Fungal nail infections ("onychomycosis") can be a persistent and difficult problem. Often there is no simple or single solution.

Risk factors

People who frequently have wet hands are at increased risk of developing a fungal nail infection, as are older individuals and people who have diabetes, but anyone can develop a fungal nail infection. 

Diagnosis

The diagnosis of "fungal nail infection" is generally straightforward. Your doctor will endeavour to diagnose the specific type of fungus that is involved in order to most effectively direct your treatment. This diagnosis involves sending nail clippings or scrapings for culture in a laboratory. This can take at least 8 weeks, as fungus grows very slowly. In some instances no fungal growth will be detected from the tests. 

Common treatments

Common treatments for fungal nail infections include applying anti-fungal nail paint (such as amorolfine or bifonazole), taking oral anti-fungal medications such as griseofulvin, ketoconazole, fluconazole, itraconazole and terbinafine (although these can have side effects including liver damage, skin rashes, headaches, gastrointestinal upsets and heart problems). These treatments need to be used regularly for many weeks - treatment may take 3-12 months. 

How can a hand surgeon help?

Melbourne Hand Surgery can help with persistent, severe fungal nail infections by removing your nail, which is where the fungal infection resides. The removal can be done as a rooms procedure, or in a hospital operating theatre. If done as a rooms procedure, your finger will be made completely numb through the injection of local anaesthetic, prior to the gentle removal of your nail. If done as a hospital procedure you can be administered sedative medication so that you are sedated for the local anaesthetic injections. 

Once your nail is removed it is sent for testing, to see what type of fungal infection is involved. A dressing is applied to your finger for at least one week. If your finger is quite red or inflamed before the nail removal then we may recommend wearing a temporary splint to keep your finger still - splinting and elevation play an important role in speeding the resolution of any hand or finger infection. After one week the dressing is removed and we advise regularly applying an anti-fungal nail paint for at least 4 weeks. 

Your nail will regrow. While removing the nail means that you will temporarily not have a nail, within a few weeks your new nail will start to become evident, and after a few months the nail will completely regrow. 

What other options are available for persistent fungal nail infections? 

Laser nail treatment is commonly advertised for the treatment of fungal nail infections, but the evidence that laser nail treatment is effective in treating fungal nail infections is lacking. Dr Andrea Bershow, the director of the nail procedure clinic at the Minneapolis VA Health Care System, conducted a literature review in 2013 which found that fungal nail treatment with laser and photodynamic therapy has not been proven to be effective. A subsequent US study published in 2013 in The Journal of the American Academy of Dermatology found that laser treatments did not cure fungal nail infections, even after five sessions.

Two home remedies that are said to assist with clearing fungal nail infections are vinegar soaks and Vicks VapoRub.