Fungal Nail Infection

Q-Is there anything, apart from conventional antifungals, that can cure persistent fungal nail infection? I have suffered from this condition for several years and nothing seems to get rid of it completely. PG, Aberdeen......

A-While this type of infection is less common than athlete's foot, it is thought that fungal infection of the nail affects 2-3 per cent of people in the UK. The condition is more common on the toenails (called tinea unguium) than on the fingernails (onychomycosis) and usually strikes young swimmers and athletes who are more likely to be sharing communal showers.

Those who spend a lot of time with their hands in water, such as cooks and cleaners, are also at higher risk as water and cleaning agents can damage the skin at the base of the nail, allowing the fungus to take hold. Another group likely to have such infections are those aged over 60.

Because nail infection can develop from fungal skin infection, there is a link with athlete's foot. Thus, treating fungal infections as soon as they are recognised is an important preventative. Fungal nail infections spread quickly and are extremely difficult to treat, whatever type of medicine you choose. Some people even choose not to treat, especially if there is no pain, and only mild discoloration and malformation of the nail. Conventional treatment usually consists of a long course of oral antifungals, such as griseofulvin or terbinafine. Griseofulvin has only a 50-70 per cent success rate and may produce adverse effects such as headaches and nausea. It must be taken until the nail grows out as long as 6-12 months and liver damage is associated with long term use. Terbinafine is taken for only 6-12 weeks and also has a 50-70 per cent success rate. It is associated with problems such as nausea, loss of appetite, abdominal pain, diarrhoea, skin eruptions and kidney dysfunction, including jaundice and hepatitis (WDDTY, vol 8 no 8).

Alternatively, some doctors recommend antifungal nail paints, which are useful if infection is confined to the tips of the nail. Even so, this requires lengthy and conscientious applications to combat the problem.

The condition is hard to treat partly because nails are slow growing. Even when the treatment is successful, it can take several months for fresh, new nails to grow back. When treating fungal nail infections, it is advisable to keep a special pair of scissors to trim the old, infected nail as it grows out to prevent any risk of reinfection.

Some alternative remedies may help. Tea tree oil contains powerful antifungal components. In one study, neat tea tree oil applied to the nail was as effective as the topical antifungal clotrimazole (J Fam Pract, 1994; 38: 601-5). In another study, a 10 per cent solution of tea tree oil was as effective in treating athlete's foot as the over the counter drug tolnaftate (Aust J Dermatol, 1992; 33: 145-9). In one recent placebo controlled trial, 60 patients aged 18-80 with nail infection achieved an 80 per cent cure rate after 16 weeks of using a 5 per cent solution of tea tree oil in a cream base. None of those cured had a recurrence (Trop Med Int Health, 1999; 4: 284-7). If you are self treating, try applying the oil neat twice a day.

Ajoene, a garlic derived organosulphur, can keep athlete's foot in check (J Am Acad Dermatol, 2000; 43: 829- 32). Applied to nail infections, it may be similarly effective. (You might also try to increase your intake of garlic as well as following an anti Candida diet.) Other anti fungals you might consider include goldenseal, echinacea and chamomile, applied topically. Although research is lacking, some practitioners also recommend topical olive leaf extract. A weak solution of hydrogen peroxide applied twice daily to the nail may also be helpful.