Diabetes increases the risk of many complications, including skin disorders and infections. Among these are fungal infections such as vaginal yeast infections, oral thrush and nail fungus (onychomycosis).

Medical researchers at Vanderbilt University reviewed the incidence, diagnosis, treatment and prevention of nail fungus in diabetic patients. Highlights of their report:

• About one-third of people with diabetes have nail fungus.

• Diabetic toenail fungus increases the risk of other foot problems and even foot or leg amputation.

• Diagnosis begins with visual inspection and is confirmed with laboratory studies such as periodic acid Schiff (PAS) staining.

• Generally the preferred treatment is 250 milligrams of oral terbinafine daily for 12 weeks. If a yeast or mold caused the problem, pulse itraconazole is administered instead. Patients should be treated until cured and monitored in case of later reinfection. Surgical removal of nails is seldom advised for diabetic patients except in extreme cases because diabetes impairs healing.

• Regular foot care by the patient and complete foot exams by a physician are crucial preventive tools.

The report was published in the fall issue of Clinical Diabetes.

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