Treating this disease in its early stage is simple.  For fifteen minutes every evening, the feet should be soaked in a basin. The incidence of fungus infections of the nails increases with age.  It usually begins with the toenails, and after a number of years may migrate to the fingernails.  Most patients who suffer from fungus infections of the toenails also suffer from athlete’s foot, the symptoms of which are maceration and cracks of the skin and an intense itch.  The affected nails are usually thick and yellow, with flaking upper surfaces.

The fingernails of housewives and of people who work in hot, moist environments (such as cooks and bakers) can be affected by a fungus called Candida.  In these cases the skin surrounding the affected nails becomes red and infected; the damage begins at the base and sides of the nail.

Since there are other diseases which affect the nails, such as psoriasis, laboratory tests should be performed before treatment is begun in order to confirm the presence of a fungus and its exact classification.

TREATMENT

Despite the fact that fungus infections of the nails are not painful, they should always be treated.  Untreated nails serve as a reservoir of fungi which spread to the surrounding skin, causing itching and discomfort when jewelry is worn.

In a relatively high percentage of cases, antifungal creams and lotions are not effective in curing infections of the nails.  When only one nail has been affected, it may possibly be cured by dissolving the nail in a cream containing a high concentration of urea and fungicide.  Unfortunately, this treatment fails in most cases, and the fungus must be treated with oral medications.  The specific medication prescribed depends upon the type of fungus involved.  Most of the fungi are dermatophytes, which react well to Gryphyllin.  When the infection has been caused by Candida, ketoconazol (brand name: Nizoral) is prescribed.  Fingernails are renewed every six to eight months, whereas for toenails the process takes a year to eighteen months, and therefore the treatment must be continued for several months until all symptoms of the disease have disappeared.

Recently two new drugs have come onto the market.  The first, terbinafine (brand name: Lamisil) is suitable for treating dermatophytes; the second itraconazole (brand name: Sporanox) is suitable for both dermatophytes and Candida.  These two drugs remain present in the nails for weeks and even months after the completion of treatment, with the result that only a short course of treatment is required.  When one of these “new generation” drugs is used to treat a fungus infection of the skin, two to four weeks of treatment are sufficient, and for the treatment of fungus infections of the nails it is sufficient to take one or two pills a day for three months.

SIDE EFFECTS OF
TREATING FUNGUS
INFECTIONS

Until 1995 two kinds of fungicidal drugs in pill form had been approved for use: Gryphyllin and Nizoral.  Grifuliin is active in cases of dermatophytes, and causes almost no side effects.  If any do appear, they disappear with the completion of the treatment.  The most common side effect is stomach irritation, and patients are therefore advised to take this drug with or within half an hour after a meal.  The disadvantage of Grifuliin is that an adult patient must take four pills a day for an extended period of time.  Pregnant women and patients suffering from stomach or duodenal ulcers cannot take this drug.  Before prescribing Grifuliin a blood count must be performed, another after two weeks, and every two months thereafter until the treatment has been completed. 

Nizoral is suitable for the treatment of all types of fungi, including Candida.  In infrequent cases this drug can cause hepatitis, and it is therefore recommended only to the few patients who do not respond to other treatment.  Blood tests should be performed once a month during a course of treatment with Nizoral.

In 1995 two new fungicidal drugs were approved for use.  Despite the fact that these two drugs, Lamisil and Sporanox, are relatively safe to use, during the course of treatment blood tests should be performed monthly to monitor liver function.