Tuesday 04 April 2017, 4:34PM
"Would you have a quick look at my nail?" is something
pharmacist Ahmad Zareh is often asked, and he is always happy to
Mr Zareh, who recently sold his share in an Auckland pharmacy
and is buying one in Hamilton, has a special interest in fungal
nails and likes to make his customers feel cared for.
It may not be the sexiest ailment, but when a yellowing toenail
is thrust under your nose, he thinks it's good to be up to speed on
all things fungal.
Not only that, fungal nail infections can be embarrassing and
uncomfortable for patients, and in some cases have more serious
Officially called onychomycosis, a fungal nail infection can be
caused by three different organism types.
These are yeasts (Candida), moulds and dermatophytes (tinea),
with the most commonly seen and treated infection being tinea
While it affects both fingernails and toenails, 70-80% of cases
affect the big toe, says Mr Zareh.
"It never hurts to have a look," he says, "they get so
excited when I want to, so it's good practice."
He says those most at risk are the elderly, athletes and users
of warm wet footwear, and says it's more common than most people
While there are plenty of treatment options, many people find a
fungal nail infection to be stubborn and hard to get rid of, mainly
due to treatment time.
Mr Zareh says the biggest reason for treatment failure is
non-adherence, as it can take from three to seven months to allow
for the nail to fully grow out.
He gives some practical advice on how to get a foothold against
What to be wary of
While fungal nails are generally more unsightly than risky,
there are also times when referral to the GP is necessary,
according to adjunct associate professor at the University of
Auckland, Dr Amanda Oakley.
"It's important to know the patient's history as there can
be complications for those with conditions like diabetes, a
weakened immune system or susceptibility to other
"Pharmacists need to be careful when diagnosing," she says, as
misdiagnosis can mean a different condition gets left untreated, or
there can be a risk of the fungus spreading to other parts of the
A visit to the GP will have the doctor take clippings for
microscopy. For more severe cases, an oral antifungal drug,
Terbinafine, is prescribed but, according to Mr Zareh, this can be
heavy on the liver and may require a blood test, which puts a lot
of patients off.
Listed below are some symptoms that should act as flags for a GP
weeping or green coloration, which can indicate a bacterial
the cuticle is affected - this may indicate the presence of
over 70% of the nail is affected
Practical home tips to prevent recurrence
The most important home tip according to Mr Zareh, is to wear
footwear in communal showers or at home if someone is known to have
an infection. Others are:
Wear breathable footwear whenever possible.
Maintain nails regularly, keeping them trimmed and looking for
signs of infection.
Fast treatment of athlete's foot, which can easily spread onto
If you use nail salons, make sure they are thoroughly cleaning
equipment between customers.
Use of nail files with treatment is encouraged, but make sure
these are disposable to prevent re-contamination.
What treatments are available?
Fingernails are usually cured more quickly and effectively than
toenails, according to Dr Oakley. There are various options
available, though, unfortunately, treatment time is long. She says,
in many cases, the treatment can be more tedious than the condition
However, Mr Zareh says mild infections that affect 50% or less
of the nail often respond well to topical treatments, and he
provides an overview of what's available.
These are creams, such as Lamisil and Canesten, which are
applied directly to the nail. Unfortunately, they don't absorb
easily into the hard nail surface and most people prefer
Who said pharmacy wasn't glam? These treatments are polished on
twice a week until the nail grows out, and are absorbed much more
easily into the nail surface than creams. As well as
over-the-counter products, there is a fully subsidised treatment,
Loceryl, available on prescription, and its generic,
A product called Canesten Fungal Nail Treatment Kit emerged a
few years ago that guarantees results in seven to eight weeks.
Several months of prescribed oral antifungal medication may be
needed to cure a stubborn case, and Dr Oakley says a combination of
oral and topical treatment is sometimes required.
In recent years, there has been new laser treatment developed
using PinPointe technology; it involves
three sessions across about 12 weeks.
"We have been successful in many cases and the trials from the
States show a 71% success rate," says John Ringer of Auckland's
Laser Nail Clinic, but he explains that there are no data yet on
success in New Zealand.
He also says that for chronic long term cases, the infection can
be very hard to clear and it's difficult to achieve