Sunday, November 24, 2013
Toenail Fungus: Key Points of Treatment
Fungal toenails, or onychomycosis, can be unsightly and lead to ingrown toenails due to their increased thickness. In general, I like to stay away from medicine, oral anti-fungals, due to their liver side-effects. I try to stay in an environment-changing treatment arena. It can easily take up to a year to notice a considerable difference with any treatment, so many just leave it alone. For those of you willing to undertake the task of attacking this invader, here are your weapons.
What kills fungus? Air, vinegar, bleach, tea tree oil, and dryness are a few of the weapons we can easily combine to kill fungus. Fungus lives in the moist areas of our lives like shower stalls or shoe linings. Fungus lives in an anaerobic environment under the nail made more comfortable with fresh nail polish holding out the air.
One problem we have conquering toenail fungus is time. It takes over one year for the toenail to completely grow out twice. There is a general rule that it takes not one, but two of these growth spurts to push the unsightly debri of the killed fungus out from under the nail bed. Some smart person figured that out, but like anything else it is still a general rule with exceptions for longer and shorter time periods. So, we can successfully kill the fungus, but the nail still looks disfigured until all the debri is pushed out from under the toenail. Definitely, this is unfair!!
Let us again look at our weapons and how we will use them. They are:
1) AIR---get as much air under the nails by cutting the nails as short as possible monthly, gently cleaning the debri under the nails as long as there is no bleeding monthly, using an emery board weekly to file the top of the nails as thin as possible, and avoiding toe nail polish as much as possible (quickly remove when not needed).
2) VINEGAR---soak in white vinegar 30 minutes twice weekly using a 1 part warm water to 1 part white vinegar ratio (see another post on using gauze to create vinegar patches for nightly use especially for only 1 or 2 bad nails).
3) BLEACH---disinfect your shower weekly with bleach (for example, Lysol).
4) TEA TREE OIL---apply daily tea tree oil twenty minutes before you go to bed to each affected nail and surrounding soft tissue. It must dry well before getting under the sheets.
5) DRYNESS---air out your shoes weekly that you use regularly by removing the shoe inserts, applying foot powder under and on top of any insert, and rubbing at the top of the toe box where you imagine the toenails rub.
6) PATIENCE---you will need some of this to succeed, and you will!!
If you have very thick toenails when you are starting, ask a podiatrist about doing the Carmol 40 Urea Ointment occlusion treatment. This is discussed in another post, but is great at removing the nail without shots, and without bleeding. It is the bleeding that is bad in this process, because the blood is a candy store for the fungus. Many podiatrists recommend seeing them once every 1 or 2 months during the initial 6 months to thin the nails with their electrical grinders. It sounds gross, but it should not hurt at all. In fact, this whole process should be painless.
If you decide to use oral medicine, use pulsed Lamisil. It is the safest that I know where you take for only 7 days each month for 6 months. You still have to do the topical treatments as mentioned above. At present, the pulsed Lamisil does not need liver testing as part of the treatment, but your prescribing doctor may feel safer doing that. Golden Rule of Foot: Always error on the side of caution.
With the advent of Laser toe nail cleansing treatment, I would normally recommend this over oral medicines. If helps clean out the fungus debri faster than anything, but it is not a cure. 50% of patients think they were helped by it.