70% to 80% effective. This drug interacts with many medications and should always be taken with some kind of food. It can be taken daily or as pulse therapy with one but very large dose. The daily dose is 200 mg once a day for 6 weeks for fingernail infections and 12 weeks for toenail infections. The pulse dosing is 200 mg twice a day for one week per month repeated for 2 or 3 months.

Fluconazole (Diflucan®)
This medication is not approved by the FDA to treat fungal nail infections. However, it is an effective oral antifungal medication. The advantage of fluconazole is that it stays in the body for a long time and only needs to be taken weekly. 

Other treatment options

Doctor may also suggest these treatments:

Antifungal lacquer
If patient has a mild to moderate infection of nail fungus, sometimes the doctor may prefer to prescribe some simple antifungal nail polish instead of any medication. FDA has approved a topical antifungal lacquer called Ciclopirox (Penlac). This lacquer should be applied onto infected nails and surrounding skin once a day. Single treatment lasts for seven days after which the patient should wipe the piled-on layers clean with alcohol and begin fresh applications. Daily use of Penlac for up to one year or longer has been shown to help clear nail fungal infections.

Topical medications
The doctor may also recommend some other topical antifungal medications, such as econazole-nitrate (Spectazole®). Topical medications usually don't provide a cure but may be used in conjunction with oral medications.

Nail removal
If other treatments have failed, the infected nail can be removed by a small operation done under local anaesthetic. This is combined with treatment with antifungal medication.

Not treating
If the infection is mild or causing no symptoms it can be left untreated. Some people may prefer not to take medication as, although rare, there is a small chance of serious side-effects from antifungal medication.

Some treatment tips

All the fungi that are killed with treatment remain in the nail until the nail grows out. When a fresh, healthy nail grows out from the base of the nail, it is a secure sign that the treatment is working. When this healthy nail reaches the end of the finger or toe, the nail will often look normal again. Most people already know that fingernails grow faster than toenails, so it may appear they are quicker to get back to normal.

Prevention tips

To help prevent nail fungus and reduce recurrent infections, practice good hand and foot hygiene by following these steps:

• Patient should keep nails short, dry and clean.   
• Only appropriate socks should be wear. Synthetic socks that wick away moisture may keep feet dryer than cotton or wool socks
• Some antifungal spray or powder should be used on a daily basis.   
• Patient should wear rubber gloves and give up nail polish and artificial nails. Although it may be tempting to hide nail fungal infections under a coat of pretty pink polish, this can trap unwanted moisture and worsen the infection.
• Hands should be washed after touching an infected nail.