I had acrylic nails about three years ago, and I developed fungus on one nail. Since then, my nail will not grow back properly. It grows, but it doesn't attach to my skin. It lifts all the way off, and now it seems like my other nails on the same hand are developing something. Also my cuticles are getting white, and the skin around my nail seems to be receding. They always feel swollen and are red around the nail bed. I would appreciate any suggestions.

Cede

The medical term for fungal infection of the nail is onychomycosis. This infection has received a great deal of press and advertisement time, as there are finally therapies that actually successfully eradicate these infections. There are various forms of onychomycosis, but the most common involves the sides and end of the nail. The fungus invades the nail itself, causing discoloration and thickening. Sometimes, the entire nail is thick, with large amounts of debris under it. Other forms of fungal nail infection leave the tip intact. There is also a superficial form in which whitish discolorations appear on the surface of the nail and there is minimal destruction of the nail itself.

A variety of fungi can cause nail infections. Most common are the dermatophytes, the group of molds that cause fungal skin infections such as athlete's foot and ringworm. In addition, Candida albicans, the fungus responsible for vaginal yeast infections, can cause an nail infection indistinguishable from other types. This organism occurs especially on the hands of people who immerse their fingers in water frequently.

A doctor can usually diagnose a fungal nail infection simply by examining the nail. However, it can be difficult to distinguish the typical dermatophytes from the less-common causes of the infection. This is important in that some treatments work only for dermatophytes while others do best with Candida albicans. In addition, there are some other causes of nail abnormalities that are not due to infection. Psoriasis of the nail, for example, is frequently misdiagnosed as a fungal infection. Sometimes a clinician will snip a small piece of the nail and have the debris examined microscopically. This, along with culture (taking a sample and growing any microbes in a laboratory), will usually establish the diagnosis.

While most of the fungal skin infections can be treated with a topical medication, that is not the case with onychomycosis (or with scalp infections). In the past, griseofulvin (trade name Fulvicin), a relatively toxic oral medication, was the only effective treatment for fungal nail infections. Now, there are two other choices, terbinafine (Lamisil), and itraconazole (Sporanox). Both of these drugs, which are available in pill form, are about 75 percent effective in eradicating the fungus.

Remember that it takes months for a nail to grow out, so it may take many months for an infected nail to return to normal. Fingernail infections are treated for at least six weeks, while toenail infections are treated for at least 12 weeks. Terbinafine can affect the liver, so if it is given for more than six weeks, your doctor should measure your liver function. Itraconazole can also affect the liver. In addition, it interacts with quite a few other medications and must be used cautiously or avoided altogether in patients taking some of those drugs. If Candida is the cause of the infection, as it may be in your case, fluconazole (Diflucan) is probably the best choice. This medication is the best tolerated of the three, but it is probably not as effective for the more common causes of nail infection.