Nails on, Point!

Nail fungus also known as Onychomycosis is a common nail condition primarily caused by dermatophytes, yeast, and on-dermatophyte molds. This is a therapeutic challenge and there has been an increase in resistance to oral and topical antifungal agents, which increases the relapse rate of this condition.

The treatment costs start from Rs 2,000 and depends on the number of infected nails, the area of infection, severity etc. Typically two to three sessions are required, one month apart. Paula Abdul, Madonna, Kate Moss, and Robert Pattinson are just some of the celebrities who have tried treatments for nail fungus.

The fungus is mostly caught from moist and wet areas. The common sources include public swimming pools, showers, gyms etc. Nail salons that use inadequate sanitisation of instruments is another cause of this condition. People with athletes foot are more likely to have fungal nails, since the causative fungus may infect the toenails. The symptoms of this condition generally include discolouration, flaking, thickening etc. Fungal nails may appear brittle, broken, and lifted or separated from the nail bed. This might cause pain and discomfort while walking, standing and exercising.

Common treatments for nail fungus include mechanical and chemical debridement, topical antifungal creams, systemic antifungal drugs and newer laser treatments. Systemic drugs which are the treatment of choice require additional blood tests since they have been known to have adverse effects on the functioning of liver, kidney etc. Also, these require anywhere from three to six months which also increases the cost of the treatments. Topical antifungal treatments in the form of nail lacquers are preferred by most patients as they have less serious side effects. Lasers have emerged as potential new treatment as they have few contraindications and minimal side effects.

Any fungal material in the nail bed is heated to extremely high temperatures which inhibits growth, causes damage and targets cells. Patients might feel a heating sensation at the point of application. This high temperature, toxic levels of adenosine triphosphate (ATP) and oxygen are created, disrupting fungal mitochondrial membrane potential, leading to slower growth rates which eventually lead to stopping the growth completely. Multiple studies have shown that laser treatments are more effective in terms of shorter treatment time, minimal side effects and patient acceptance as compared to other classical treatments.

No specific post-treatment care is required except the generic advice of ensuring cleanliness of nails, using sterile manicure tools, trimming of nails regularly, avoiding moisture and follow up with a dermatologist for post-treatment indications.

—The writer is a Mumbai-based dermatologist and medical director