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 ®) 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 Importance Of Using Electric Wheelchairs To Improve Mobility

No person likes to feel housebound and dependent on others.... Read More

CT and MRI Scans in Neurological Practice: A Quick Overview

Before computed tomographic (CT) scans became available in the 1970s,... Read More

Check Out The Wonders Of Tea Tree Oil

Tea tree oil is the essential oil comes from the... Read More

Celebrex Side Effects Lawsuit Lawyer

The Food and Drug administration urges people to stop taking... Read More

Pharmaceuticals: The Next Frontier in America?s War on Drugs

America's war on drugs, which has been fought in the... Read More

Stopping Hospital Infections

Each year hospitals end up killing twice as many people... Read More

Melatonin, Sleep Enhancement, and ADHD

Overview Melatonin is a natural hormone, which is produced and... Read More

Substance Abuse Attitude Testing by a Standardized Survey

This is a short overview of a questionnaire used for... Read More

Hypnotherapy as a Treatment for IBS

Hypnotherapy is one of the best known and most widely... Read More

4 Reasons Why You Should Use Canadian Pharmacies

Let's face it: purchasing prescription drugs in the U.S. can... Read More

Lipitor Side Effects

Lipitor is a drug intended to help lower cholesterol. The... Read More

First Step To Addiction Recovery

The first step to over comming any addiction is to... Read More

Lunesta Side Effects

Before you decide to buy Lunesta, make sure you have... Read More

Protopic Cancer Risk Lawyer

The FDA issued a warning in July of 2005 on... Read More

Bextra and Vioxx Withdrawal Spawn Advertising Pause from Bristol Myers

Pharmaceutical giant Bristol Myers Squibb has announced that they will... Read More

Bextra, Some Facts To Consider

For those who take Bextra, there are many warnings out... Read More

Stevens-Johnson Syndrome

Stevens Johnson Syndrome (SJS) is a severe and deadly allergic... Read More

The Trouble with Tranqs

There's a whole group of drugs out there called benzodiazepines.They... Read More

Ambien Sleep Medication And Insomnia: What Is Insomnia And How Can Ambien Help?

What's Insomnia?Identifying insomnia is a little like the old joke... Read More

Lumbar Puncture: This (Really) Is Spinal Tap

I couldn't resist the title's corny riff on the name... Read More

Quitting Smoking: Planning To Succeed With Zyban!

Step One: The Big DecisionOne of the most frustrating things... Read More

?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... Read More

Five Secrets of High Blood Pressure Treatment

Thirty percent of human population has a high blood pressure... Read More

CRP And Your Heart

Monitoring your CRP level is vitally important because it is... Read More

The Highway to Health - Bumped Heads

I recently had a reader send me this comment:"As a... Read More

Rogue Online Pharmacies: The Internet War Of 2005

Online Pharmacy owners who haven't been working within moral and... Read More

What You Should Know About Mixing Medications and Diet...

I had a call the other day from a potential... Read More

Orthotics: Prefab or Custom-Made?

If you take a simple stroll down the foot product... Read More

Potassium and The Dialysis Patient

Any dialysis patient who has had a brush with high... Read More

?Do you suffer from Osteoarthritis? Here?s how to tell!?

The most common type of arthritis is osteoarthritis (OA). This... Read More

Be Informed About The Medications You Take

The recent withdrawal of the prescription drugs Vioxx and ... Read More

Common Drugs and Their Uses

The five drugs that are discussed in this article are... Read More

Lunesta Withdrawal

Lunesta is a newly released sleeping pill. Marketed as a... Read More