September 2010 – Patient Sympathy

August 2010 – Back to School Shoewear

July 2010 – Womens Shoewear

June 2010 – Summer Foot Care

May 2010 – Skin

April 2010 – Ingrown Toenails

March 2010 – Barefoot Running

February 2010 – Pediatric Flatfoot

January 2010 – Being a Compliant Patient

December 2009 – Raynaud’s Disease

November 2009 – NA

October 2009 – Shin Splints

September 2009 – Dealing with Corns and Callouses

August 2009 – Relieving Painful Gout

July 2009 – Caring for Plantar Warts

June 2009 – Bunions

May 2009 – Children's Heel Pain

March/April 2009 – Heel Pain

February 2009 – Shoe Fitting

January 2009 – Nail Fungus

December 2008 – Neuroma

November 2008 – Diabetic Foot Care


January 2009

Published in - Healthy Lifestyles

Nail fungus. Most of us have heard of, or about it. Some of us even have it. Yuk. Even the mere mention of it during an office visit with a patient or casual conversation with friends or even strangers for that matter, evokes a distorted facial look. I really do enjoy those looks when discussing this topic. Even now most of you may be wrinkling your nose a bit just thinking about it.

What is fungus?
Okay fungus, what is it? Fungus, or Onychomycosis, refers to the invasion of the nail plate by one of many ‘fungal’ organisms. Fungi are plant-like organisms that lack chlorophyll, meaning: they do not use light to make food. Therefore, they must absorb food from elsewhere. That is why fungi can live in damp and dark places. Think about the shoe wear that have been on your feet all day, the wet shoes from the rain you were caught in and didn’t dry out completely, or the sweaty sneakers from the gym. None of these scenarios fit you? Okay, how about the nail polish that has been covering your nails for weeks or months on end? Go to a nail salon?

What are possible signs or symptoms of nail fungus?
In the beginning, the nail may look a little discolored with a yellow or brownish color, possibly whitish spotting. Maybe not enough to cause any concern so most of the time it goes unnoticed until it worsens and is much more evident. The more involved the fungal infection becomes, the more it can cause the thickening, discoloration and discomfort associated with the painful nails. The nail also has a tendency to become brittle, breaks easily and is frequently a cause of ingrown nails.

Why do people get nail fungus?
As mentioned above, feet that are not dried well after a shower or stay somewhat moist in shoewear attract fungus. Fungus is a ubiquitous organism and can be picked up almost anywhere. It is possible to ‘catch’ it from another person, but unless you are sharing shoewear of an infected person, it’s not likely. Sharing a shower does not, I repeat not, cause you to get fungus. Also, if you have athlete’s feet, it is possible that the fungus causing it can also cause the nail fungus. Think about it. Your feet are in shoewear that are dark, moist and warm. What better place for fungus to grow? Furthermore, fungus can reoccur if the environment in which it began is not eliminated. Meaning, if you have a tendency towards sweaty feet, it is important to treat that issue to decrease the likelihood of the fungus returning.

Risk Factors (TABLE)

1.Increasing age
2.Male gender
4.Nail trauma
5.Hyperhydrosis (increased moisture or perspiration)
6.Peripheral vascular diseases
7.Poor hygiene
8.Tinea pedis, or athlete’s foot
10.Chronic exposure of the nails to water

What do you do to treat nail fungus?
Onychomycosis, or nail fungus, has long been one of the most difficult fungal infections to treat. This is because of the lengthy process the nail takes to grow, the hardness of the nail plate, and location of the infection that is between the nail bed and plate are major factors interfering with the eradication of fungus affecting these tissues.

Everyone seems to know of a story about how someone they know soaked their nails in vinegar, bleach or Vick’s Vaporub and was cured. I have patients who have tried those as well as others, with very little success. They haven’t gotten any worse but, no better either. All of the home remedies seem to have one thing in common: lots of attention to local nail hygiene. If as much attention was given to the nails in the beginning stages of the fungal infection, there wouldn’t be the need for the diligence of nail care this late in the game. There are quite a few Over-The-Counter medications available for this concern but again, I haven’t seen a whole lot of success with these products. As with anything, some OTC medications will work for some people some times.

Until recently, topical therapy alone was in general not useful for the treatment of onychomycosis. However, ciclopirox (Penlac) solution, a topical nail lacquer, has been successful in the treatment of mild to moderate nail fungus. The solution is applied daily covering the entire nail and a small area of surrounding skin until the nail completely clears. Overall, however, this approach is not nearly as effective as systemic therapy with the above-mentioned medications.

In my experience, one oral medication, terbinafine (Lamasil), is an excellent medication for treating onychomycosis. The key to this medication is that once given, it is absorbed into the nail matrix where it has a reservoir effect. Nails grow slowly and can take more than a year to completely grow out an infected toenail. No, this medication is not dangerous if prescribed to the right patient population. Personally, I have never taken any of my patients off of this medication because of issues associated with their liver, kidney or any other organ. (Hear the knocking on wood?). I have, though, prevented patients from taking it due to blood work used as a screening tool prior to taking the medication.

As with any medication this needs to be discussed with your doctor and may depend on your health, drugs you are already taking, as well as other possible concerns you may have.