Fusarium infection in my nail

Two nail cultures revealed that I have a Fusarium infection in my right big toe. No other toes are affected. I've been to 2 general MDs, 2 dermatologists, 1 podiatrist. I was given a course of Diflucan, and twice received treatment with Sporanox. I used Penlac for 4 years--no change.

I injured my toe while doing volunteer work in a developing country. At the time, I lived in a house on a property that used to be cow pasture. For about 7 years now, the fungus (or bacteria?) grows at the root of the nail. When it does, it is very painful, it turns the whole nail white and/or black gray--it looks like a typical fungal nail infection. Once it grows out, it breaks again at the root and then slowly detaches as the new nail grows in. Once the new healthy nail has partially grown out, the whole process starts all over again. It used to be unbearably painful with swelling and redness all around the nail.

Since no meds seem to work, I've been trying to resolve this on my own by keeping my feet dry, the nail short, and for the last 3 years, by applying tea tree oil to the affected toe nightly. The symptoms are still there but not as severe as the first couple of years when I couldn't even put a closed shoe on. Now, my nail breaks less frequently but it still is overtaken by the infection and then breaks (I'd say every 6-8 weeks or so).

The discomfort has lasted too long. Is this condition so rare that it cannot be treated? The doctors think it strange that ONLY ONE toe is affected but have offered no other suggestions. Should I visit a tropical disease specialist, a different dermatologist, a veterinarian? Is the only option to have the nail removed?

[Alan Rockoff, MD]

The changes in the nail that you describe sound like those related to trauma not to infection.  Infections don't happen every 6 weeks.  Of course, the lack of response to antifungals supports this notion too.  Fusarium is generally considered a contaminant and not a cause of infection--it just grows in nails that have been banged around, etc.

Perhaps you should have the nail removed, and then be very careful to avoid trauma as it grows back in.  Nail removal is a simple procedure, and the skin underneath hardens right away, so you wouldn't be in any discomfort while it grows back in.

Take care.

Dr. Rockoff