{"id":9485,"date":"2026-08-10T13:21:47","date_gmt":"2026-08-10T13:21:47","guid":{"rendered":"https:\/\/majistraleczacilari.org.tr\/?post_type=docs&p=2098"},"modified":"2026-08-21T11:47:04","modified_gmt":"2026-08-21T11:47:04","password":"","slug":"nail-fungus-onychomycosis-2","status":"publish","type":"docs","link":"https:\/\/majistraleczacilari.org.tr\/en\/dokumanlar\/antiseptic-antibacterial-antifungal-antiviral\/nail-fungus-onychomycosis-2\/","title":{"rendered":"Nail Fungus – Onychomycosis"},"content":{"rendered":"
Treatment option with a compounded formula in the treatment of nail fungus (Onychomycosis = Tinea unguium).<\/strong><\/div>\n
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Onychomycosis accounts for 20% of all nail diseases. It is generally seen in adults. Its prevalence in the general population between the ages of 40-60 is 15-20%. Wearing closed shoes for long periods, hyperhidrosis, and humid and warm environments facilitate the onset of the disease. The disease, which becomes dormant during cold seasons, flares up again during the summer months. Nail fungi are most commonly seen on toenails, and among toenails, most frequently on the big toe or little toe. It is very rarely encountered on fingernails. It most frequently starts on the toenails, especially the first toe. It usually develops following tinea pedis. Yellow-brown discoloration of the nail, subungual hyperkeratosis, and easy nail breakage are the main symptoms. The periungual area is normal. It is the most treatment-resistant superficial fungal infection. Systemic antifungals are used for 3-12 months. Filing the diseased nails increases treatment efficacy.<\/p>\n

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The disease originates from untreated fungus on the skin of the feet and hands. The risk of infection increases especially after foot trauma. Colonization of Candida species fungi on the nail is also more frequently seen after paronychia (whitlow). In cases of paronychia, the skin of the nail fold is red, swollen, and painful. This inflammatory condition lifts the nail from its bed and causes pain.<\/p>\n

Nail fungi can sometimes be confused with bacterial infections, psoriasis, eczema, lichen, warts, spontaneous nail detachment (Onycholysis), and age-related nail thickening (onychogryphosis).<\/p>\n

Onychomycosis (Tinea unguium): It is a mycotic infection of the nails. It is a nail infection caused by all types of dermatophytes (most commonly T. rubrum and T. mentagrophytes). The pathogen usually colonizes the nail plate by multiplying in the hyponychium (nail bed) from the free edge of the nail. Toenails are more frequently affected, and the condition is often accompanied by T. pedis. The infection is generally seen in adults. Inflammation around the nail is not an expected finding in dermatophyte-origin onychomycosis. The disease, which has a slow course, can manifest with different presentations. The nail bed thickens starting from the free margin. The infected part of the nail takes on a whitish, dirty yellow, or brown color. The resulting subungual keratosis crumbles and sheds easily, leading to loss of nail substance. It also causes the nail plate to separate from the nail bed (onycholysis). This most common presentation is defined as “distal subungual onychomycosis”. Sometimes, it may present with changes starting on the nail surface and involving the entire nail plate. Whitening and dulling of the nail surface, a rough appearance, and increased brittleness are notable. This form is defined as “superficial white onychomycosis”. The treatment duration is long and expensive. Completing the treatment may even take up to a year. Since fingernails grow faster, they respond to treatment more quickly. When less than 80% of one or two nails is involved, local treatments are generally applied; however, oral antifungal medications for months are usually required. The combination of local and oral treatment is more effective.<\/p>\n

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Diagnosis is made by physical examination and, when necessary, microscopic examination of scrapings taken from the nail. If deemed necessary, a fungal culture may be requested before starting treatment. Since mold fungi in particular require different treatment compared to dermatophytes, performing a fungal culture is sometimes beneficial to identify the species of the fungus.<\/p>\n

The disease can manifest in several different forms.<\/p>\n

Lateral onychomycosis:<\/strong> Characterized by a white or yellow opaque discoloration on the lateral border of the nail.
\nSubungual hyperkeratosis: <\/strong>Appears as a scaly thickening beneath the nail.
\nDistal onycholysis: <\/strong>The nail is detached from the nail bed at the distal edge. The nail tip becomes crumbly.
\nSuperficial white onychomycosis: <\/strong>The nail plate shows whitish scaling and has small pits scattered over it.
\nProximal onychomycosis: <\/strong>The crescent-shaped white area (lunula) near the root of the nail disappears and takes on a yellowish color.<\/p>\n

Formula;<\/strong><\/p>\n

Rp.<\/strong><\/p>\n

Thymol                                0.1 g<\/strong><\/p>\n

Salicylic acid                      3.9 g<\/strong><\/p>\n

Tincture of Iodine T.K (1940)   20.0 g<\/strong><\/p>\n

Alcohol 96%     q.s.               100.0 g<\/strong><\/p>\n

Ingredients in the formula;<\/strong><\/p>\n

Thymol T.K.- Thymolum- Thymol-<\/strong> Isopropylmetacresol- Acido timico;<\/strong><\/p>\n

Thymol occurs as colorless crystals, often large, or as a crystalline powder with a pungent thyme odor. According to the British Pharmacopoeia (BP), its melting point is between 48-52\u00b0C. Its solubilities according to the BP are: Very slightly soluble in water; freely soluble in alcohol and ether; freely soluble in volatile and fixed oils; sparingly soluble in glycerol; soluble in dilute solutions of alkali hydroxides. Thymol is a phenolic antiseptic exhibiting antibacterial and antifungal activity. Thymol exerts its antiseptic and disinfectant effect by increasing the permeability of the cytoplasmic membrane of bacteria and fungi, thereby producing bactericidal and fungicidal effects. Thymol is applied topically. Although more effective than phenol, its use is limited due to its low solubility in water, greater irritancy, and susceptibility to proteins. Thymol is used as a deodorant in mouthwashes and gargles. In addition, it is useful topically in certain skin diseases due to its counter-irritant (applied to improve localized skin inflammation by producing mild irritation) and antiseptic effects. Thymol iodide is also utilized in the treatment of dermatological diseases. Thymol is found alongside other volatile substances in the composition of preparations used for colds, coughs, and various respiratory tract ailments. As an antioxidant, it is added to halothane, trichloroethylene, and tetrachloroethylene at a concentration of 0.01%. Thymol should be stored in airtight containers and protected from light.<\/p>\n

Acidum salicylicum- Salicyls\u00e4ure- Acide salicylique- <\/strong>Spirs\u00e4ure-<\/strong> Salicylic acid;<\/strong><\/p>\n

Salicylic acid is a white or colorless acicular crystalline powder or white fluffy crystalline powder. Its synthetic form is white and odorless. Salicylic acid is a beta-hydroxy acid with the chemical formula C6H4(OH)CO2H. This colorless, crystalline organic acid is generally used as a plant hormone. It is a metabolite of salicin. It shares similar chemical properties with acetylsalicylic acid, known as aspirin. It is used in the treatment of acne and in the treatment of fungal species such as tinea barbae, tinea capitis, and tinea cruris.<\/strong> When prepared from natural methyl salicylate, it has a pale yellow or light pink color and a faint minty odor. It dissolves in water at 1:460, in boiling water at 1:15, in alcohol and ether at 1:3, and in chloroform at 1:45. Salicylic acid is a keratolytic agent. It is used in the treatment of conditions characterized by hyperkeratosis and skin scaling, such as dandruff and seborrheic dermatitis, ichthyosis, psoriasis, and acne. Solutions and ointments used for this purpose are available. Salicylic acid accelerates desquamation (the peeling and shedding of the outer layer of any surface). It exerts a mild fungicidal effect. Salicylic acid is rapidly absorbed through the skin and slowly eliminated via urine. Excessive application of salicylic acid to large body surface areas can lead to systemic acute salicylate poisoning (salicylism). Fatalities, predominantly in children, have been reported due to such inappropriate applications. To minimize the risk of systemic absorption following topical application, salicylic acid should not be used for prolonged periods or in high concentrations, and application to large body areas, inflamed, or open skin should be avoided.<\/p>\n

Salicylic acid should be stored at room temperature below 30\u00b0C in tightly closed, airtight containers and protected from light.<\/p>\n

Iodine tincture- Teinture d’iode- Tincture iodi- Turkish Codex (1954);<\/strong><\/p>\n

Formula;<\/strong><\/p>\n

Rp.<\/strong><\/p>\n

Iodine                          7 parts<\/strong><\/p>\n

Potassium iodide   3 parts<\/strong><\/p>\n

Ethanol  (90%)          90 parts<\/strong><\/p>\n

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Alcohol-<\/strong> Ethanol<\/strong>– <\/strong>Ethyl alcohol<\/strong>– <\/strong>Spiritus vini<\/strong>– <\/strong>Weingeist- Ethanolum<\/strong>– <\/strong>Alcoholum<\/strong>;<\/strong><\/p>\n

Alcohol is a mixture of ethyl alcohol and water. In the British Pharmacopoeia (BP), alcohol is referred to as “Ethanol (96 per cent)” and is defined as containing not less than 96.0% and not more than 96.6% v\/v. It is a clear, colorless, mobile liquid with a characteristic odor and a burning taste; it is volatile and readily flammable, burning with a smokeless blue flame. It is miscible with water; during mixing, the temperature of the mixture rises and the volume contracts. It is miscible with chloroform, ether, glycerol, and most other organic solvents. According to the BP, dehydrated ethanol (Ethanol, BP 1993; absolute alcohol; dehydrated alcohol) should contain not less than 99.4% v\/v or 99% w\/w C2<\/sub>H5<\/sub>OH (density 788.16 to 791.2 kg\/m3<\/sup>). According to the United States Pharmacopeia (USP), dehydrated alcohol (Dehydrated Alcohol, USP 23) contains not less than 99.5% v\/v or 99.2% w\/w C2<\/sub>H5<\/sub>OH (specific gravity not more than 0.7964 at 15.56\u00b0C). According to the BP, dilute alcohol (Dilute Ethanols, BP 1993) is available in several different concentrations. One of these is 90% ethanol, also known as “Rectified Spirit”. Dilute Ethanol is a mixture of ethyl alcohol and water. It should contain not less than 69.1% v\/v and not more than 71.0% v\/v, and not less than 61.5% w\/w and not more than 63.5% w\/w of C2H6O. Alcohol strength is expressed as percentage by weight at a specified temperature.<\/p>\n

While Ethyl Alcohol is active at concentrations of 60-90%, a 70% concentration (vol\/vol) exhibits optimal efficacy for skin antisepsis. Conversely, when the concentration falls below 50%, it largely loses its activity. Regarding the effect of 70-degree alcohol<\/strong>, the English description found on hand sanitizer pages is quite clear: “70-degree alcohol is the most antiseptic ratio and kills 99.9% of bacteria in one minute”.<\/p>\n

Preparation of the formula (Modus operandi);<\/strong><\/p>\n

Thymol and salicylic acid are dissolved in approximately 70 g of alcohol, and tincture of iodine is added. It is then brought to 100 g with 96% alcohol.<\/p>\n

The preparation is applied to the fungal-infected nail several times a day. The solution should be stored protected from heat and light.<\/p>\n

Wishing you a good week\u2026<\/p>\n

References;<\/p>\n

1- Formulas in Dermatology (Prof. Dr. Nuran Atmano\u011flu).<\/p>\n

2- RxMediaPharma\u00ae<\/sup>2016 Interactive Drug Information Source.<\/p>\n

Spec. Pharm. Ahmet Nezihi Pekcan
\nPekcan Pharmacy – Konya
\npekcanecz@gmail.com
\nTel: (332) 3520657
\nhttp:\/\/www.majistralformul.com\/<\/a><\/strong><\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

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