Accurate Diagnosis Should Be First Step in Treating 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, M.D., Ph.D., 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," Dr. 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," Dr. 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 Dr. 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, Dr. 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 only approved by the U.S. Food and Drug Administration for cosmetic improvement of nail fungus, researchers are looking into ways to improve laser treatment and potentially use it to clear the condition, Dr. 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 Dr. 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: