Fungal nail infections are very common

Adiya Gupta and Fiona Simpson. New pharmacotherapy for the treatment of onychomycosis:an update. Expert Opinion in Pharmacotherapy 2015;16:227-36.

J Galletti et al. Fusarium spp is able to grow and invade healthy human nails as a single source of nutrients. European Journal of Clinical Microbiology and Infectious Disease. 2015; In Press.

Onchomycosis can cause foul smells, loss of fingernails or toenails, and occasionally spread to other parts of the body.

Onchomycosis is caused by a wide variety of molds including Epidermophyton, Microsporum, Trichophyton, Candida, Fusarium, and other species. Risk factors for fungal nail infections include diabetes, peripheral vascular disease, HIV, immunosuppressive drugs, and smoking. 

Fungal nail infections are treated in a number of ways. A number of oral drugs are currently used including oral and topical allylamines, azoles, benzoxaboroles, ciclopirox, and amorolfine. Oral terbinafine is the most common treatment which results in a cure rate of about 74%. Drugs currently under development or investigation for nail fungus treatment include oral albaconazole, posaconazole, and topical efianconazole, TDT-067, and tavaborole. Other drugs called photosensitizers include topical aminolevulinic acid and methyl aminolevulinate, Photogem, methylene blue, and toluidine blue. After topical treatment with photosensitizer drugs, reactive oxygen species are formed which kill or inactivate fungi.

Laser therapy has also been used to treat onchomycosis and several laser systems have been developed for this purpose. Most studies report a fungal cure rate of 50 to 100% with lasers.

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