Fungal Nail Testing and Treatment
Fungal infection of the nail (known as onychomycosis), is the most difficult of the superficial fungal infections to treat. This is because most of the treatments available, are topical agents (nail paints, ointments and sprays) and are unable to penetrate the nail plate and reach the infected area, which is usually in the skin beneath the nail, rather than in the nail itself.
Anti-fungal tablets (only available on prescription), although effective, can carry many side-effects and therefore are not suitable for many people. There is also evidence, that there is a risk that the microbes which are commonly responsible for nail infections, are becoming resistant to this treatment and so it is necessary to ensure that a positive Microscopy & Culture (Lab) or dermatophyte test is received, before being prescribed.
With only a few, often unreliable, treatment options available, many people accept that they will just have to live with this problem. But now there are effective alternatives.
Fenestration/Lacuna Method, is where several rows of tiny holes are made in the nail plate. The number of holes depends on the size of the nail being treated and the extent of the infection. Anti-fungal spray (Terbinafine 1%, also known as Lamisil), is applied over the nail and passes through these holes, spreading under the nail to reach the infected area. It can then treat the infection more effectively than simply being applied to the surface of the nail. This spray is then applied daily at home, until the infection is clear.
Toe nails grow slowly and the treatment will need to be applied daily for 6 months and in some cases, even longer. During the treatment period, more holes may need to be added as the nail grows forward. As the nail is ‘dead’, the holes remain and will grow out naturally. Any fungal infection of the skin must also be treated.
Keratolytic Nail Reduction
Keratolytic Nail Reduction is where the affected fungal nails are removed, using a 40% urea cream (a keratolytic) to soften them to a point where they can be painlessly reduced. This then allows anti-fungal sprays to actively treat the underlying fungal infection. The anti-fungal treatment will need to be applied daily for 6 months and in some cases, even longer.
Before undertaking any fungal nail treatment, we will require you to have either a dermatophyte test (in clinic) or a M&C (Lab) test to ensure that the treatment is appropriate for you. If you have a positive lab result provided by your GP in the last 3 months, we can use that.
If you are medically well enough and your GP is happy to prescribe anti-fungal tablets, you can use them alongside the above treatments. This provides even better rates of success.
Although we have had some excellent results using the above treatments, there unfortunately isn’t any guarantee of success.