As podiatrists at Healthia, we understand the profound impact that tinea-related nail infections can have on the confidence and well-being of our patients. Tinea has a worldwide prevalence of 5.5% which makes it the most common condition that affects nail health and therefore one of the most common nail conditions we see in our clinics (Lipner & Scher, 2019).
In this blog, we delve into both how tinea can impact the health of our nails and the different options for treatment available to our patients at My FootDr to address fungal nail infections. Tinea in the nails (known as tinea unguium or onychomycosis) can lead to a range of unpleasant changes in the nails. These changes may include thickening, discoloration, brittleness, and deformity (Elewski, 2015). As the fungal infection progresses, the nails become more fragile and prone to breakage. Moreover, onychomycosis often leads to cosmetic concerns, which can make some patients feel self-conscious. Without proper treatment, the infection can spread to neighbouring nails and worsen over time, exacerbating the impact on the overall nail health. Early recognition and intervention are crucial for mitigating the consequences of onychomycosis.
- Topical Antifungal Agents: For mild to moderate cases of onychomycosis, topical antifungal treatments are often the first line of defence. These treatments, including creams, solutions, and nail lacquers, work by directly targeting the fungal infection at the nail surface Topical antifungal agents are some of the more cost effective and accessible forms of treatment. However, to be effective these agents require consistent application for long periods of time, depending on the severity of infection, to achieve any noticeable improvement. Topical agents also tend to be insufficient for more severe or longstanding infections.
- Oral Antifungal Medications: In cases where topical treatments prove insufficient, oral antifungal medications can be prescribed by a general practitioner or podiatrists with endorsement for prescribing medicines, to combat the fungal infection. Medications such as terbinafine are commonly used and have demonstrated efficacy in clinical studies (Gupta & Simpson, 2021). This method is more appropriate for longstanding infections or infections that have descended to the base of the nail. However, it is essential to consider potential side effects and drug interactions, particularly for patients with underlying health conditions or those taking multiple medications.
- Laser Therapy: Laser technology has been used to treat fungal nails in Australia for over a decade. Laser treatments utilise specific wavelengths of light to penetrate the nail plate and destroy fungal cells without causing harm to surrounding tissues. Whilst being a newer treatment modality it has fewer known side effects compared to oral medication and can be suitable for patients who are unable to consistently apply topical treatments.
- PACT Therapy: Photodynamic antimicrobial therapy (PACT) is a somewhat new modality that also shows potential in treating tinea-related nail infections. PACT involves a podiatrist applying a topical agent to the nails which is then activated by light of specific wavelengths to selectively target and destroy fungal cells while minimising damage to healthy tissues. This innovative approach offers a targeted and potentially effective treatment option for patients seeking alternatives to traditional antifungal therapies.
- Surgical Intervention: In cases of severe fungal nails or toenail deformity, surgical intervention may be necessary to remove the infected nail tissue and promote healthy nail regrowth. Procedures such as partial or total nail avulsion can effectively eliminate the source of infection and allow for the topical antifungal treatments or laser treatments to be used on the regenerating nail bed. Surgical options are typically reserved for those with advanced or suborn cases of tinea-related nail infections.
- Combination Therapies: In some instances, a combination of treatment modalities may be recommended to optimise outcomes and address underlying factors contributing to fungal infection. For example, combining oral antifungal medication with topical therapy or topical therapy with laser treatments to enhance the effectiveness of treatment and reduce the risk of recurrence.
As patients navigate the challenges of tinea-related nail infections, proactive management and preventive strategies also play a vital role in maintaining nail health and overall well-being. No matter which modality is used proper foot hygiene, footwear selection, and ensuring no opportune environment for the infection to spread will help with the success rates of treatment.
In conclusion, tinea-related nail infections present a unique set of challenges for patients. By exploring the diverse range of treatment modalities available, our podiatrists can offer personalised solutions that address the specific needs and preferences within an appointment.
References:
- Lipner, S. R., & Scher, R. K. (2019). Onychomycosis: Clinical overview and diagnosis. Journal of the American Academy of Dermatology, 80(4), 835-851.
- Elewski, B. E. (2015). Onychomycosis: Pathogenesis, Diagnosis, and Management. Clinical Microbiology Reviews, 28(1), 115–167. https://doi.org/10.1128/CMR.00026-14
- Gupta, A. K., & Simpson, F. C. (2021). New therapeutic options for onychomycosis. Expert Opinion on Pharmacotherapy, 22(6), 713-725.