Fungal Nail Treatment Darwin

What is Fungal Nail Infection?

Medically known as onychomycosis, fungal nail infections can affect both toenails and fingernails although it is more commonly present in toenails due to warmer darker and humid environment of our footwear.

It is a fungal infection that is caused by fungus or yeast and the clinical signs are discolouration (yellowish, brown, white), detachment of the toenail on the nail bed, crumbling of the nail, thickening, curling and nail deformity.

When the nail starts to become involuted in the edges, this can lead to secondary painful ingrown toenails.

Many of our patients use dark coloured nail varnish to hide the nail infection, which can make the condition worse and spread quickly.

Causes and Risk Factors of Fungal Nails

Not changing socks daily
Feet remain wet in between toes for long periods of time after showering or exercising
Communal showers, unsanitory conditions of pedicure salons, nail varnish, nail clippers
Inability to cut toenails
Nail biting

1. Poor general foot hygiene

Micro repetitive trauma from footwear
History of a heavy object dropping on toenail
Tight fitting footwear

2. Trauma

Prevalence is much higher is patients > 50 years of age
Although it is also common in < 40 age group from other causes and factors

3. Age

Also known hyperhidrosis, it creates a constantly moist environment allowing the fungus to thrive

4. Sweating Excessively

Low immunity such as diabetes mellitus or HIV
Poor peripheral blood circulation
Immunosuppresive therapies associated with cancer treatment
Extensive use of broad-spectrum antibiotics

5. Compromised Immunity

Fungal infection of the skin, or athlete's foot, is a common presentation in people with fungal nails

6. Tinea Pedis

Fungal Nail Treatment Options

Three main treatments exist in the market for fungal nail infections:

Laser Treatment

Antifungal laser therapy is the most widely used and recommended treatment, it is highly effective at targeting fungal nail tissue. Laser uses heat and light energy (photothermal and photochemical interactions) to cause an effect on the physiology of fungal tissue.

Laser treatment has virtually no side effects, painless and a safe alternative for patients who are not suitable to take oral medication or use topical agents.

The main factor for laser to produce antifungal activity is the laser wavelength. At Northern Podiatrist Clinic, we use a multi-wavelength Class IV Laser to effectively treat fungal nail infections. A multi-wavelength laser not only has a higher efficacy due to the ability to penetrate the nail plate and target fungal tissue, it also repairs and promotes healthy nail tissue growth.

Antifungal laser therapy is the preferred treatment by podiatrists and doctors.

Systemic Oral Medication

This is a prescription drug that is normally a 3-month course, which your doctor may repeat if symptoms persists. A blood test may be required to monitor for proper liver function. The complete cure rate is in the range of 20%-35% with oral antifungal treatments, therefore it is more effective than applying topical antifungal agents.

However, systemic toxicity and other side effects such as gastrointestinal and liver toxicity has been widely published in multiple studies.

It is not shown to be as effective as Laser Therapy.

Topical Antifungal Agents

There are many nail lacquers in the market that have antifungal properties, and this method has lesser side effects than oral medication. The process requires you to paint the nail lacquer on your toenails frequently, sometimes on a daily basis for many months, and you may have to file the nail surface or remove the old layer before each new application. Many patients do not follow through with this treatment due to the tedious process and slow improvement.

Nail lacquers do not penetrate the nail plate properly and effectiveness is low with very poor treatment outcomes.

We still recommend using this option when used in combination with Laser Therapy.

Published Research

1. Clinical laser treatment of toenail onychomycoses.

Zalacain A, Merlos A, Planell E, et al. Lasers in Medical Science. 2018 May;33(4):927-933.

2. Treatment of mild, moderate, and severe onychomycosis using 870- and 930-nm light exposure

Landsman AS, Robbins AH, Angelini PF, Wu CC, Cook J, Oster M, Bornstein ES. J Am Podiatr Med Assoc. 2010 May-Jun;100(3):166-77.