Ten Pearls For Treating Difficult Nails

By Aditya K. Gupta, MD, PhD, and Jennifer Ryder, HBSc

Onychomycosis is a common nail infection, which is often chronic, difficult to eradicate and tends to recur.1 Current therapeutic approaches include mechanical or chemical avulsion, topical therapy, oral therapy or a combination of one or more of these treatment modalities. Treatment of onychomycosis has improved greatly with the addition of broad-spectrum oral antifungal agents and topical nail lacquers. However, even with the therapeutic advances, onychomycosis continues to increase in prevalence, treatment is not always successful, and relapse and reinfection may occur even after successful therapy.
With this in mind, here are 10 key tips for recognizing and treating difficult nail conditions.

1. Ensure A Correct Diagnosis Of Onychomycosis
Fungal infections of the nail apparatus may be classified as distal-lateral onychomycosis (DLSO), proximal subungual onychomycosis (PSO), superficial white onychomycosis (SWO), total dystrophic onychomycosis (TDO) and, more recently, endonyx onychomycosis (EO). The clinical presentation of the infection may provide you with information for identifying the causative organism. For instance, Candida infections are generally confined to the fingernails. Subungual hyperkeratosis with onycholysis is a common feature of dermatophyte infections.2

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