This man came in with a script for something else however as he was about to leave, he asked me about his toe. His toenail was discoloured and the nail was lifting off the nailbed. It was very obvious he had nail rot.
I explained to him that if he left it untreated, his nail would come off completely and another one might not grow back. Until it was treated.
Walking around with a rotted nail – likely to fall off – was another bother that he didn’t really have time for (not unlike many of us).
He looked at me and asked, “Do I need a nail?”
To which I had to laugh.
“Well… maybe you don’t,” I shrugged, “but it won’t go away until you treat it.”
He wasn’t totally convinced his toes needed help at this point.
Nail rot is a commonly used name for fungal infections called Onychomycosis. About 10 % of the population has onychomycosis1. Risk factors include already having tinea, having a pre-existing nail issue, older age, being male ☹ and having a circulatory disease (EG people with diabetes). Toenails are 10 times more likely to get infected than fingernails 1.
The treatment is with a course of antifungal tablets taken for up to 3-4 months, depending on which antifungal is used and whether it is the fingernails or toenails that are affected. A nail lacquer that’s applied twice a week is also used in conjunction with this.
To limit relapse, patients should:
- Ensure nails are trimmed regularly so they are short
- Dry feet after bathing
- Wear absorbent socks
- Use anti-fungal foot powder
- Avoid old shoes that may harbour a lot of spores
In this particular case, I explained to the gentleman that this was a slow-growing and generally non-invasive type of condition and it is very common for me to see people who have had it for 10 years +, without it affecting them!
He told me he noticed his nail discolouration about 20 years ago when he was in the Army. It hadn’t spread very fast so he didn’t pay too much attention until it spread across his entire nail. And here we were, in the pharmacy, with a loose nail that reminded me of my son’s last loose tooth that was hanging on by a thread.
In my attempt to convince him to see the Doctor (he had just come out from the Doctor surgery next door) I completely understand how it wouldn’t be on the top of the priority list.
I drew his attention to his other foot where his big toe and a few other nails were also affected. The poor man looked away for 20 years and when he looked back, his toenails were riddled with this infection!
The gentleman tried to rebook another appointment with the Doctors next door but there were none available so he said he would organise one for later in the week.
He took it all in good humour, I have to say, because practically speaking, all he needed for this weekend was for his toenail to stay where it was, so I gave him some paper tape to hold it together and off he went.
- The Merck Manual – 18th Edition