Tinea unguium, also known as onychomycosis, is a fungal infection of the nail bed, matrix, or plate. It is caused by a type of mold called a dermatophyte, which feeds off of keratin, a protein found in fingernails and toenails. The most common form of tinea unguium is distal subungual onychomycosis, which can also be distal and lateral. The infection is usually caused by Trichophyton rubrum, which invades the nail bed and the underside of the nail plate, beginning at the hyponychium and then migrating proximally through the underlying nail matrix.
Tinea unguium is notoriously tricky to treat, and you may need to treat it for several months to get rid of the fungus. Some treatment options include topical or oral antifungal medications, laser therapy, or surgical removal of the nail. However, periodic thorough debridement is unlikely to clear onychomycosis, but it appears to improve the immediate patient satisfaction and aid the efficacy of medications. Concurrent treatment of the tinea pedis should be undertaken and along with the long-term daily use of an antifungal powder to reduce reinfection and recurrence.
Older antifungal agents such as ketoconazole and griseofulvin are unsuitable for onychomycosis because of their relatively poor efficacy and potential adverse effects. Newer agents such as terbinafine and fluconazole have equal effectiveness and safety and shorter treatment courses. Terbinafine may be superior to griseofulvin for Trichophyton species, whereas griseofulvin may be superior to terbinafine for the less common Microsporum species.
Other alternative medicines used to treat nail fungal infections include Australian tea tree oil, vinegar, Listerine, and grapefruit seed extract, but their effectiveness is not well established.
