A thick, yellowish nail with splotchy white areas is a classic presentation for a fungal toenail. In the early stages the toenail is only slightly discolored, or slightly thickened. In the late stages the nail can become very thick and has a tendency to "grow up" more than in grows out. The nail will be very discolored, typically dark yellow-brown and will start to change shape and crumble. In some cases the nail becomes very loose and many will lose the nail, only for it to regrow with the fungus.
The medical term for toenail fungus is "onychomycosis," pronounced on * EE * ko * my * ko * sis. The prevalence in America is about 2-3%, but some have reported it as high as 13%. Toenail fungus affects men twice as often as it affects women and the prevalence among elderly individuals and diabetics is 25%. In the 1800s, fungal toenails were very rare. The increased prevalence is linked to the increased exposure to fungus through the use of showering facilities in gyms, the use of hot tubs, saunas and public pool areas. There has also been an increase in the number of individuals participating in sporting activities and wearing occlusive footwear. More individuals have diabetes and there has been an overall increase in age of the general population, both of which are associated with a less than optimal immune system. It is no surprise that the risk factors for developing toenail fungus are increasing age, male gender, nail trauma, sweaty feet, poor circulation, poor hygiene, foot fungus and a compromised immune system. Athletes will also have a higher risk.
There are a number of treatments for toenail fungus. The most aggressive and effective way to treat the fungus is with oral anti-fungal medications. The most common oral anti-fungal medications are Itraconazole (Sporonox ®) and Terbinafine (Lamisil ®). Both medications can be quite expensive as they need to be taken once daily for 3 months. The effectiveness of the medications ranges from 60 to 80%, with a recurrence rate of 15%. Lamisil® appears to be more effective and has fewer drug interactions than Sporonox®. With both medications there is a long list of benign side effects including nausea, vomiting, abdominal pain, diarrhea, rash, headache, taste disturbances and dizziness. Serious adverse events are very rare, less than 0.5%, but do include hepatitis and acute hepatic necrosis.
There are many other options besides oral anti-fungal medications. Unfortunately, they are not very effective. The most effective topical medication is Ciclopirox (Penlac ®) lacquer. Some studies have shown cure rates up to 60%, but in my experience the effectiveness is about 10-15%. Side effects occur in less than 2% of patients and include burning and redness around the nail. This medication is only available by prescription and is also quite expensive. A few other prescription medications that help decrease the thickness of the fungal nails are Carmol® 40 and Keralac® Nail Gel. You should not expect to see complete cures with these products, but they can decrease the thickness and discoloration of the nail in some cases.
There are many home remedies and over the counter products that you can purchase. Some home remedies that can be used include bleach, tea tree oil, grapeseed extract, and Vics VapoRub®. With any home remedy or non-prescription topical, you must understand that the effectiveness of the treatment is fairly low, less than 10%. If you do try one of these therapies make sure to use it every day. Roughen up the nail surface with a file and apply the medication with a q-tip. Bleach can cause skin irritation and some individuals have had skin reactions to the Vics VapoRub®. In general these treatments are considered very safe.
Combination therapy can help increase the effectiveness of the treatment. If you choose to take an oral medication, make sure you use a topical anti-fungal agent as well. Nail removal is also an option. Once the nail is removed, the topicals can reach the nail bed and they become more effective. The nail will grow back in over a period of 8-10 months. Permanent nail removal is reserved for those with chronic ingrown nails, ulceration under the nails or pain from the fungal nails.
The best form of treatment is prevention and preventing the fungus from spreading to other toenails may be the best treatment option. I recommend choosing a topical that you feel comfortable with and use it once a week. No matter which treatment option you choose, you should take the following steps to avoid re-infection.
1. Place an anti-fungal powder or spray in the shoes to help fight off the fungus.
2. Make sure you rotate your shoes often and keep them in a cool dry place.
3. Change your insoles frequently, and make sure they dry out between use.
4. Bleach out the shower on a weekly basis.
5. Wash your shower mat regularly in hot water.
6. If you belong to a gym or health club, wear sandals in the locker room and don't walk around barefoot.
7. Don't keep your shoes in the gym locker where they cannot dry out.
8. Make sure your athletic shoes fit well to prevent jamming at the toes. Jamming at the toes leads to microtrauma at the nails and increases the chance for fungal infection.
9. If your feet sweat excessively, try using an antiperspirant spray on your feet before your workout.
10. Cut your toenails straight across. Don't cut too short and cause breaks in the skin. This will increase the chance for fungal infection. Don't let the toenails grow too long or they will jam against the shoe and cause bleeding under the nail, again increasing the chance for fungal infection.
The bottom line is that prevention is easier than treatment. Treating toenail fungus is very difficult and will take months regardless of the type of treatment you choose. If you have fungal toenails that cause pressure, pain or infection, consider talking to your doctor about prescription medications or nail removal. If your fungal toenails are only unsightly and don't cause any discomfort, consider topical therapy for treatment. The last option is to prevent the nails from becoming worse or becoming a problem. Try a weekly application of an over the counter topical along with methods to prevent re-infection.
Christine Dobrowolski is a podiatrist and the author of Those Aching Feet: Your Guide to Diagnosis and Treatment of Common Foot Problems. To learn more about Dr. Dobrowolski and her book visit http://www.skipublishing.com/. To learn more about products for toenail fungus visit http://www.northcoastfootcare.com.
The Food and Drug administration urges people to stop taking... Read More
While there are numerous options for people to lower cholesterol... Read More
A neuroma is an inflamed nerve. In the foot, the... Read More
The police arrive at the accident scene promptly. A driver... Read More
The news has been full of the recent FDA findings... Read More
Would you buy groceries without knowing their prices? I suspect... Read More
The FDA issued a warning in July of 2005 on... Read More
Thirty percent of human population has a high blood pressure... Read More
Nowadays many people are familiar with the appellation of "low... Read More
A hypnotic "trance" is not something that is foreign to... Read More
New antidepressant development, until fairly recently, was at best a... Read More
Tea tree oil is the essential oil comes from the... Read More
Lunesta is a newly released sleeping pill. Marketed as a... Read More
Pfizer's exciting drug history traces back to the most popular... Read More
For many of us change is a difficult process. In... Read More
We have a marvelous array of medical tests available to... Read More
When Aspirin Isn't EnoughIt's surprising how clearly we can recall... Read More
The word Antibiotic is constructed from Greek words anti, which... Read More
I am a strong believer in Cetyl Myristoleate for the... Read More
If you ever go to cold countries, you should undoubtedly... Read More
You've been getting headaches. Finally, you find some medications that... Read More
What's Insomnia?Identifying insomnia is a little like the old joke... Read More
I remember a friend in college who would blush, sweat,... Read More
Zyprexa is a prescription drug that treats schizophrenia, acute mania... Read More
Stevens Johnson Syndrome (SJS) is a severe and deadly allergic... Read More
IntroductionAntibiotics are said to be the greatest contribution of modern... Read More
Irritable bowel syndrome can be a nightmare?constant diarrhea and terrible... Read More
Internet Pharmacies are convenient and quick, but some websites selling... Read More
In a recent survey on pain conducted by the Stanford... Read More
Marketing Authorisation: Medicinal Products The case of R (on the... Read More
Have you been struggling to lose weight, but diet and... Read More
According to ongoing research about the needs of patients with... Read More
Healthcare professionals are under pressure to remember, utilize and absorb... Read More
When you search online for Electric Wheelchairs, like any other... Read More
NIH Official Altered Drug StudyDr. Edmund Tramont, director of the... Read More
Acid reflux symptoms vary in degrees of discomfort, from person... Read More
We have a marvelous array of medical tests available to... Read More
Depression is a disorder marked by sadness, low energy, impaired... Read More
Your Remedy No. 1 ==============Stretch Gently for Strength and Mobility.When... Read More
There has definitely been a good deal of controversy over... Read More
Serzone is a prescription medication that is given to patients... Read More
Personal injury attorneys representing clients who have allegedly been harmed... Read More
The police arrive at the accident scene promptly. A driver... Read More
What an oxymoron the Physicians Committee for Responsible Medicine has... Read More
Just about all health care providers have need of stethoscopes.... Read More
Ever given a piece of thought to how actually one... Read More
If you have been diagnosed with irritable bowel syndrome (IBS),... Read More
Finding the right treatment for any person suffering with a... Read More
More and more people have started travelling to India for... Read More
Do you suffer from ulcers?If yes, what kind is it... Read More
There are many different causes of heel pain, but the... Read More
Are you currently on one or more pharmaceutical drugs? Perhaps... Read More
Using ice to treat injuries is one of the oldest... Read More
The beginning is very much hard to spot as we... Read More
How Does Online Pharmacies Affect Pharmacy Leaders?With cheaper drugs made... Read More
A thick, yellowish nail with splotchy white areas is a... Read More
At one moment, a life of activity consumed with enjoyable... Read More
The American Heart Association estimates that one of three Americans... Read More
There are high arch feet and low arch feet and... Read More
With the hum of the election campaign and the debate... Read More
Sinusitis and Sinus Infection Starts with a Little SniffleYes, I... Read More
Marketing Authorisation: Medicinal Products The case of R (on the... Read More
An estimated 85 million Americans have acquired the herpes simplex... Read More
There is a large amount of talk lately in regard... Read More
While the recent Lamisil commercial featuring Digger, a disgusting cartoon... Read More
According to ongoing research about the needs of patients with... Read More
Medicine |