Toe Nail Fungus

A fungal infected toenail (onychomycosis or onychomycotic toenail) can be a stubborn cosmetic and functional, even painful, problem. Early in the course of the disease process, the nail may become yellowed or may have superficial white spots. This may progress under the toenail until the entire nail is discolored, crumbly, and eventually becomes thickened. At first the discoloration is more of a cosmetic problem, but as the disease progresses, the nail becomes thickened and difficult to trim. Later yet, the nail may become difficult to fit into a shoe and actually cause pain or ulceration due to the extreme thickness.

The fungal organism, or fungi, is called a hyphae (hi phee) or hyphal element. The type that likes to live on our skin, hair and nails are called dermatophytes. Yeast can also do this but is less frequent. People who frequent public places such as swimming pools, gyms, public showers and those who perspire a lot are more often infected as the fungi grows best in a warm, moist environment.

Until 5 years ago, treatment of a fungal toenail was limited to Fulvicin™. It required over a year of daily pills and frequent blood tests to monitor the liver. The success rate was less than 25%. After stopping the Fulvicin, the fungus often returned.

More recently, oral medications and newer topicals have become available. These have a higher clearance rate than the older medications. Terbinafine is the generic for the no longer produced Lamisil. It is often available on the $4.00 of many pharmacies, including Target, Wal-Mart and Kroger. Terbinafine is the most commonly used oral medicine for toe nail fungus.. This used to require frequent monitoring of blood work but with the new dosing regimens used today only one laboratory study is used prior to starting this medication.

Over the counter, Formula 3 is also a new product offered in the office. This is a very good topical that is applied twice a day as a new healthy nail grows in. This is accompanied by a money back guarantee by the manufacture.

Unfortunately, none of the above treatments are a 100% cure. A nail fungus is a difficult disease to effectively treat. The dermatophyte is found nearly everywhere in nature, and we are all, mostly, immune to infections by it. Unfortunately, some of us are not. Age, infirmary, diabetes, family history and trauma to the nails are all important in deciding who gets a fungal nail infection.

New treatments on the horizon and available in some areas is laser treatment. This works by rapidly heating the nail itself with a laser, and thereby destroying the fungal element. Even this, while sounding high tech and impressive, only affords about an 86% clearing rate. As it is new, it is still expensive ( averaging around $1000.00) and is not covered by insurance. I am carefully watching the development of this technology so if the clearing rate becomes more impressive, and the cost less prohibitive, I can offer it to my patients.

Many "do it yourself remedies are out there but none have been studied. They include:

  • Vinegar and water
  • Listerine and vinegar
  • Vicks VapoRub
  • Oil of oregano
  • Tea tree oil
  • Listerine

The proponents of these home remedies all include the warning that you must continue to apply the remedy daily until the nails are clear. This can be as long as eight or more months.

It is always a good idea to get a firm diagnosis from your podiatrist before starting home treatments since there are several other diseases, psoriasis and eczema to name just two, that can resemble a fungus infection.

To help prevent a nail fungus in the first place, try wearing socks that wick moisture away from your feet. Cotton socks hold it in. Change socks often. Wear properly fitted shoes to prevent damage to the nail plate. Powder your feet daily. Wear flip-flops in public showers and around swimming pools. If you are diabetic, control your blood glucose levels. All of this can help, but not prevent a nail fungus from getting a "foot hold" on your nails.

Avon Podiatry
Avon Station Medical Center
8244 E. US Highway 36, suite 120
Avon, Indiana 46123



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