How is nail fungus treated?

The medications we use to treat nail fungus are expensive, potentially toxic and rarely provide a permanent cure. So patients should balance this against the fact that we are dealing with a largely a cosmetic problem with potentially serious health consequences.

One of the problems inherent in onychomycosis is the patient's delay in seeking professional treatment. In its earliest stages, a fungal infection of the nail manifests itself as a color and/or texture change, and may be viewed as merely a bothersome cosmetic problem. For that reason, affected individuals may not even consider it a condition about which they should seek a professional's help, preferring instead to try over the counter remedies, or to wait and see if the situation rectifies itself. Unfortunately, because having mycotic nails means an unsightly appearance of the feet, women will often cover the discoloration with toenail polish. Other times, patients will mistake the condition as the result of dry skin, and will apply moisturizers to the toes and toenails. All these things actually aggravate the situation by increasing the moisture under the nail and accelerating the growth of the fungus. A change in nail color or texture, while seemingly only annoying at first, is something that should be immediately addressed by a doctor. Waiting only allows the infection to accelerate, and can add months to treatment time. Why? Onychomycosis is a particularly stubborn infection, and is not easily or quickly dispatched - something that is only aggravated by putting off treatment. It's also quite common-onychomycosis cases make up approximately 50% of all the toenail problems seen by podiatrists each year.

Treatment might in the past included topical creams or oral medicines (antifungal drugs). Topical antifungal agents both OTC (over the counter) and prescription medications are not very effective in fact the results are abysmal. They are most effective when used to treat milder cases. Occasionally surgery might be required. Removal of the infected nail can be performed to permit direct application of a topical antifungal or killing of the nail root. Oral medication (terbinafine/Lamisil, itraconazole/Sporanox, fluconazole/Diflucan, Griesofulvin and ketoconazole/Nizoral).

People should not wear shoes and/or socks that have become wet, through previous injury to the toe or toenail that opens a path for the fungus, by wearing improperly fitted shoes, or shoes that are too tight, too narrow or too shallow - or in any number of other ways. One of the problems with treating onychomycosis is that the fungus that causes it is difficult - if not impossible – to eliminate from the environment.

Remember - the more quickly you get the jump on a fungal infection, the better the likelihood that it can be treated successfully. Prescription oral anti-fungal drugs, such as Sporanox or Lamisil can be used to fight the infection. Be aware, however, that because this is one tough infection, there is a high relapse rate, and many patients may require a second course of treatment. There is also a brush-on lacquer (Penlac) that can be used with success; however, doctors caution against relying solely on a topical medication, especially in the case of a more severe infection such as onychomycosis. In extreme cases, surgery may be necessary to remove the infected nail.

Prevention Tips and prevention of reinfection

Onychomycosis is an opportunistic infection. Fungus loves a warm, dark, damp environment, so promote dryness, light and air circulation instead. Keeping toenails trimmed straight across, and keeping feet clean and dry at all times, will reduce the chance of fungus getting a toehold. Wash and dry feet after athletic activity, or after anything that causes the foot to perspire. Do not work out in a pair of shoes, then wear them for the rest of the day, or even over the next several hours. It's an invitation to infection. See a doctor promptly in the event of injuries to toes, nails or feet.

Take precautions to insure you won't have to wear wet, damp or even perspiration-soaked socks and shoes. Carry an extra pair of each with you, keeping one at work, one in your car, etc. That way, should your shoes and socks become wet at any time (rainstorms, etc), slip them off, clean and dry your feet thoroughly, and change to a dry pair of shoes and socks. Wearing breathable shoes made of natural fabrics - canvas, leather, sandals, etc., rather than man-made materials - will assist, too. Avoid walking barefoot - even at home - as this directly exposes toenails to all manner of organisms on floors, carpeting, tiles, etc. Alternate shoes, too, so that you're not always wearing the same pair of dress, sport or casual footwear.

Athletes and/or health club members can cut their risk of infection (or re-infection) by wearing foot protection (flip-flops or other quick-drying sandals that provide separation between feet and the shower/locker room/rest room floor) when using public shower facilities, and by discarding heavily used sports shoes which may have a high density of fungal spores. Remember - even expensive running or workout shoes (and even dress shoes or casual footwear) can be a culprit, if they aren't changed often enough. Your podiatrist can advise you on how often various types of shoes should be discarded and new ones purchased. Ask us about ultraviolet light shoe trees instead of replacing your shoes frequently. A combination of Laser Therapy, Steri-shoes, anti-fungal creams, sprays for shoes and powders can be used on the feet daily at least once. Dust the inside of shoes with anti fungal powder on a regular basis and spray with MycoMist. Toenail infections are more difficult to treat than fingernail infections because the toenail grows more slowly. In addition, a damp, warm environment of a shoe or boot can encourage fungal growth.

Home remedies?

Tea tree oil. First make sure that all debris is removed, all material from under and around the toenail allowing the oil to get under the toenail. Use it every morning and night for 1-2 years. There are commercial preparations that we stock called Tineacide that helps penetrate the nail to the nail bed. Vick’s Vaporub as recommended by Dr. Gott. Use it twice daily. I have seen it work a couple of times but mainly it keeps our sinuses clear in the office. There's a lot of interest in using more natural vinegar toenail fungus treatment options.