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General Information: Nail Fungus

What is Nail Fungus?
An infection of nail fungus occurs when fungi infect one or more of your nails. A nail fungal infection may begin as a white or yellow spot under the tip of your fingernail or toenail. As the nail fungus spreads deeper into your nail, it may cause your nail to discolor, thicken and develop crumbling edges - an unsightly and potentially painful problem.These infections usually develop on nails continually exposed to warm, moist environments, such as sweaty shoes or shower floors. Nail fungus isn't the same as athlete's foot, which primarily affects the skin of the feet, but at times the two may coexist and can be caused by the same type of fungus. An infection with nail fungus may be difficult to treat, and infections may recur. But medications are available to help clear up nail fungus

Signs and symptoms:
• Thickened
• Brittle, crumbly or ragged
• Distorted in shape
• Dull, with no luster or shine
• A dark color, caused by debris building up under your nail

What are the causes of Nail Fungus?:
Fungi are microscopic organisms that don't need sunlight to survive. Some fungi have beneficial uses, while others cause illness and infection.
Nail fungal infections are typically caused by a fungus that belongs to a group of fungi called dermatophytes. But yeasts and molds also can be responsible for nail fungal infections.

All of these microscopic organisms live in warm, moist environments, including swimming pools and showers. They can invade your skin through tiny invisible cuts or through a small separation between your nail and nail bed. They cause problems only if your nails are continually exposed to warmth and moisture - conditions perfect for the growth and spread of fungi.

Infection with nail fungus occurs more in toenails than in fingernails because toenails are often confined in a dark, warm, moist environment inside your shoes - where fungi can thrive. Another reason may be the diminished blood circulation to the toes as compared with the fingers, which makes it harder for your body's immune system to detect and eliminate the infection.

Risk factors:
Nail fungus is more common among older adults for several reasons, including diminished blood circulation, more years of exposure to fungi and because nails may grow more slowly and thicken with aging, making them more susceptible to infection. Nail fungus also tends to affect men more than women and those with a family history of this infection. Resistance to fungal infection likely has a genetic component.

These factors also can increase your risk of developing nail fungus:
• Perspiring heavily
• Working in a humid or moist environment
• Wearing socks and shoes that hinder ventilation and don't absorb perspiration
• Walking barefoot in damp public places, such as swimming pools, gyms and shower rooms
• A minor skin or nail injury, a damaged nail or another infection
• Diabetes, circulation problems or a weakened immune system

Treatments:
Nail fungus can be difficult to treat, and repeated infections are common. Over-the-counter antifungal nail creams and ointments are available, but they aren't very effective. ADSCI has recently acquired the Cooltouch laser, which is FDA-approved for use on the skin.  It has recently has been used for the treatment of toe nail fungus. The principle behind the treatment is the heating of the nail bed and nail plate to about 40C.  This kills the fungus and the spores. We recommend three Cooltouch laser treatments once a month apart combined with a topical anti-fungal lacquer. We have seen fantastic results with this new anti-fungal treatment.  The advantage of this treatment is that oral anti-fungals, which could have potential side-effects, are not needed.

Oral medications: To treat nail fungus, your doctor may prescribe an oral antifungal medication, such as:
• Itraconazole (Sporanox).
• Fluconazole (Diflucan)
• Terbinafine (Lamisil)

These medications help a new nail grow free of infection, slowly replacing the infected portion of your nail. You typically take these medications for six to 12 weeks but won't see the end result of treatment until the nail grows back completely. It may take four months or longer to eliminate an infection. Recurrent infections are possible, especially if you continue to expose your nails to warm, moist conditions. Antifungal drugs may also cause side effects ranging from skin rashes to liver damage. Doctors may not recommend them for people with liver disease or congestive heart failure or for those taking certain medications.

Other treatment options
Your doctor may also suggest these nail fungus treatments:
Antifungal lacquer. If you have a mild to moderate infection of nail fungus, your doctor may prefer to prescribe an antifungal nail polish called ciclopirox (Penlac). You paint it onto your infected nails and surrounding skin once a day. After seven days, you wipe the piled-on layers clean with alcohol and begin fresh applications. Daily use of Penlac for about one year has been shown to help clear nail fungal infections, but researchers found that it cured the infections in less than 10 percent of people using it.

Topical medications. Your doctor may also opt for other topical antifungal medications. In some cases, you may be advised to use these creams with an over-the-counter lotion containing urea to help speed up absorption. Topical medications usually don't provide a cure, but may be used in conjunction with oral medications.If your nail infection is severe or extremely painful, your doctor may suggest removing your nail. A new nail will usually grow in its place, though it will come in slowly and may take as long as a year to grow back completely.

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