My toenails have fungal infection and they have become discolored. I have taken several oral antifungal medications such as terbinafine, grisofulvin, and itraconazole, but the infection doesn’t heal. I have read on a print ad a medicine that is applied like a nail polish. Is this medicine available locally? The situation has worsened and seeing my ‘dirty” nails is really embarrassing.

The two most common causes of fungal infection in the nails are from Candida, a yeast-like fungus, and from tinea fungus, which is also responsible for ringworm infection in the skin. Candida infection of the nails is called paranychia, making the nails greenish or brownish. This infection invades the under portion of the nails, causing the underlying and surrounding skin to thicken and redden.

Tinea infection of the nails, on the other hand, is called onychomycosis. The infection starts at the free end of the nails, making them thick, irregular, and whitish to yellowish. The infected nails are not only unpleasant to look, they usually snag on clothing because of the ragged edge they form. Forty percent of the time, there is also a concomitant fungal infection on the other parts of the body. The toenails, rather than the fingernails, are more frequently affected,

Fungal infection often occurs because of moist or wet surroundings. Those who handle wet work are the most commonly affected by paronychia, while those who perspire a lot; wear enclosed and tight shoes; or have diabetes mellitus, cancer, or are malnourished are also predisposed. A crack on the skin can start the infection.

Diagnosis can be made by examination under the microscope or fungal culture. Most of the time, the characteristic lesion will already help in the diagnosis.

I suggest that you consult a dermatologist since treatment is quite tedious and frustrating. Treatment for chronic cases may last up to six months or more, but the success rate may be up to 70 percent only.

By the way, there are nail lacquers available in the pharmacy, which need to be applied once a week for several months. Oral antifungal agents are also available and can be taken especially if there is an infection on the other parts of the body. If these treatments are not still effective, removal of the affected nail is the best solution. This can be done by either chemical nail avulsion or surgical removal of the infected nails.