A 40 Year Old Female With Problem In Toe Nails

A 40 years old female with known case of diabetes presents to the clinic with a chronic history of repeated infection in the toe nails, with occasional pain and sometimes a foul odor from the infection. Her toe nails has become distorted in shape and have lost the normal shine.

What is the Diagnosis?
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Toe Nail Fungus Also Known as Onychomycosis or Tinea Unguium


Discussion:

The fungal infections in the toes usually cause discoloration, thickening and often softening of the nails. Nail fungus is a difficult condition to treat and may often cause permanent damage and possibly nail loss.

The nails of our toes are very effective barriers. This barrier makes it quite difficult for a superficial infection to invade the nail. Once an infection has set in however, the same barrier that was so effective in protecting us against infection now works against us, making it difficult to treat the infection.

Clinical Symptoms:
The involved nails are:

• Thickened 
• Brittle, crumbly or ragged
• Distorted in shape
• Dull, with no shine
• A dark color, caused by debris building up under the nail.

Risk Factors: 

The risk factors for getting this infection include:

• Old age
• Perspiring heavy.
• Male gender
• Family history of nail infections.
• Working in moist and humid environment.
• Diabetes
• Compromised blood supply.

Management: 

A good history and physical examination gives a clue to the diagnosis. Scraping some debris from the infection site and sending to laboratory for culture may identify the cause of infection and type of fungus. 

1. Over the counter anti-fungal creams and ointments may help if the infection is not severe. 

2. Controlling the blood sugar levels in patients with diabetes helps prevent spread and re occurrence. 

3.Oral anti fungal drugs like itraconazole and terbinafine are effective but needs to be given for 6 to 12 weeks.