Toenail Fungus: Tips For Treatment

The medical term for toenail fungus is "onychomycosis," pronounced on * EE * ko * my * ko * sis. Despite the commonly used term "fungal toenails", onychomycosis describes both fungus and yeast infections in the nail. The prevalence in America is about 2-3%, but some have reported it as high as 13%. Even at a low estimate of 2%, this accounts for 6 million Americans with toenail fungus. Toenail fungus affects men twice as often as it affects women.

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 is an increase in occlusive footwear, an increase in sporting activities, an increase in diabetes and increase in age of the general population.

The risk factors for developing toenail fungus are increasing age, male gender, nail trauma, sweaty feet, poor circulation, poor hygeine, foot fungus and a compromised immune system.

Athlete's tend to have a higher rate of fungus infection than non-athletes. The moisture in the shoe combined with repeated nail trauma increases the chance of infection. Hikers, runners, backpackers, soccer, basketball and tennis players, athletes wearing loose fitting shoes that allow jamming of the nails against the shoe and any individual wearing shoes that toe tight are at risk for developing toenail fungus.

There are a number of treatments for onychomycosis. 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. I would 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. Make sure you rotate your shoes often and keep them in a cool dry place.

2. Change your insoles frequently, and make sure they dry out between use.

3. Place an anti-fungal powder or spray in the shoes to help fight off the fungus.

4. Bleach out the shower on a weekly basis and wash your shower mat regularly in hot water.

5. 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.

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. If your feet sweat excessively, try using an antiperspirant spray on your feet before your workout.

9. 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 treating onychomycosis is very difficult. If you have fungal toenails that cause pressure, pain or infection, consider talking to your doctor about prescription medications or nail removal. Make sure you take precautions to prevent re-infection and take multiple approaches to eradicate the problem. If your fungal toenails are only unsightly and don't cause any discomfort, 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

---

First Responder Human Hibernation Units

In the next few years paramedics, first responders and military medics will have instant hibernation devices. These devices will come in small canisters of the gas to... Read More

Celebrex Side Effects Lawsuit Lawyer

The Food and Drug administration urges people to stop taking Celebrex, but even so the drug has remained on the market. Recent studies have found that Celebrex... Read More

Cholesterol Prescription Medications Can Kill You

While there are numerous options for people to lower cholesterol naturally, thousands and thousands of people are taking prescription medication to lower cholesterol ? risking some very... Read More

Modern Medicine Has Extended Life - BUT 9 Out of 10 People Say Its a Miserable Extension!

Sit down in a quiet place alone and take a minute to notice how you really feel inside and out? Would you consider yourself in good health... Read More

A Compelling Look at Pain Relief

If your back aches when you're loading groceries in the car or your hands cramp up with arthritis when you sit down at the computer, you're not... Read More

Signs of an Addiction

Addictions come in many forms. It's important to recognize the signs of addictions in order to seek out help before the problem becomes to large.Some different types... Read More

New Treatment for Peripheral Neuropathy

Millions of Americans suffer with Peripheral Neuropathy and until recently there was no specific treatment available. Peripheral Neuropathy is often associated with Diabetes, but can occur on... Read More

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... Read More

Flatfeet in Children: When Are They A Problem?

There are high arch feet and low arch feet and many different foot types in between. Many individuals have flatfeet, but do not have foot problems. All... Read More

Phenylpropanolamine (PPH) Lawyer: Decongestant Causes Stroke

Phenylpropanolamine, or PPH, used to be an active ingredient in many over the counter nasal decongestants and weight control drug products. The FDA pulled phenylpropanolamine off the... Read More

The Pharmaceutical Drug Cartel and the FDA

According to the Los Angeles Times, the California Association of Physicians and Surgeons, and even the Center for Diseases Control's own admission, well over 100,000 people in... Read More

Advanced Surface Ablation

In patients with corneal thickness below a certain minimum, performing LASIK would be unwise, because the "foundation" may not go back to its original stability. Our colleagues... Read More

Alcohol Rehabilitation Centers - Take An Informed Decision

Alcohol rehabilitation centers in the United States offer a wide range of treatment programmes for your recovery from alcoholism.They provide services such as detoxification, residential treatment, day... Read More

Infants and Acid Reflux

Infant acid reflux is quite common. People of all ages, especially infants because they consume only liquids or soft foods, suffer from mild heartburn or acidic regurgitation... Read More

Adaptogens for Life - The Science Behind the Discovery of Adaptogens

Modern civilization has produced an unusually stressful environment to humans and animals, with extreme high demands on our physical and mental abilities. The last one hundred years... Read More

Bextra Recall: Lawyer Says Help Is On The Way

By now, you have probably heard of the prescription drug Bextra. You may not know, however, why that a recall is in order. The reason is quite... Read More

Strong Pain Relief - Powerful & Effective Natural Pain Management Alternative

The recent removal of several high profile and popular prescription pain medications of the same pharmaceutical family, nonsteroidal anti-inflammatories, from the buyer's market has left many people... Read More

Lunesta For Insomnia: A Guide To Compare Generic Lunesta ( Eszopiclone )

We all know that there's no such thing as cheap Lunesta, but if you'd like to save money without sacrificing quality, you may want to buy Eszopiclone... Read More

Healthcare Providers -- Its Time for Your Physical

I think this is a good time for a checkup, or physical as it is termed in the healthcare industry. I mean this is a good time... Read More

Safely Mimicking the Effects of Accutane Without the Side-effects or Costs

Since 1982 Accutane has been a reliable, if not controversial, drug for treating severe acne. Now with FDA representative David J. Graham's statement that Accutane should be... Read More

Generic Drug: Its Pros and Cons

A generic drug can be defined as an identical, or bioequivalent to a brand name drug in its dosage form, safety, strength, route of administration, quality, performance... Read More

A Fresh Start Plan for People With Neck Pain!

"If you have to deal with chronic neck pain, it can be a real struggle. I know? because I've had to do it myself," states Dr. Nathan... Read More

Hypertension & High Blood Pressure: How To Improve Life Threatening Weight-Related Diseases

The American Heart Association estimates that one of three Americans have have hypertension. And yet many of us don't know what it is, why it's dangerous, and... Read More

Finding the Medical Supplies you need!

It's now possible to locate and purchase a wide variety of Medical Supplies on the internet. Whether you're looking for Medical Supplies for your medical practice or... Read More

Does Heel Pain Mean that I Need to Stop Running?

Heel pain, medically termed plantar fasciitis, is a common and frustrating injury for many runners. It accounts for up to 10% of all running injuries and results... Read More

Facial Pain: When a Nerve Is a Live Wire

Of all the places in the body that can hurt, the face might seem the strangest. But for some people, that's exactly where the agony occurs, and... Read More