Nail fungus, otherwise known by its medical term, onychomycosis, can be unattractive, embarrassing, and even potentially dangerous. Since nail techs are in an ideal position to help prevent the condition, NAILS spoke to former pharmacist and now podiatrist, Dr. Bill Danzeisen, who helped develop Nourish, a line of antifungal nail lacquers and solutions, to get to the sole of the matter.

NAILS: How can nail techs identify nail fungus?
Bill Danzeisen: The first sign of onychomycosis is usually a spotted or mottled yellowish discoloration of one or more nail plates. Other color hues are not uncommon. As the disease progresses over time, nails become thickened, brittle, deformed, and accumulate ugly, malodorous fungal debris under the nail. At this point onychomycosis is more than just a cosmetic problem, it’s a medical problem. Nail deformity often leads to pain, ingrown toenails, secondary bacterial infection, and more.

NAILS: What are the primary functions and uses of antifungal treatments in the nail care industry?
BD: Nail fungus is something to actively avoid. The best cure for nail fungus is to prevent getting it in the first place. Prevention is key and not too difficult to achieve. Once onychomycosis is clinically apparent in nails, it can be a costly, time consuming, and difficult, if not an impossible condition to cure. Luckily, you don’t always need to cure onychomycosis to return nails to a clinically attractive appearance.

NAILS: What are topical antifungal treatments made of?
BD: Topical antifungal treatments for onychomycosis are most often solutions or lacquers containing active antifungal ingredients either natural or synthetic, suspended in a carrier base. Carrier oils that penetrate nail plates are most effective.

NAILS: Are there any natural ingredients that have antifungal activity?
BD: There are indeed a variety of essential oils that exhibit effective antifungal activity including tea tree oil, thyme oil, lavender oil, lemongrass oil, peppermint oil, eucalyptus oil, and others. Using a blend of antifungal essential oils is particularly effective because they attack fungi in different ways at the cellular level. Some are also effective against bacteria.

NAILS: Do antifungal treatments double as a disinfectant?
BD: They may double as a disinfectant against fungal infections, but not necessarily against other types of infections like bacteria, viruses, and parasites.

NAILS: Can antifungal treatments be used as a preventative product?
BD: They are used best as preventative products. Even the strongest of the topical antifungal treatments have only a 10%-15% cure rate, and that’s after using them daily for many months. However, if you’re not in that 10%-15% cure population, you can still expect to see clinical improvement in appearance, as well as prevention of progression of the disease and spreading.

NAILS: Why do some cases of onychomycosis require oral medication versus a topical antifungal treatment?
BD: There are now three general antifungal nail modalities including topical antifungal agents, oral antifungal agents (pills), and laser treatment. Laser offers the highest cure rate at about 85% with minimal risk, but high cost. Pills offer a cure rate of about 45%-50%, but at higher risk and potential for liver disease. Topical treatments offer a minimal cure rate of about 10%-15%, but no risk and lowest cost. Combining topical treatment with laser and or oral treatments has enhanced effectiveness.

NAILS: At what stage of nail fungus should a nail tech refer the client to a specialist?
BD: Clients should be referred to a podiatrist at the very first sign of nail infection including discoloration, thickening, etc. The sooner onychomycosis is identified and treated, the higher the success rate. It’s a progressive disease that gets worse and more resistant over time.

NAILS: Is nail fungus contagious? If so, what can nail techs do to prevent it from spreading?
BD: Nail fungus is contagious and nail techs are in an ideal position to help prevent it in a number of ways. Proper disinfection protocols of instruments and equipment must be strictly adhered to. Autoclaving of instruments is particularly effective in this regard. Proper cold sterilization is acceptable. Whirlpools must be properly sanitized between clients. Using treatments that contain effective antifungal ingredients is another excellent way to prevent nail fungus because they contain a strong blend of antifungal essential oils.

Finally, educating clients on proper at-home antifungal protocols is important. Some methods include drying feet and between toes thoroughly after bathing. Rotate shoes on a daily basis because it takes about 24 hours for shoes to dry from perspiration, so don’t wear the same shoes two days in a row. Apply antifungal spray or powder in shoes on a regular basis. Apply antifungal solution to nails soon after visiting high-risk areas like locker rooms, pool decks, etc.

Common ingredients: 

> miconazole
> tolnaftate
> terbinafine
> undecylenic acid
> ketoconazole
> clotrimazole
> ciclopirox
> efinaconazole