September 29, 2014
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Nail infections


Infections of the toenails and fingernails can occur at any time during the year.  However, many become more concerned during the summer months when they more frequently bare their feet.  

Nail fungus, or onychomycosis, is caused by dermatophytes (fungus germs) that gain entry into the nail or nail bed and then spread throughout the nail.  It’s more common as we get older and is rarely seen in children.  More than 15 percent of individuals will be faced with the problem at some point in their lives.    

These infections can cause the nails to become discolored, thickened, and brittle.  Sometimes they cause the nail to separate from the underlying nail bed.  They can also change the shape of the nail as it grows.  It may start as a small whitish patch within the end of the nail and then spread to involve more area of the nail.

Fungi love warm, moist and dark places to grow.  This is why individuals who have sweaty feet from wearing heavy work boots or playing sports are more apt to get common fungal infections of the foot.  You can also pick up fungal germs by walking around barefoot on warm wet floors, such as at the pool or in the locker room.

Though people can feel embarrassed exposing their “disfigured” toenails in public, fungal nail infections are not just a cosmetic concern.  Complications can arise due to the altered growth of the nail and the infection itself.  Some will experience pain in the toe, disruption of the skin around the nail, and ingrown toenails.  Bacterial infections can develop if the skin has been disrupted, especially in those with altered sensation in the feet such as diabetics.  The infection can also spread to other nails.  

Treatment of fungal nail infections is difficult because the nails grow slowly and infected nails tend to be thicker than normal skin.  Topical antifungal medications, both over the counter and prescription, are in general not very effective.  It’s hard to get these medicines into the nail with enough concentration to kill the organisms.  

Some oral medications can be expensive and potentially toxic to other organs, particularly the liver.  Oral prescription antifungals for the treatment of nail infection must be taken daily for three to four months.  Blood tests to monitor the liver need to be done at baseline and every few weeks during treatment.

There are some things you can do to take care of your nails if you have a fungal infection.  Keep your nails cut short and file down any thick areas.  Don’t use the same nail trimmer or file on healthy nails and infected nails.  If you have your nails professionally manicured, you should bring your own nail files and trimmers from home.

Wear waterproof gloves for wet work (like washing dishes or floors).  To protect your fingers, wear 100 percent cotton gloves for dry work.  

Wear 100 percent cotton socks. Change your socks when they are damp from sweat or if your feet get wet.  Put on clean, dry socks every day.  You can put over-the-counter antifungal foot powder inside your socks to help keep your feet dry.  Wear shoes with good support and a wide toe area.  Don’t wear pointed shoes that press your toes together.

Avoid walking barefoot in public areas, such as in locker rooms or at swimming pools.

The content in this column is for informational purposes only.  Consult your physician for appropriate individual treatment.  Dr. Reynolds practices Family Medicine in Chesterfield.


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