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The term for nail fungus is called "onychomycosis".  Nail fungus is one of the most common diseases of the nails known to man today.  The disease also can cause some pretty significant appearance changes to the toenail to make it unsightly. 

Have your nails ever looked like this?

If they have, then you may have or have had onychomycosis. 
What to do about it?
  • The first thing to do is to get an appointment with a podiatrist, primary care physician, or dermatologist to evaluate the condition to confirm that it is indeed onychomycosis.
  • Have a culture of the nail performed to have a nationally recognized lab confirm the suspicion that the nail is clinically infecteced wtih fungus
  • Begin some sort of treatment

How does this happen?

Onychomycosis is a fungal infection where a fungus of some type (not a plant, animal, virus or bacteria) infects the skin that makes up a nail.  Anyone who has had athlete's foot or who has come into contact with any area that others who have had this problem may have been is susceptible to the disease.  You may say to yourself, "well that's not me" or "I've never been near anyone like that before", but you have to consider that if you have ever walked barefoot anywhere like a gym, pool, or shower then, yes, that means you.  The fungus that infects the nail naturally grows on all types of skin.  It doesn't become a problem until the fungus is given a "reason" to cause an local infection.  For example, if the cuticle of the nail becomes disrupted by any means then that represents a door way into which the fungus can move into the local skin around the nail and cause a problem.  This means that every time someone gets a pedicure and the cuticle on the front of the nail or the back of the nail is pushed away, fungus could be introduced.  This also means that if anyone has stepped on your toe or you have stubbed your toe, then that as well is a way for fungus to be introduced to the surrounding skin. 
Now, does all this mean that the entire world is infected. There answer is No.  Aside from the things listed above, there are other factors that can contribute to whether a person is going to get infected or not.  This is not an exhaustive list and by all means it does not mean that if you have fungus you must have one of these other associated diseases as well.  The people that are most susceptible to fungal infections are diabetics, people with circulation to the feet, immune compromised people (HIV), people taking steroid medicines on a regular basis, people who have excessive sweaty foot and those that have psoriasis.

What to do about it

Although it is difficult to treat and erradicate, it is not impossible.  Like I mentioned before, the first thing you have to do is get evaluated.  Get confirmation that whatever you are looking at IS actually a fungal infection and not something else.  Having said that, there are a number of treatments available for onychomycosis these days.  The key to successful treatment is understanding that the infection is within the skin underneath the nail plate.  It is for this reason that treating onychomycosis has been a very daunting task.  Any treatment modiality that you would use, has to be able to penetrate into the nail to get to the heart of where the fungus lives. 
Methods of treatment:
  • Home Remedy
  • Topical Medication
  • Oral Medication
  • Laser
  • Surgery

Oral medications, Laser therapy and surgery are all treatment modalities that MUST be administered and monitored by a physician.  The 2 currently accepted oral medications are terbinafine and  itraconazole.   It is important to note that solely taking the oral medications and knowing that you have absolutely no underlying liver disease does not cause a problem.  If that were the case then the FDA would not have approved their usage.  As a precautionary measure, providers may require that the patient first get a test of their the liver to see if there are any unknown problems that might be made worse by taking the medication. The doctor(s) may order tests called the AST and the ALT which are enzymes that are followed as known liver function indicators.  If these are elevated for any reason, you are NOT a candidate for the medication.  The doctor who tested you should then recommend you be further worked up as to why your liver function studies are elevated.  Also anyone who has normal liver function studies and begins taking the medication that experiences sickness or yellow discoloration of the skin (called jaundice), should stop taking the medication immediately and seek emergent follow up as there may be something significantly wrong with your liver. 

Laser therapy of onychomycosis requires that a strong enough light source be applied to the area of the infected toenail(s) so that the water within the nails is dried out and thereby it kills the fungus.  Most commonly those lasers are in the near infrared range of wavelengths.  There are several types of lasers for this available for the treatment of fungus within the nails, some of them are even FDA approved to treat nail fungus and still others are making their way through the FDA trials.  I would caution you though on putting all of your faith in the laser treatment alone.  There are so many factors that go in to whether a person gets fungus or would potentially reinfect themselves unknowingly that laser treatment alone is not a guaranteed 100% cure although it does have a vey high success rate.

Usually the last resort for a patient would be surgery.  As podiatrists, we can surgically remove an unsightly nail and cauterize the nail matrix (the skin part that makes the nail) by a variety of ways so that a nail is not able to come back.  This method of treatment results in a permanent loss of any and all of the toenails.  I would only consider this as an option if a person has failed all of the above treatments and has no other options left.  For more information about this, speak to your podiatrist.

Topical and Home rememdies are by far very popular ways of attempting to treat fungus.  Many people believe that if they can use a home remedy or something they can just put on a nail that it is better than the alternatives listed above.  In part, that is true.  The positive portion is that by applying something topical, it does not make a large systemic effect such as taking a medication orally does.  The lack of dealing with side effects certainly represents a positive mark for using these types of remedies.  The neative aspect is that not all topical remedies are the same.  Each home remedy and topical medication may have different strengths, application styles, or time lines in which they need to be used in order to be effective.  The other challenge is that the infection occurs below the nail itself.  Therefore, all topical remedies have to be able to penetrate the nail to the source of the infection first for it to have any effect.  But, knowing these draw backs this still may be a viable alternative to try in the hopes that it may get some results and avoid other systemic issues.

Home Remedies:

The following is a list of home remedies that I have found through talking with patients and interenet research.  It is not an exhaustive list and by being mentioned here is not to be miscontrued as these methods having my approval.

  • Listerine - has active ingredient "thymol" which is the essential oil of the herb Thyme.  Thymol has been shown to have antimicrobial properties.
  • Tea Tree Oil - an essential oil that has been shown to be active against fungus of various types
  • Grape Fruit Seed Extract - made from grape fruit seeds.  Has shown anti-microbial properties but no definitive activty against onychomycosis.
  • Vick's Vapor Rub - Has reports in the newspaper about being effective for fungus nails.  Upon review though, there is nothing listed within the active ingredients of the product that is actually considered antifungal.  Although this is the case, there are still reports of this modality being effective.  Literature review shows that it works best if the toenails are occluded after the application of the ointment.  I would caution anyone who tries this without first seeing a doctor as it may result in the nails falling off or inadvertantly burning the surround skin by the use of the chemical.


Topical Medications:

The following is a list of topical medications that I have researched.  Just as noted above, this list is not exhaustive and none of these that are listed should be misconstrued as having my approval as any one being better than the other.

Nail Polish

Is it possible for nail polish to contain the elements to spread nail fungus? There is a bit of debate about that.  Some say yes toenail polish can harbor fungus. Others say that there are various chemicals in the toenail polish that stop fungal infections.  Still others report that altough the nail polish itself might not harbor the fungus, the occlusion that the nail polish causes can lead to making an existing infection worse by traping the fungus against the nail through creating a barrier with the lacquer to prevent the fungus from escaping.  Whatever the cause may be, it is the recommedation of the doctors at Advanced Foot Care Center that you should use a medicated toenail polish to avoid any of the potential issues listed above.  The presence of a known antifungal agent within the nail polish will both stop the fungus from spreading directly into the polsih itself and will be present on top of the nail after the polish has cured thus treating the underlying fungus on the nail itself.
We recommend using Danipro medicated nail polish.  It is made with undecylenic acid which is a known antifungal medication.  Please call our office to obtain the nail polish.  As you can see from the link provided and the pictures below, it does come in a variety of colors.  Danipro even comes in clear which is an ideal solution for fungal problems for men.  At times, we do get our nail polish at a discounted price from the supplier and are happy to pass that savings on to our patients.  Give us a call and find out how competetive we are!



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Thorofare Podiatrist offering botox injections, diabetic foot care, plantar fascittis and other podiatric services in the Thorofare and Deptford, NJ area
Podiatrist - Thorofare, Advanced Foot Care Center, 204 Grove Ave. Suite G, Thorofare, NJ 08086 856-579-8674