Nail Diseases :Treatment : Treatment, Procedure, Cost And Side Effects

Nail disease is a deformity of the nail. Although nail is a structure produced by the skin and is a skin appendage, nail diseases have a distinct classification as they have their own signs and symptoms which can relate to other medical conditions. Some nail conditions that show signs of infection may require medical assistance. Nail inspection can give hints to the internal condition of the body as well. Nail disease can be very subtle and should be evaluated by a dermatologist with a focus in this particular area of medicine. The disease can be caused due to infection of surrounding tissue of the nail plate of the nail with formation of pus and shedding of the nail, due to fungal infection, due to injury etc.

The treatment requires a proper examination of the nail condition by the doctor. The doctor will examine the patient’s nails and may also take some nail clippings or scrape debris from under the patient’s nail and send the sample to a lab to identify the type of fungus causing the infection. The eligibility criteria depend on the CD4 count. If it is 200 cells or lower, then the patient is eligible for the treatment. Other conditions like psoriasis may occur like a fungal infection of the nail. Nails can also be infected by microorganisms such as yeast and bacteria. Knowing the cause of infection it helps to determine the best course of treatment.

Based on the condition of the nail following nail disease treatments are available: Nail disease treatments are as follows:

1. Oral antifungal therapy: It has high rate of curing, depending on medication. It may take 9 to12 months to see the results. Fungus may come back, when therapy works. This therapy is best because of higher cure rates and shorter duration treatment compared to topical therapy.
2. Laser treatment. High doses of light can destroy stubborn fungus. This treatment is fairly new. While many results have so far been good, more studies are needed to prove that it can be safe and useful.
3. Use of electrical current to help absorption of topical antifungal medications into the nail which is also called iontophoresis.
4. Surgical treatment: One way to permanently get rid of toenail fungus is by surgery. Surgical treatment of onychomycosis involves nail removal. However, this only provides temporary relief, and recurrence is common unless additional antifungal medication is used simultaneously. However, surgical treatment may be warranted when the affected nail is associated with other factors such as trauma and or infection.

Oral Antifungal Therapy treatment prescription that are effective against nail fungus includes:

1. Griseofulvin: This drug is the mainstay of oral antifungal therapy for many years. Not effective against toenail fungus. Disappointing longterm results also have been reported.
2. Terbinafine: It is taken daily for 12 weeks for toenails and 6 weeks for fingernails. This drug is safe, effective and produces only few side effects.
3. Itraconazole: It is prescribed one week per month for 2 or 3 months. It can interact with some common drugs such as antibiotic erythromycin. It is treatment of choice if nail disease is caused by candida yeast and non- dermatophytic molds.
4. Fluconazole: It is prescribed once a week for several months. The dose of this drug need to be modified if patient has impaired kidney function or if taking certain other medications simultaneously. Should be used cautiously in patients suffering from liver disease.

If nothing works well then surgery should be performed for removing nail and permanently treating. But this this only provides temporary relief, and recurrence is common unless additional antifungal medication is used simultaneously. Precautions should be taken care of after surgery.

Firstly we have to observe the symptoms and check the diagnoses. Some of the disease includes:

1. Onychia: It is an infection of surrounding tissue of the nail plate of the nail with formation of pus and shedding of the nail.
2. Onychocryptosis: It is ingrown nails that can affect either the fingers or the toes. In this type of condition, the nail cuts into one or both sides of the nail bed, resulting in infection.
3. Onychodystrophy: It is deformation of the nails that can result from chemotherapy while treating cancer. It can include discoloration of the nail.
4. Onychogryposis: It is a thickening and increase in curvature of the nail. It is normally the result of injury to the matrix. It is most commonly seen in the large toe but may be seen in other toes as well as the fingernails. An affected nail has many grooves and ridges and is brownish in colour, and grows more quickly on one side than on the other.
5. Onycholysis: It is loosening of the exposed portion of the nail from the nail bed, usually beginning at the free edge.
6. Onychomadesis: It is the separation or falling off of a nail from the nail bed. Common causes includes localized infection minor injury to the matrix bed, or severe systemic illness. It is sometimes a side effect of x-ray or chemotherapy treatments for cancer.

If the patient has above symptoms or has any similar problems then they are eligible for the treatment. The eligibility criteria depend on the CD4 count. If it is 200 cells or lower, then the patient is eligible for the treatment. Other conditions like psoriasis may occur like a fungal infection of the nail.

Patients who have no such issues related to the nail disease are thus not eligible for the treatment. But in case patient is also suffering from diseases like diabetes, liver disorder, etc., these patients require proper care and thus may not be eligible for some type of treatment like surgery.

Many drugs have many types of side effects. Therefore, before taking any medications or drugs, you should inform doctor if you have or ever had, Kidney disease, Liver disease, Human immunodeficiency virus (HIV), Acquired immunodeficiency syndrome (AIDS), Depression, Autoimmune disorder such as lupus or psoriasis. Medicines like anti-fungal medication may cause side effects like diarrhea, heartburn, loss of appetite etc. In case any patient reports any other complexity after undergoing the treatment the patient is advised to consult the doctor immediately.

Post treatment guidelines or prevention to be taken care of are to wear protective footwear to avoid re-exposure, apply of an absorbent powder, and antifungal powders in shoes and on the feet, wear 100% cotton, absorbent socks, discard all old and mouldy footwear, keep nails as short as possible and avoid sharing toenail clippers, wear comfortable and well-fitting shoes to avoid trauma to the nail.

Recovery time depends on what treatment is being given to patients.

For antifungal nail cream it can take up to 12 months to cure the infection and it doesn't work always. For nail softening cream it takes 2 weeks to soften the nail so the infection can be scraped off. For oral drugs it depends on what drug is given, it may take up to 6 months showing best results.

The treatment cost depends on what treatment is been performed. It may vary from Rs.100 to Rs.10000. It may even go higher is surgery is performed.

No, the results of the treatment are not permanent, hence fluconazole is used as a suppressive therapy in such cases. Proper hygiene needs to be maintained because relapse rate is quite high even though there has been growth of a new nail. Have a proper bath and keep finger and toenails clean.

Some of the alternative treatments:

1. Over-the-counter remedies. Local drug store also have antifungal creams and lotions which can be tried without a prescription. They may not be expensive, but often they’re not strong enough to get rid of the fungus.
2. Mentholated salve. It is also found that a mentholated salve (like Vicks Vaporub) can get rid of a fungal infection of nails.
3. Snakeroot extract. Snakeroot is also a natural antifungal from the sunflower family. For some people, it may work about as well as a prescription antifungal cream.
4. Tea tree oil. It is a natural antiseptic, and can be tried applying this oil to affected nail twice a day. Never take tea tree oil orally, because it can be toxic. Still, it’s unclear how well this treatment works.
5. Listerine or vinegar. Soak the affected nail(s) in listerine or vinegar for 5 minutes a day to dry out the affected nails.
6. Take food items made from coconut oil, oregano oil, garlic, yogurt, apple cider vinegar. These will prevent the recurrence of fungal infection.