Ugly toenails, fungal infection in diabetics

In older patients with long-standing diabetes, toenails that are thickened and discoloured often suggest a fungal infection. Researchers from the Rosalind Franklin University of Medicine and Science in North Chicago, USA, emphasised that just because a nail is thickened and discoloured does not mean that there is a fungal infection. These changes may be the result of mild trauma to the foot, such as occurs from wearing ill-fitting shoes. They evaluated 96 patients with decreased foot sensitivity, a common finding among diabetics, and thickened, discoloured nails. The patients, who were seen for routine care at a diabetes clinic, were all male, an average of 71 years old, and had diabetes for an average of 16 years. The investigators obtained nail clippings of the most affected nail and debris under the nail. Twenty-five of the patients had nail thickening but no evidence of infection. The other 71 patients had fungal nail infections. The researchers noted that antifungal treatment is usually effective, but oral agents must be used with caution because of their association with heart failure and hepatic toxicity. Successful resolution of the fungal infection is not the only goal of treatment. Diagnosis of fungal infection of the nail will motivate patients to pay more attention to their feet, which will ultimately help prevent ulcers from developing. Doctors should be alert to the finding that in patients at high risk for developing diabetic foot ulcerations, fungal infections of the toenails are also common.