By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

GRANDPA PROBABLY HAS ONYCHOMYCOSIS -- A COMMON NAIL INFECTION

Question: I was out with my grandfather last weekend on our boat and I noticed his big toenails were yellow and thick. He is a very clean man, so I know this wasn’t just dirt. What can be wrong with his toenails and what can he do about it? I would like to help him.

Answer: It sounds like your grandfather may have a fungal infection of the nails called onychomycosis (OM). This malady is very common in the United States and most frequently involves the toenails, but it can affect the fingernails as well.

While anyone can acquire this type of infection, your risk increases with age. In fact, it is estimated that 90 percent of elderly people are affected. OM is also more common in those with diseases such as diabetes and other immunosuppressive illnesses. You are also at higher risk if you are male or if you frequently have athlete’s foot.

If you see your doctor because of a fungal nail infection, he or she will want to examine not only your nails but also the skin on your hands or feet to determine if any other disorder is present. In toenail fungal infections, for instance, he or she will look for signs of athlete’s foot.

Several different fungi cause nail infections but testing is seldom necessary. The diagnosis is usually straightforward. Sometimes, however, your doctor might want to scrape away a portion of the damaged nail, study the scrapings under the microscope, and have a culture for fungus performed in the laboratory.

In most cases, as I mentioned, the diagnosis is the easy part. The treatment can be much more difficult and time consuming. Many topical creams and lotions do not work very well. The most successful treatment involves removal of the nail and treatment of the underlying infection. This can be painful and healing takes many months.

There are several newer oral medications that work very well, but the medicines must be taken for a long period of time, up to six months, to be fully effective. These oral medications can sometimes produce serious side effects, so they are not for everyone. If you take them, you will need periodic blood tests to monitor things such as liver enzymes.

In some instances, the oral medication, surgical removal of the nail and topical treatment are all used together. This can decrease the length of time you must take the oral medicines and often produces good results.

The final phase of clinical trials is underway on a new topical medication with a “permeation enhancer.” In plain English this means that the drug will have the ability to penetrate directly to the nail bed. It may be available sometime in 2009.

Your grandfather should be sure to wear shoes in public places, even the boat, and treat any athlete’s foot he has. A podiatrist, foot specialist, may offer the most help in resolving his probable fungal nail infection.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.