With so many patients having recurrent fungal nail infections, is treatment actually effective in the long term?
The most important factor is to get the diagnosis correct. Patients treated for recurrent fungal nail infections often do not have that problem but a primary skin disease affecting the nail. Good examples would be psoriasis or lichen planus affecting the nail alone or in conjunction with a co-existing fungal nail infection. Taking appropriate samples and confirming the diagnosis with mycology is extremely important, so that the fungus can be identified and the treatment targeted. Sometimes multiple samples of subungual tissue are necessary before infection can be excluded, but with accurate diagnosis and modern treatments, 80 per cent of fungal nail infection is cured. If the patient has underlying primary inflammatory nail disease as well, the appearance of the nail is not going to be normal even when the fungus is eliminated; so if positive pre-treatment mycology becomes negative after treatment, but the nail remains abnormal, further investigation of the nail apparatus is essential.
