What precautions needed for nail maintenance with fungal infections?

Skin, nail and hair health
1

I've always had strong, healthy nails, but apparently caught a fungus from my elderly mother (who was infected) while trimming and filing her nails.  I did wash hands and brush my nails after, as well as throw those implements away, but several weeks later noticed a slight discoloration and white spots creeping up my nails.  

My doctor prescribed the generic lamisil, which I took for 30 days.  In the meantime I kept the nails trimmed and the discoloration continued to grow out and seemed to be gone.  But after about a month, I noticed it starting again, so did another 30 days of the prescription.  Again, it seemed to be nipped in the bud and all looked good.  At this point I did my usual manicure and the nail beds were not visible.

Now when I removed the polish and looked, it's starting AGAIN.  Plus, I think I see similar signs on my toenails.

Although I threw away all of my emery boards, etc. and started with new, I wonder if I've somehow spread the infection, or reinfected myself by re-using a board or clippers after I THOUGHT the infection was gone.

I've been looking and looking for information on how to make sure this does not happen.  How often should nail files be replaced?  At what point in treatment could I be sure I'm not re-spreading an infection?  Can clippers which have been used on infected nails be thoroughly sterilized, and if so, HOW?

I'm about to start the Lamisil again, and this time want to make sure I'm not making any mistakes.  I've also read the posts about the UV driers being effective and am considering purchasing one of these to use in conjunction with the pills.

TIA for advice on exactly how to handle nail hygiene!

Best,

Ellpea

2

Hi Ellpea, clippers and nail scissors can be sterilized by washing them in hot water and soap, drying them, and finally rubbing them with alcohol or if you can get isopropyl alcohol. The big problem are nail files. It's best to use disposable ones to file infected nails. I personally would get a separate set of equipment for treating infected nails. After filing an infected nail wipe it carefully with a cotton bud soaked in rubbing alcohol. 

Regarding your nail infection, the good thing is that in your case Lamisil is effective in treating it. You probably should have had a longer course of Lamisil the first time you started your treatment.  For toe nails the treatment period is around 12 weeks.

However, Lamisil can have side effects and puts a real strain on your liver. I felt nauseous while taking Lamisil. During a long treatment period you doctor might want to monitor your liver values. 

Have you considered using a medicated nail laquer (for example containing Ciclopirox)? The active ingredient penetrates the nail plate and treats nail fungus locally. These laquers can be used for (very minor) nail infections and to prevent reinfection. You could use it while taking Lamisil and then continue treatment to prevent a relapse. 

Hope this helps. 

 

3

Hello danR,

Thank you for your response!  I have been using FungiNail in addition to the Lamisil, which I just finished again after 60 days.  I don't seem to have any remaining problem, although that's what I thought the last time I stopped after 30 days of Lamisil.

The two most troubled nails have lost all look of infection, but the nail bed kept receding for a while.  I would trim it down, and the next morning it would have receded a bit again.  Also, there were sharp little pin-pricks of pain.  In addition, instead of having a clean, straight line, a white "spot" would occasionally show up just inside that line (which is how this seemed to start originally).  So I continued with the Lamisil for another 30 days.

Now the nail beds seem to be growing out and fine again, nails look healthy, but where I see *any* oddness to the shape of the white edge of the nail as it grows out, I'm a little panicked.  Previously, when I saw a suspicious spot, by the time the weekend was over 1/4 of the nail was in trouble again before I could get the Lamisil refilled.

So I appreciate your suggestion about the Ciclopirox... I've already ordered this from Amazon and perhaps it will keep any percolating little problem at bay or knocked down entirely without having to do the Lamisil again.

My question before about how to avoid re-infection was a bit more complicated.  I wondered how long I should wait before I would be safe to re-use implements again.  With the previous infection everything appeared to be clear, and I had all new tools and files.  But apparently something was still there, and it not only came back but possibly managed to move to the toes, probably following the clippers.  I would have been completely sterile in all movements if I'd had a clue there might be some infection lingering somewhere.

I think the Lamisil caught the toe problem before it took hold.  But now I'm afraid to re-use anything... not knowing how long something evil might be lurking somewhere.  Do we have any hard and fast rule, or even a sort of medium-firm rule about this?

Again, I think the lacquer *may* help kill off and prevent anything from returning, but am nervous enough about Lamisil side-effects to be a bit paranoid about having to start a new course of treatment.

Sorry for the long response, and thanks for your thoughts.

4

Hi Ellpea, 

I understand your feeling that "evil might be lurking somewhere". The truth is fungal spores are virtually everywhere. If you were to take a swab from a healthy persons trainers and culture it in a lab you would probably find fungus. 

In normal circumstances our nails are well protected by the nail plate. Fungal nail infections most often happen due to an injury to the nail area or due to tiny lesions occuring during a pedicure or manicure. The problem is that once the fungus has established itself on the nail bed it is difficult to get rid of it since the nail protects it really well. 

Btw is looked up FungiNail. The active ingredient is undecylenic acid. I tried a product with this ingredient before and it did not have much impact in my case. But my nail was totally infected and it also depends on the type of fungus causing the infection. I even tried laser treatment once. It did not work for me. 

What did work was the use of an occlusive bandage. I treated a toenail that got reinfected after initial treatment with Lamisil tablets.  In my opinion this method works best if only one nail is affected. 

Basically, you have to squirt a bit of Lamisil into a small rubber 'sock' and pull it over the nail. Just enough antifungal cream to cover the nail. 

 As a rubber sock I used the finger part of a (non-latex) disposable glove. To secure the sock I used micro-porous tape ( a normal plaster will work). You will have to use a new 'sock' every evening. 

(Caution: Do not fix the bandage too tight. If you notice any irritation of the surrounding skin then leave the bandage off for a few nights. If the irritation gets worse I think it's best to discontinue the use of this method. )

By soaking the nail in cream overnight the brittle part of the nail becomes soft and can be gently scraped away. The nail and the surrounding skin will become saturated with Terbinafine. In my case, the whole nail become soft and I scraped it away. After about a month I could see healthy nail growth, smooth and pink. I stopped the treatment after about half the nail had grown back. But when I noticed white spots creeping back in I picked up the treatment again. This time till the nail had fully grown back. That was about a year ago and today everything looks fine. 

Regarding prevention I forgot to mention that I first got infected after sharing a nail brush with a family member. If toenails are infected you might want to use laundry disinfectant especially when washing socks. I got used to add it to the fabric softener drawer of the washing machine. 

Another thing you might want to try is applying a bit of alcohol based hand sanitizer gel to the infected nail before clipping of filing it. This will prevent clippings and nail dust from flying everywhere and will disinfect the nail area at the same time.

I think the key to success with any method, tablets or cream or laquer is to continue the treatment well beyond the point where the nail looks normal again. After all it takes about a year for a toenail to grow back completly.

All the best and I am sure you will be fine. Diligently keep using whatever means available FungiNail and laquer and you will see eventually the fungus will stay away for good. 

 

5

danR,

Thanks for your further thoughts.  Fortunately, none of these have reached the point of needing to remove a nail, or soak it loose.  It advanced the first time because I kept my nails manicured and polished, and the signs were hidden underneath.  I caught this from my elderly mother, who developed a nasty case while she was on hospice.  Her nails had grown way too long and clipping did not seem wise, so I filed them all down.  My left hand, the one holding her fingers as I filed them, developed the worst infection.

I threw the files away, washed and scrubbed my hands, and really had little fear anything would come of it.  I was certainly wrong about that -- wearing gloves would have been the smart thing to do, but we had no idea how contagious this could be.  Neither did any of the caregivers at her home... no one seemed to know what it was.

At any rate, that was a year ago, and with luck this is beaten back for good. BTW, FungiNail does not penetrate the nail, but I used it on the tips after trimming and also spread it on my clippers as an extra precaution between fingers.  Oh, and when trimming, always started with the uninfected, or least infected nails first.

Cheers!