“Gray finger (toe) nail”, is the common name of the people on the “nail fungus”, is caused by the skin fungus invasion of the nail plate and nail bed caused by the infection, with the continuous development of clinical mycology, in addition to the skin fungus, mycologists have found that the yeast, conditionally pathogenic molds can also cause Infection of the nail plate, and thus the clinical mycology now refers to all infections of the nail plate and nail bed caused by any fungi as nail fungal diseases. These fungal invasion of the nail plate can cause thickening or atrophy of the nail plate, brittleness, unevenness, nail separation, nail breakage and disfigurement, cloudy color and other different forms of skin lesions. Nail fungal disease is mostly caused by secondary infection of tinea pedis, and at the same time become the “root cause” of human skin fungal disease, so it should be actively treated. Decades ago, the treatment of gray fingers (toes) nail is a “difficult” thing, in recent years, many antifungal new drugs, special drugs emerge one after another, whether oral or topical drugs and the old drugs compared to the past, the efficacy of the more reliable, the application of the more simple, fewer adverse reactions in the doctor’s guidance, as long as the patient adheres to the sufficient course of treatment, the complete cure of nail fungus is no longer technically possible. Under the guidance of doctors, as long as the patient adheres to a sufficient course of treatment, there is no technical problem in curing nail fungus. Nevertheless, due to the dense nail plate tissue, general drugs are not easy to penetrate, and the nail plate growth rate is extremely slow (nails grow forward at an average rate of 0.1mm per day, the old nail renewal takes about 1-2 months, and the toenail growth is even slower, and the old nail renewal takes at least half a year or more), it is the long course of treatment for nail fungal disease, coupled with the expensive cost of long-term medication on the organism has a certain adverse reaction, the patient’s adherence to the poorer. At present, the problem of nail fungal disease treatment is: the old drugs in the general working class still accounts for a large market, the new drugs have not yet been popularized, how to make rational use of the old drugs, new drugs to treat grey finger (toe) nails, and minimize the adverse effects, which requires doctors to weigh the patient’s condition and economic conditions, and to choose an individualized treatment plan. Now the author on the systematic and local treatment of nail fungal disease clinically effective methods are described below. Systemic treatment 1.Itraconazole capsule (trade name Spirenol) is a new generation of triazole broad-spectrum antifungal drugs, with the broadest antimicrobial spectrum, highly selective, potent, safe and so on, especially suitable for the grassroots hospitals that don’t have to do the culture and drug sensitivity of the fungus. Treatment of nail fungal disease using a short course of impact therapy, each 200 mg, 2 times a day, that is, after meals, serving 7 days, stop 21 days, for a course of treatment, nail fungal disease shall be 2 to 3 courses; toenail fungal disease shall be 3 to 4 courses of treatment, the mycological cure rate of 97.7%, the recurrence rate of 12%, so after stopping itraconazole capsules can also be given to local topical drugs to consolidate the treatment. Adverse reactions are mainly gastrointestinal reactions, long-term use of drugs occasionally see edema, urinary difficulties, headache, rash, itching, serum glutamine transaminase elevation, hypokalemia, etc., the total incidence of adverse reactions is 2.4~17.7%. Rifampicin, phenobarbital, phenytoin sodium can reduce the blood concentration of itraconazole, should be avoided; with warfarin, digoxin, cyclosporine A together with synergistic effect, should be discretionary reduction of dosage. It should be avoided in pregnant women. 2. Terbinafine Tablets (trade name Lancet) is a kind of acrylamide with broad-spectrum antifungal activity, the treatment of dermatophytosis is characterized by high efficacy and low toxicity. Take 250 mg orally once every night for 7 days and then change to once every other day. Nail lesions should be 6 weeks~3 months, toenail lesions should be longer than 3 months, and can also be taken for 6~8 weeks. The course of treatment can also be appropriately extended according to the condition. This product is well tolerated, the most common adverse reactions are gastrointestinal reactions, transient, mostly in the first week of taking the drug, occasional urticaria or other rashes, oral odor sensation, the effect on hepatic and renal function is small. Hepatic and renal insufficiency should be reduced by 50% of the dosage; pregnant women should not be taken; with rifampicin, phenobarbital, phenytoin sodium can reduce the blood concentration of terbinafine, should be avoided; cimetidine can inhibit the clearance of terbinafine, thus increasing its effectiveness, the two drugs should be used together with a discretionary reduction in the dosage. It is not advisable to use contraceptives together, so as not to cause contraceptive failure. 3. Fluconazole (trade name three-dimensional Kang) capsule is the third generation of triazole broad-spectrum antifungal drugs, with high efficacy, minimal hepatotoxicity, no teratogenic effects, high safety index, is the safest systemic antifungal drugs. It has better efficacy in treating nail fungal disease, but it is not as effective as itraconazole, and the treatment cycle is longer than itraconazole, so the clinical application is limited. 150 mg weekly for 3~9 months, or 100 mg every other day for 3 months. Combined with dihydrochlorothiazide can increase the blood concentration of fluconazole by 40%, and the dosage should be reduced when the two drugs are used together. Fluconazole is one of the azole antifungal drugs with the least adverse reactions, occasionally gastrointestinal reactions, headache, rash. Use with caution in pregnant women and children. 4. Ketoconazole (trade name Risulau) is a synthetic broad-spectrum antifungal imidazole drugs, 200 mg per day, immediately after meals, the course of treatment for 6-12 months, the efficacy of better, the use of drugs should be regularly checked liver function and blood, symptoms of hepatic impairment immediately stop the drug, should not be used in combination with antacids, cholinergic receptor blocking drugs, H2-blocking drugs, pregnant women should not be taken. Because of its hepatotoxic reaction, with the emergence of new special antifungal drugs such as itraconazole and terbinafine, it has been less applied, and mycological experts do not advocate the application of ketoconazole for the treatment of nail fungal disease. 5.ashwagandha particles orally is an antibiotic class of antifungal drugs, 250mg each time, 3 times a day, after meals, 2 months after the new nail grows 1/3, you can stop the oral medication, the application of local treatment. During the use of drugs should be regularly checked liver and kidney function and blood, avoid alcohol during the drug, liver and kidney insufficiency, photosensitive skin disease patients, pregnant women should not take. Due to the long-term application of ashwagandha, adverse reactions, treatment of nail fungal disease efficacy is not significant, has been less used. Local treatment 1. Surgical extraction of nail treatment method for the disease of nail less, the deck has been obviously hollow, nail separation of patients with serious damage, can consider surgical extraction of diseased nails, after the extraction of diseased nails must be carefully removed from the nail bed and the deck of the diseased tissue, pay attention to the protection of the mother of pearl, otherwise it will affect the growth of the nail, the trauma healing should be coated with antifungal topical drugs in a timely manner, such as imidazole ointment (clotrimazole, miconazole, econazole, bifenbenzazole) or terbiphenylbenzazole, or the use of a combination of antifungal drugs to treat the disease. (imidazole ointment (clotrimazole, miconazole, econazole, bifonazole) or terbinafine ointment, cyclopyrrolidine ointment, 5% iodine tincture, 5% salicylic acid ointment. At the same time in the surgical extraction of nails, a short period of time to take itraconazole capsules, terbinafine tablets, fluconazole capsules and other one of the antifungal drug therapy, can greatly improve the cure rate, to prevent its recurrence, the course of treatment should not be less than 3 months. 2. Urea dial nail therapy nail dissolution available 40% urea cream or compound urea cream preparation (40% urea, 12% lactic acid, 6% salicylic acid) first with waterproof adhesive tape to protect the skin around the nail, then coated with nail dissolving drugs, and then translucent cellulose powder dressing cover, and then add gauze and then fixed with adhesive tape, 3 ~ 4 days or a week to change the medication for a time, 2 ~ 3 times the nail can become soft, the nail plate and the separation of the nail bed, and then scissors will be cut into two halves, and then cut with hemostatic forceps the armor plate. Then use scissors to cut the nail plate into two halves, and then use hemostatic forceps to pull out the diseased nail, and scrape the base, and then use the above mentioned antifungal drugs both inside and outside, until the new nail grows out, the course of treatment should not be less than 3 months. 3. Scraping nail therapy daily with warm water to soak the nail soft, with a sharp knife or file as much as possible to scrape or file off the sick nail or first coated with MacSu liquid, to be dry, and then a knife or file gently scraping to the degree of non-bleeding or pain, and then coated with 10-30% glacial acetic acid, 8% cyclopiazepine or 5% tincture of iodine, until the new nail grows out. To be chipped nail, still apply more than 2 kinds of antifungal drugs alternating topical, the course of treatment is not less than 3 months. 4. Single topical therapy ① 5% amorphophallus powder (trade name Luo perle): suitable for the treatment of lesions not involving the nail root of light, moderate nail fungal disease. The antibacterial spectrum is wide, strong penetration, easy to use, reliable efficacy, after the application of the drug in the nail plate to form a waterproof film, in the local long time to maintain an effective concentration of bacterial inhibition, the drug has a rapid onset of action, 24 within the nail plate to play the role of fungicide. Applied externally once a week, finger nail ringworm treatment course for 6 months, toenail ringworm for 9 to 12 months, a very small number of patients with local mild burning sensation, pregnant women and those who are preparing to get pregnant is prohibited. ② 8% Cyclopiazepam: suitable for the treatment of mild nail fungal disease involving a small number of nail plates, small area, no nail root involvement. The first month every other day to apply 1 time, the second month 2 times a week to apply the drug, the third month once a week to apply the drug, the course of treatment does not exceed 6 months. A few patients occasionally see redness and flaking of the skin around the nail. Pregnant women, lactating women and children should not use. Before using the above two drugs, the free ends of the infected diseased nails should be cut off as much as possible, and the diseased nails should be abraded as much as possible with the files provided by the manufacturers, so as to facilitate the penetration of the drugs and thus improve the therapeutic effect. In summary, for superficial, light, single, not involving the nail root of the nail fungal disease, can be applied to the local treatment, to the new drug 5% amorphophallus rubbing agent, 8% cyclopiazepine ketamine application agent has the best efficacy, and the application is simple and convenient, patient compliance is high, and imidazole ointment, 5% tincture of iodine, 5% potassium iodide, 30% glacial acetic acid, 40% urea ointment due to the price is cheap, easy to get the drug, and the same for the working class people like. The common people like it. Involving the nail root and the number of sick nails, wide range, large area of serious nail fungal disease, as well as local treatment is ineffective nail fungal disease need to systematically apply antifungal drug treatment. Clinical itraconazole, terbinafine has the best efficacy, mycological cure rate of more than 95%, for both doctors and patients like to use, especially itraconazole short-course shock therapy, easy to take, the patient’s compliance is higher, but due to the expensive price of the above drugs, the clinical application of certain restrictions. Local and systemic application of nail fungal disease in the clinical specific operation combined with the condition, can be applied comprehensively, which helps to improve the efficacy, shorten the course of the disease, reduce the occurrence of adverse reactions. Topical antifungal drugs, should first be infected with the free end of the nail as far as possible to cut, with a knife or file as far as possible to scrape or file the nail, so as to receive twice the result with half the effort. Nail fungal disease patients are often combined with tinea pedis, tinea corporis and other dermatophytosis, should be given at the same time the topical antifungal drug treatment. Systematic application of antifungal drugs have a certain degree of hepatotoxicity, patients with hepatic insufficiency should be avoided, pregnant women are prohibited, the elderly and children should be used with caution. In view of the nail fungal disease treatment cycle is long, high cost, and have certain adverse reactions, in the clinic, there are many common skin diseases such as psoriasis, hand eczema, lichen planus, pemphigus and other patients of the nail plate can also be manifested as a “gray finger (toenail)”, so in the treatment of “gray finger (toenail) nail Therefore, before the treatment of “gray finger (toe) nail”, we must do fungal examination to make a clear diagnosis, to avoid misdiagnosis and mis-treatment, which will bring unnecessary losses to the patients, before and during the treatment of regular rechecks of the liver and kidney function, do not buy their own medication, and must use drugs under the guidance of the doctor.