A Doctors Perspective on Fungal Toenails

The Doctors Perspective of Fungal Nails

Fungal nails are a very common condition in the foot and ankle. About 3% of the population will be affected. More men are affected than women and generally the infection will occur after the age of 40.

Like bacteria, fungus spores are everywhere in normal daily life. Because of its organic structure, it is stronger and heartier than bacteria and viruses so once a fungal infection takes root, it is more difficult to treat.

Fungus grows selectively in the warm moist environment of the foot. With improper shoewear, the area of the toes and nail have the ideal temperature, moisture content and pH for fungal infection.

The infection will begin in tiny cracks within the nail or skin. The nail will show early signs of change with color changes or small white or yellow spots. The nail will begin to thicken and turn yellow and begin to flake off.

Because the infection is within the substance of the nail as well as in its growth center, fungal infections can only be treated if the very roots of infection get exposed to the treatment.

There are several different types of fungal infections. The most common is Trichophyton rubrum. This type of infection can start at either the end of the nail and raise the nail up or start at the base. Most infections start at the end of the nail. It is caused by an invasion of the nail through a split in the skin or nailbed. Risk factors will include age, swimming, athlete’s foot, psoriasis, diabetes, other family members with nail infection, or a depressed immune system. If the nail raises from the base (less common), it is usually a sign of a systemic infection in people with a damaged immune system.

Another type of infection is caused by yeast or Candida. This is more common in fingernails. The nail will be yellow, brown, white or thickened. People will almost always have simultaneous infections in their mouths or thrush.

A culture is sometimes necessary to identify the exact species but most people will be able to identify the early signs of infection by the look and feel of the nail.

Treatment

Because of its common nature, there are many home remedies for fungal nails. Most home remedies use a footbath with a solution of sterilizing liquids. The most common have used a combination of Listerine, alcohol, vinegar, Vicks VaporRub, or beer. These home remedies may have some effect if the infection is detected early. But because most fungal infections involve the whole nail and its growth center, most soaking techniques do not have the penetration to make a difference.

Another treatment involves tea tree oil. This hydrophobic essential oil has been thought to have antiseptic, antibacterial, and antifungal properties. Its molecular structure is similar to phenol and consider 10x more effective.

Some topical treatments such as Formula 3 Liquid antifungal merge the best of all the home treatments with an effective antifungal solution, which has been shown to have sufficient penetration to kill most of the fungus and provide a protective coat on the nail to prevent further reinfection.

Several prescription oral medications can be used. These are the same strong systemic antifungal treatments often used in conjunction with chemotherapy and AIDS treatment. Though effective, they frequently require 12 months of treatment with regular blood tests to monitor liver function. Common options include Griseofulvin (Fulvicin, Gifulvin, Gris-Peg), Terbinafine (Lamisil), Itraconazole (Sporanox), and Fluconazole (Diflucan).

Lasers

The off label use of lasers for the treatment of fungal nails has great potential. Laser treatment of fungal nails have been getting a lot of national newsworthy attention as well.

http://abcnews.go.com/Health/OnCall/story?id=7113863&page=1

http://www.nytimes.com/2009/03/20/business/20fungus.html

By using the focused energy of a laser directly onto the nail matrix, the resistant fungal cellular walls are neutralized and eradicated. A laser can effectively penetrate into the deep nail structure. But because of the differing stages of fungal growth within a nail, a pulsed schedule of 2 or 3 treatments are often required to completely cure the condition. The procedure is safe with remarkably few
side effects.

In the end, the best treatment for fungal nails is prevention. Keep your nails cut straight across. Keep your nails and foot dry with plenty of room within all shoes. Avoid non breathable sock and shoe materials. Sterilize the inside of shoes with regular treatments of ultraviolet light. Oral medications can be effective but may have more side effects than benefits. Some topical treatments can work. New technologies such as lasers have promising potential, though often not covered by insurance.

Many of the newer commercial treatments for fungal nails can be found at a trusted source for foot and ankle products: www.footsourcemd.com