AAD speaker: Accurate diagnosis of nail fungus key to treatment

Several conditions look similar to nail fungus, so it is important to get an accurate diagnosis before beginning treatment, according to a presenter at the American Academy of Dermatology Summer Meeting in New York.

“Although nail fungus is the most common nail disorder that dermatologists treat, not every nail problem is caused by fungus, and there are several other conditions that may look similar, including nail psoriasis and nail trauma,” Shari Lipner, MD, PhD, FAAD, assistant professor of dermatology at Weill Cornell Medicine in New York, said in a news release. “If you treat something that’s not a fungus as a fungus, it may not help [the] problem; in fact, it could make the condition worse.”

However, if a fungal infection is left unchecked, symptoms could get worse and possible cause pain or interfere with daily activities, Lipner said.

Lipner’s presentation, “Onychomycosis: Tips for Improved Diagnosis and Treatment,” was part of the Hot Topics in Nail Disorders session.

Diagnostic tests to confirm the presence of nail fungus include a new technique utilizing molecular biology to identify the organisms causing the infection, according to the release. Lipner added that the method is not yet widely used.

Treatment for nail fungus includes oral medication, which has high success rates but may cause significant adverse events or interact with other drugs, according to Lipner.

Topical treatments have shown improved efficacy in recent years and may be used by patients with underlying medical conditions or if they are taking multiple medications. Topical treatment may also benefit patients who have fungal infections of the skin, including athlete’s foot, as it applied to both foot and nail simultaneously, according to Lipner.

Fingernail fungus is typically treated for 6 weeks with oral medications, while toenail fungus requires 3 months of oral treatment, according to the release.

Topical treatments typically take longer: They are applied until the nails grow out, which is 4 to 6 months for fingernails and 12 to 18 months for toenails.

Topical and oral medications can be combined in some cases, according to the release.

Laser procedures are currently only FDA approved for cosmetic improvement of nail fungus; however, researchers are considering ways that laser treatment can clear the condition, according to Lipner.

She also is investigating the use of a nonthermal plasma device as an additional treatment.

“While we can’t currently recommend laser and device procedures as first-line treatments for nail fungus, they do hold promise for the future,” Lipner said in the release.

Reference: www.aad.org

Lipner S. FRM F033. Hot topics in Nail Disorders. Presented at: American Academy of Dermatology Summer Meeting; July 28-30, New York.

Disclosure: Lipner reports being a consultant for Cipher Pharmaceuticals and investigator for MOE Medical Devices LLC