Toenail Fungus: Treatment and Prevention
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 Ž) and Terbinafine (Lamisil Ž). 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%. LamisilŽ appears to be more effective and has fewer drug interactions than SporonoxŽ. 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 Ž) 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 CarmolŽ 40 and KeralacŽ 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 VapoRubŽ. 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 VapoRubŽ. 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.
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"If you're one the nine out of ten adults in the United States who suffers from low back pain, I have good news for you!" states Dr. Nathan Wei, a board-certified rheumatologist and Clinical Director of the Arthritis and Osteoporosis Center of Maryland.
"Ooohhh? my aching knee!!!" Insider Secrets on How You Can Get Relief Quickly and Easily!
When your knee hurts, getting relief is all that's on your mind. Getting the right relief, though, depends on knowing what's wrong.
How To Locate An Alcohol Rehabilitation Center In California
Alcohol rehab in California refers to the centers that help people in California to get rid of the menace of alcoholism.Prevalence of alcoholism is increasing in California therefore more people are looking for Alcohol rehabilitation facilities in California.
Latest Medical Spa Equipment Showcased at New York Medical Spa Expo
This year, the New York Medical Spa Expo confirmed the Medical Spa industry is continuing to grow. "Not only did thousands of Spa and Medical Spa owners visit this year's show, but we also saw the release of some new and noteworthy equipment perfect for the medical spa environment" says Jeff Russell, the CEO of MedSpa Financing.
Seroquel Side Effects: Effects of Seroquel Worth the Risk?
Seroquel is an atypical antipsychotic drug that is used to treat hallucinations, delusions and confusion caused by psychotic conditions such as bipolar disorder and schizophrenia. Atypical antipsychotics are not SSRIs (selective serotonin reuptake inhibitors) or benzodiazepines.
Generic Drugs: How They Cost You Less?
If you are wondering why the chemist has charged much less than what you expected then it is not because he has developed sudden liking for you or the government decided to subsidized your medical bill.It is possible because you are getting cheaper generic alternative of some expensive brand name medication.
Ingrown Toe Nails Medical Treatment
Medical Care:Treatment options depend on the stage of ingrown toenails, medically known as onychocryptosis.Stage 1 can be managed by recommending shoes with a comfortable wide toe box or open-toed shoes.
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