FUNGAL NAILS CAN BE SAVED

( but you’ll have to be patient )

THICk, discoloured and crumbly nails are easily forgotten during the winter months — but harder to ignore once the sun comes out. But by then it will be too late to do anything about them, other than bury your toes in the sand, as curing fungal toenails can take up to a year.

The fungus that attacks toenails is usually the same one that causes athlete’s foot, from the tinea family. However, some infections can be caused by yeasts, such as candida, and other moulds.

These cases are much harder to treat, says consultant dermatologist Walayat Hussain, as most treatments are targeted chiefly at fungus, but can work on yeasts, too.

Fingernails can be affected, but far more people — one in four of the population — develop infection of the toenails. This is because hands are rarely in the same warm, moist conditions beloved of funguses as our feet often are, tucked away in socks and shoes most of the time.

People who run a lot may think that they have a fungal nail infection — but, in fact, it’s just repeated trauma to the toenails that can look similar.

If you do have an infected nail, don’t ignore it, says Mr Hussain, as it will never clear up by itself.

‘Once you get something colonising your nail, it’s like a lodger — really hard to get rid of it,’ he says. ‘I always tell my patients: “There is no miracle cure here, let’s see how far you want to push it in terms of treatment.”

‘To others I say: “Look, it’s unsightly, but it’s not going to do you any harm. Better to just leave it well alone.” ’

When treatment is considered an option, a two-pronged attack is best: a topical treatment, applied directly to the infected nail, combined with antifungal tablets.

Treatments applied directly to the nail — such as amorolfine nail lacquer, ciclopirox and tioconazole nail solution, available over the counter — are not very effective. In fact, the success rate for topical treatments alone is no better than 30 per cent, says Mr Hussain.

‘You don’t have to be a doctor to realise that the nail is a hard surface, and that if you’re putting something on the top of it you aren’t going to get much penetration,’ he adds. As over-the-counter varnishes often require daily application, sticking to the necessary regime is another problem. ‘Patients get fed up,’ says Mr Hussain. ‘They think: “Crikey, I’m not going to put this on every day for three months, life is too short.” Lots are not willing to do that; everyone just wants a quick fix.’ Tablet versions of the same antifungal drugs contained in the topical treatments, which can be prescribed by GPs, are more effective because they enter the bloodstream and attack the fungus from within. But even these work only in about half of cases. When a fungal or yeast infection has been confirmed by lab testing, dermatologists may prescribe the antifungal drugs terbinafine and itraconazole. These are taken for six weeks for fingernails and 12 weeks to six months for toenails.

As the drugs remain in the nail cuticle for several weeks, there are two treatment sessions three weeks apart, each a week long. The drugs are taken once a day during the sessions.

Sometimes this does not work, says Mr Hussain. ‘In desperation, people may have had the drugs and it’s still not clearing, so you literally just strip their toenails out and say: “Right, let’s start again from the beginning.”

‘But it would have to be a very severe case. Surgically removing nails is not something we take lightly, because walking afterwards is very painful for the patient.’ And, he says, ‘it still offers no guarantee of success’, like the drugs.

To prevent a fungal nail infection, the key is hygiene and keeping feet clean and dry. Wear cotton socks so feet can breathe, keep nails short and don’t share nail clippers.

Always wear flip-flops at the gym, pool or in changing rooms, throw away shoes that may have been previously contaminated with fungus — and if you get athlete’s foot, make sure it’s treated promptly to stop it taking hold in the nail.