What are the recommendations for supportive care of onychomycosis?

Supportive Care for Onychomycosis

For effective management of onychomycosis, a comprehensive approach including both medication and supportive care measures is essential, with regular nail debridement and proper foot hygiene being the cornerstones of supportive care. 1

Nail Care and Debridement

• Regular nail debridement: Monthly removal of unattached, infected nail by a healthcare professional with expertise in nail disorders is a critical component of comprehensive management 1, 2
• Keep nails short: Patients should maintain short nails to reduce fungal load and improve topical medication penetration 1
• Nail filing: Regular filing of thickened nails can improve the appearance and reduce discomfort while medications work

Foot Hygiene Measures

• Antifungal powders: Apply antifungal powders containing miconazole, clotrimazole, or tolnaftate in shoes and on feet 1
• Absorbent socks: Wear cotton, absorbent socks to reduce moisture that promotes fungal growth 1
• Avoid barefoot walking: Especially in public areas like swimming pools, locker rooms, and communal showers 3
• Separate nail tools: Avoid sharing toenail clippers with family members and friends to prevent transmission 1

Footwear Management

• Discard contaminated footwear: When possible, discard old footwear that may harbor fungal elements 1
• Decontamination methods:
  • Place naphthalene mothballs in shoes within a tightly tied plastic bag for at least 3 days, then air out 1
  • Alternatively, spray terbinafine solution into shoes periodically 1
  • Apply antifungal powders inside shoes regularly 1

Special Considerations for High-Risk Groups

Diabetic Patients

• More rigorous foot care is necessary as onychomycosis is a significant predictor for foot ulcers 1
• Topical treatments may be more appropriate when risk of drug interactions is high 1
• Regular inspection for early signs of complications is essential

Immunocompromised Patients

• More aggressive supportive care may be needed due to higher risk of complications 1
• Consider more frequent nail debridement and monitoring

Preventing Recurrence

• Treat all infected family members: Since onychomycosis is contagious, all infected family members should be treated simultaneously 1
• Prophylactic treatment: Amorolfine has been found effective as prophylactic treatment for recurrence of onychomycosis 1
• Ongoing foot hygiene: Continue preventive measures even after clinical cure to reduce the 25% relapse rate 3

Adjunctive Treatments

• Urea preparations: A 40% urea ointment is available over-the-counter and can help soften nails for better topical drug penetration 1
• Nail avulsion: In severe cases, partial or complete nail removal may be considered to improve treatment outcomes when combined with antifungal therapy 4

Common Pitfalls to Avoid

• Inadequate duration of supportive care: Supportive measures should continue throughout the entire treatment period (6-12 months) and beyond
• Focusing only on affected nails: Treat concurrent tinea pedis, which often serves as a reservoir for reinfection 1
• Premature discontinuation: Visible improvement may occur before mycological cure; continue treatment for the full recommended duration
• Neglecting footwear decontamination: Failure to address contaminated footwear is a common cause of treatment failure and recurrence

By implementing these supportive care measures alongside appropriate antifungal therapy, patients can achieve better treatment outcomes and reduce the risk of recurrence.