How to treat a nail fungal infection?

Fungal nail infection presents in various forms. However, there are many causes of nail deformities which can mimic the appearance of fungal nail infection. Ideally, if there is a suspicion for fungal nail infection, nail clippings should be sent for fungal culture to determine the type of fungus or moulds (which is more common and more difficult to treat).

It may take up to 2 months for the culture results to be returned to the clinic. While waiting for the results, you can try the topical treatments, e.g. clotrimazole lotion +/- amorolfine lacquer.

Once the diagnosis of fungal nail infection has been confirmed, your dermatologist will discuss the option of oral antifungal with you, as this treatment will take at least 3 months or longer, hence the cost of treatment is high and you need to be made aware of the side effects in particular liver toxicity (though uncommon but there is a need to monitor your liver through blood test if you require a prolonged treatment).

However, if you choose not to take the oral treatment, the topical treatment may help depending on the severity of your nail infection.

Occasionally, fungal nail infection can cause pain. In this scenario, the nail should be examined closely to exclude other causes.

If it is truly a fungal nail infection, the nail plate can be removed under local anaesthesia and you can proceed with topical antifungal, which can be used once your nail bed shows sign of healing. There will be some downtime after the procedure.

Common causes of fungal nail infection in Singapore are frequent visits to the manicurists, trauma to the nails (perhaps due to your activities, ill fitting shoes, foot derfomities, etc.), and sweaty feet causing recurrent athelete's feet leading to long standing toe nail fungal infection. Treating or avoiding the underlying cause will help to prevent recurrence.

Hope this information is helpful. If you need further assistance, please do not hesitate to see a dermatologist.

Regards,

Dr Liew Hui Min

Dermatologist

Hi, Thank you for your question. It is a broad one, and perhaps we could discuss a tailored treatment plan for you based on your history and doing a physical examination, or a picture of your nails. Your doctor may do some tests such as examination of a specimen of your nail under microscopy to confirm the diagnosis as some conditions may be confused with or mimic onychomycosis. A patient can also have onychomycosis in addition to other nail disorders.

If you truly have a nail fungal infection, or onychomycosis, as it is termed medically, it is important to treat it, as prolonged onychomycosis without treatment leads to discoloration and deformation of the nails. Particular problems include thickening, which may cause pain and make basic nail cutting difficult. Deformed nails can also lead to surrounding tissue damage and promote secondary bacterial infection.

Both topical and oral agents are available for the treatment of fungal nail infection. However, creams and other topical medications are usually not effective against nail fungus. This is because nails are too hard for external applications to penetrate. There are, however, some new formulations and medicated nail lacquer which have been approved to treat finger or toenail fungus that does not involve the white portion of the nail (lunula) in persons with normal immune systems. Oral medications usually have to be taken at least 8 weeks for fingernails and 12 weeks for toenails. Your doctor should be able to treat you appropriately after a proper clinical consult.

Regards,

Dr. Joanna Chan