Fungal Nail Infection (Onychomycosis) - Health Tips

Toe nail fungus (also known as onychomycosis) is difficult to treat for two reasons. 1) a toe nail is nearly impenetrable to creams and other topical medications, and 2) toe nails grow very slowly.

When do you actually WANT nail fungus?

Many people come to our office with nails that are yellow and thickened and look “fungal”. The first thing we do is take a nail clipping and send it to the lab. When we find fungus, we have something to treat, and we treat it . When we do not find fungus, we are somewhat “stuck”.

There are some products that can improve the appearance of these “fungal looking” nails that don’t have any fungus. For example, there are whitening agents to get rid of the yellow color, and urea products which decrease nail thickness. But these treatments are only cosmetic. On the other hand, when we do find fungus, then there is a chance for a “cure”.

Toe nail fungus "cure"

The most effective way to treat toe nail fungus is with antifungal medications. And the most effective medication is terbinafine Lamisil). But every patient seems to have heard from somewhere that Lamisil “kills your liver”. This is simply not true. There is a tremendous amount of data and experience with Lamisil to support its safety, or we simply would not use it. The biggest problem we have with Lamisil is cost (it is about $10 per medication) and getting it covered by insurance (many companies will not pay for it).

A different approach

Lamisil is typically prescribed as a long course of continuous therapy: one medication a day for two months to treat finger nails; three months for toe nails. We treat nail fungus with a different approach called “pulse therapy”. Pulse therapy means that you take a one week “pulse” of the medicine every month or every two months. In other words you take Lamisil for seven days in a row (= one pulse) and then nothing for the rest of the month. There is data to support that pulse therapy is just as effective as “continuous therapy”, if not more so. The obvious appeal is that one can achieve the same results with less medicine. This means less potential for side effects and lower cost.

Beyond medications

For those who can not or will not take medications, there are alternatives, but they are less effective. The treatment depends on what the nail looks like, but often consists of two parts. Part one, a topical anti-fungal agent. And part two, an agent to thin out the nail, making it appear more normal and allowing the anti-fungal medicine to penetrate better. We usually prescribe a compound so that both agents are applied as one medicine.

FACTS

• Even with medications, only about 80% of patients can expect a “cure”
• When treatment is successful, it still takes 6 to 12 months for a toe nail to grow out completely and look normal again.
• The nail on the large toe grows at rate of approximately 1mm per month.

You've seen the TV commercial with the creatures having a party inside a toenail. It's not so funny if you're the one with the "creatures" in your toenails. But the bugs do have a name - dermatophytes. And they really do love the keratin that makes up your toenails.

These bugs are actually a fungus, and they can cause your toenails (and even fingernails) to become discolored, thick and misshapen.

Dr. Schlessinger comments on the risk of acquiring fungal infections at nail salons.

1 in 10 people who see a dermatologist come for problems with toenails or fingernails. Fungal infections cause about half of those problems.

Don't ignore symptoms such as a change in the shape or color of a toenail or its thickness. You might see swelling around the nail, bleeding or pus, or have pain.

Toenails are more likely than fingernails to be affected by a fungus (the medical name for nail fungus is onychomycosis). Why are toenails so vulnerable? Because toes are often inside cozy socks and surrounded by a tight shoe. Warm, sweaty feet happily welcome the growth of fungus.

Fungus is everywhere, and it just needs a little invitation to invade unsuspecting feet. That's why wearing flip flops in swimming pools and in locker rooms and showers at your gym is always a good idea.

Nail problems can appear any time in life, but the risk for toenail fungus increases with age, and many seniors develop the problem.

What are your toenail fungus treatment options?

Treatment can help you cure or control your fungus, and your dermatologist has many options because what works for one person may not help another.

Many medications can cause side effects, and your doctor is sensitive to these concerns. He will work with you to find a good solution for your condition.

Prescription anti-fungal medications may be in the form of pills you take, a topical solution drizzled into the nail area or a cream you use on your feet - or combination treatment may be prescribed. Athlete's foot is usually caused by the same fungus, so topical medications can help treat the athlete's foot.

Fungus grows under the nail in the nail bed. Topical medications may not reach the infected area, which is why pills may help knock out the infection through the bloodstream. Sometimes, both forms of medications may be used to treat infected nails.