How to Treat Onychomycosis

Onychomycosis is a generic term meaning a fungal infection of the nails. It is usually caused by the dermatophytes Trichophyton rubrum (70 percent) and Trichophyton mentagrophytes (20 percent). Onychomycosis can affect any component of the nail, including the nail matrix, the nail bed or the nail plate. It can be painful and disfiguring but is not otherwise serious. The following steps will show how to treat onychomycosis.

Instructions

Difficulty: Challenging

1. Realize that the recurrence rate of onychomycosis remains high even with newer treatments, so the costs and risks involved should be carefully considered.
2. Use topical agents only in cases involving the most distal half of the nail plate or if the patient is unable to tolerate oral antibiotics. Topical treatments are generally ineffective because they are not able to penetrate the nail plate sufficiently.
3. Consider ciclopirox solution as the best choice for a topical solution. It may be effective when combined with oral antibiotics and to prevent recurrence.
4. Administer itraconazole or terbinafine to treat onychomycosis. The efficacy of these antifungal agents comes from their ability to quickly penetrate the nail plate. Evidence suggests terbinafine may be more effective than other oral agents.
5. Remove the nail in combination with oral therapy to treat onychomycosis. This can be done surgically through a nail avulsion and matrixectomy. A 40 to 50 percent urea compound also may be used for patients with thick nails or those who may not tolerate surgery. Educate the patient about avoiding high-risk areas in public places.