2017 HCHB_digital

Fungal Nail Infections (Onychomycosis)
Fungal nail infections (also known as onychomycosis or Tinea Unguium) account
for 15%–40% of all nail diseases. Prevalence increases with age and the
condition affects almost 20% of people older than 60 and over 50% of people
in their seventies.
The infection actually resides in the nail bed and on the underside of the nail
plate. Symptoms can vary but may include:
• nail discolouration or white or yellow streaks on the nail
• a crumbly or brittle nail edge or lifting or thickening of the nail
• complete nail destruction.
Either fingernails or toenails may be infected and usually more than one nail
is involved. Fungal fingernail infections may occur with paronychia (infection of
the nail fold, see below) and fungal toenail infections commonly coexist with
athlete's foot (see Foot Care). People with diabetes are three times more likely
to develop onychomycosis than people without diabetes. People with diabetes
are also prone to complications such as foot ulcers, osteomyelitis, cellulitis and
gangrene which may or may not originate from fungal nail infections.
Onychomycosis is also more common among people who sweat excessively,
athletes, men, people with psoriasis or with immunodeficiencies such as HIV.
Dermatophytes are the main group of fungi responsible, although some
fungal nail infections may be caused by yeasts (eg, Candida albicans) or moulds
(eg, Scopulariopsis brevicaulis). Trichophyton rubrum is the most common
dermatophyte implicated, and this fungus is prevalent and hard to eliminate from
carpeting, showers and changing-room floors.
Paronychia
This, usually painful, condition affects the nail fold (skin at the sides of the nail).
Redness and swelling are key features of paronychia and sometimes pus or a
discharge may be present. Staphylococcus aureus are the most likely bacterial
cause. Occasionally, the cold sore virus (herpes simplex), C. albicans, or moulds
may be responsible. Risk of paronychia is highest in people who have constantly
cold and wet hands (eg, dairy farmers, fisherman, cleaners), after manicuring,
and in children who bite or pick their nails.
Paronychia may also affect the way the nail grows, especially if it remains
untreated for long periods of time. It may cause distortions, ridges, or
discolouration of the nail. Topical antibiotics may be needed for severe or
prolonged bacterial infection, and it may take up to a year for the nail to grow
back after recovery.
Initial assessment
If the customer has onychomycosis of the toenails, offer to take them to a private area
where they can sit down and you can have a proper look at their feet. Determining
the severity of the infection is important, as severely infected toenails or fingernails
are unlikely to respond to pharmacy-sold treatment products.
Some fungal nail infections are also difficult to distinguish from other types
of infections or medical conditions, such as psoriasis (usually affects all nails
and tends to exist elsewhere on body), dermatitis (fingers or toes are typically
TREATMENT OPTIONS
Category Examples Comments
Topical nail preparations
Fungal nails
[PHARMACY ONLY MEDICINE]
eg, amorolfine (Loceryl Nail Lacquer),
bifonazole (Canesten Fungal Nail),
ciclopirox (Apo-Ciclopirox Nail Lacquer),
poly-ureaurethane (RestoraNail*)
eg, Excilor Fungal Nail, Nailclin Antifungal
Nail Treatment, Pronail Fungal Nail Pen
Discoloured and damaged nails
eg, Loceryl Nail Gel
eg, poly-ureaurethane (RestoraNail*)
Products for infected nails usually work better if most of the infected part of the nail is removed or extensively
thinned before application. Application needs to be regular and consistent and according to manufacturer’s
instructions.
RestoraNail contains poly-ureaurethane, a unique substance that covers and protects the nail, treating both
the fungal infection and repairing damage.
Excilor and Nailclin contain a mixture of ingredients designed to penetrate the nail plate and alter the pH of
the nail bed preventing fungal growth.
Loceryl Nail Gel visibly improves discoloured nails and restores natural water content. Also promotes healthy
regrowth. It is not an antifungal treatment like Loceryl Nail Lacquer.
Natural products Tea-tree oil, garlic Tea-tree oil has been effective at treating fungal nail infections. Garlic reportedly has antifungal properties.
Products with an asterisk have a detailed listing in the Fungal Nail Infections section of OTC Products, starting on page 238.
TREATS DAMAGED
NAILS AND FUNGAL
NAIL INFECTIONS
Page 76 HEALTHCARE HANDBOOK 2017-2018 Common Disorders