Toenail Fungus is Among us!!!

Hello,

We have been faithfully 100% following your protocol you sent me back in FEB!!!!! Vinegar soaks 3x per week, sanding once a week and nightly application of TT oil on the toenails. The first pic is what they look like today and the other is back in Feb. when I first contacted you! They are looking better, but still not GREAT! I am curious to know what I should do next?? Do I continue or switch it up at this point? OR LEAVE THEM ALONE?! It has been quite a process

Thank you for your kindness in helping me!

Before Treatment

After 8 months, a lot of Vinegar (70% better to my eye)

Dr. Blake's comment: My comment to the mom was to keep going. She is doing this for her son. I told her for her reward of doing so well, 6 more months of the same thing. The nails seem to be clearing, the part at the end of the toenails is the last to go. 

Toenail Fungus begins to get a Toehold!!

Dear Dr. Blake, 

I have noticed brownish skin above my toenail for a few weeks, do you know what it is caused by? I have included a picture. 

Dr. Blake's comment: Looks like fungus, so start vinegar soaks for 30 minutes 3 times a week. Try to time it right before you shower to get the salad dressing smell off. 

Toe Nail Fungus: 30 Minute Vinegar Soaking

Dr. Blake,

I just looked at my calendar and noticed I will be seeing you soon, this week!

I also realized that I hadn’t the sent the photographs of my soaking method that you requested.

I so sorry for the delay, though I did take the pictures soon after our conversation.

I am using my rubber like Adidas sandals to raise the back of my tub so I can soak my toes

comfortably as I relax. I found that I use a combination of about 3 to 4 oz of vinegar and warm water each.

I pull my legs in as if I wanted to put my feet beneath my chair that’s I need to do.

I do this every other day which is a schedule that enables me to remember.

Here is my original blog post:

http://www.drblakeshealingsole.com/2010/04/key-points-in-treating-fungaled.html

And here is a link to other reasons to use Vinegar all the time!!

https://www.tipsbulletin.com/vinegar/

Toenail Fungus: Try using the Vinegar Balloon Method!!

Hi Rich,

Check out my improvised vinegar soak method.  Took some doing (a plastic syringe to get the fluid into the ballon, once installed, and deflated, on my toe). Only downside i see is the mild tourniquet effect it's having...  But I'm up and about at home, and not using a quart of vinegar to get the job done!

Hope you're well, and perhaps enjoying the Olympics...

Most of you know that I love vinegar soaks or patches two or three times a week for toenail fungus. And, most of you know I live in San Francisco, also called Northern Silicon Valley, where very smart people live. Here is one of these very smart people with family obligations improvising to make sure he gets his vinegar soaks done. Thinking outside the box to be sure!!!!

http://www.drblakeshealingsole.com/2010/04/key-points-in-treating-fungaled.html

Cold Plasma on the horizon for Toenail Fungus

http://www.gizmodo.com.au/2015/11/cold-plasma-could-be-used-to-freeze-out-toenail-fungus/#learnMore

https://www.facebook.com/devicefarm/

Toe Nail Fungus: Onchyomycosis

Hi Dr Blake,

     You treated me for big toe onychomycosis a few years ago. I had used penlac for many months.It had cleared my infection. You just had to remove the build up of the med I had on my toe. Anyways, I am a pharmacist with Walgreens. Since my visit with you have a regularly referred 1-2 patients a month to your site regard toenail onychomycosis. I encourage them to visit your site. Forget the otc stuff and trying oral meds until they try your simple vinegar protocol. If that does not work, go see you. I thought that I would share that with you. 

Dr Blake's comment: I personally thanked this doctor for his note to me, and here the link to the protocol he mentioned. 

http://www.drblakeshealingsole.com/2010/04/key-points-in-treating-fungaled.html

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).

http://www.drblakeshealingsole.com/2011/11/onychomyosis-toe-nail-fungus.html

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.

http://www.drblakeshealingsole.com/2011/11/onychomyosis-toe-nail-fungus.html

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.
http://www.drblakeshealingsole.com/2011/12/toenail-fungus-news-about-lamisil.html

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.

Common Tips for Toenail Fungus

http://www.drblakeshealingsole.com/2010/10/toenail-fungus-summary-of-various.html

Article showing Effectiveness of 10% Efinaconazole for 48 weeks topical for Fungus Toenails

This is a very promising new medication awaiting full FDA approval for toenail fungus. 

http://dermatology.jwatch.org/cgi/content/full/2013/426/1?q=pfw-featured&eaf

http://www.podiatrytoday.com/could-efinaconazole-10-have-impact-onychomycosis

Toe Nail Fungus: Email Advice

Hi Richard,

Thanks a lot for today, specially for noticing me standing out there and taking a few minutes to sort out my other concern.  I was just about to leave when I saw you in the main office.  Quite fortuitous.  ONe of the secretaries had just told me that you had just begun an hour appointment. 

So I took Lamisil orally for four months and got rid of a fair amount of fungus on two big toes and three or four smaller ones. Since the treatment I have been applying Desenex powder on my toes almost daily. Nevertheless, a sliver of fungus showed up n my right toe just as the last part of it was growing out on the top.  So now the sliver is about i/8 of an inch by 3/8 lying perpendicular to my left big toe. 

I have a metal file that is about 1/8 wide which was perfect for filing a 1/16 by 3/8 inch section across the toe and about 1/16 inch deep.  I have filed rather  easily, and applied the vinegar patch with your little cover.

http://www.drblakeshealingsole.com/2011/11/onychomyosis-toe-nail-fungus.html

Here are my questions:

1. The vinegar seems to burn a little.  Any concern about overdoing this treatment?
Dr Blake's comment: Vinegar is 5% acid so you do have to watch how your skin reacts.

2. Is there any danger in filing deeper and even getting down trying to make a little hole in the nail just above the skin.  Possibility of infection? or pain?  The reason I ask is that I want the vinegar, if that is the best treatment, to be able to soak in as best I can.
Dr Blake's comment: The nail bed is under the cuticle, and under the nail, firmly attaching itself. You do not want go through the nail since you risk damaging the bed. 

3. How often should I apply the vinegar and for how long.  For the soaks in vinegar, you recommend 2-3 times a week for 30 minutes each time.  Is that the same for the vinegar patch? Dr Blake's comment: The vinegar patches I recommend 3 hours max. If your skin does well, you can try longer. You can do the vinegar patch daily, but probably go to rest the skin every 4th day. Continue to monitor the skin for excess dryness with cracking.

4.  Since Lamisil is clearly a very effective killer of the fungus.  Why would I not use Lamisil ointment to penetrate and kill the new fungus rather than vinegar?  Perhaps because the ointment does not permeate the nail.  All the more reason for trying t create a hole in the nail.  Perhaps cutting through the nail is something that would be better to leave to you.  Do you do such things in a case like mine? Dr Blake's comment: Answered above, but Vinegar is 100% anti-fungal and Lamisil is not 100% active ingridient. Fungus loves moisture, so when medications do not kill fungus well, they can actually make the situation worse by keeping the area too moist. 

5.  I understand that fungi do not do well when exposed to oxygen.  Again, a hole would bring more exposure. Dr Blake's comment: Toenails breathe, they are alive not dead, polished toenails stop oxygen from penetrating the nail bed allowing toenail fungus to thrive after a pedicure. 

6.  What about supplementing the vinegar with Vick's vapor rub and/or tea tree oil?  Is a combination more effective than just the vinegar?Dr Blake's comment: See my blog post below. 

http://www.drblakeshealingsole.com/2010/10/toenail-fungus-summary-of-various.html

7. Is it better to apply powder directly on my toes or better in my shoes and between my orthotic and shoe, or both? Dr Blake's comment: Powder it all. 

8. Finally a question about balancing on one toe.  What do you think about shifting my arms and one leg in different directions to challenge my balance and to increase my ability to balance on one foot? Dr Blake's comment: That is a great idea as you do the Single Leg Balancing Exercise. It is important to continue to make it harder over the next year as you get stronger and stronger. 

Thank you for your excellent in office treatment and for your willing (so far) electronic bedside care!!!!!

Toenail Fungus

Hello Dr. Blake,

I found your website and have read the toenail fungus section carefully. I have a toenail fungus problem and I am interested in using more simple (non-pharmaceutical) methods in fighting it. Unfortunately I also have a fingernail that got infected by a contaminated nail clipper over a year ago.

I live in a rural area and a few months ago I went to a local dermatologist.  He prescribed Lamisil for my nail fungus. I had already researched the matter and tried to discuss the urea nail removal option but he was not at all interested and was even rude and just cut me off, so to say.  He said, rather sarcastically, "What's the dosage for Urea?!"  I considered the Lamisil option but after looking at a website that had hundreds of people telling about their experiences with side effects in using that, I decided not to go that route.
Dr Blake's comment: If you use Lamisil tablets, I recommend 1 week per month for 6 months. This is called pulsing, and definitely safer than daily dosing for 6 months, and very effective for my patients when I use it this way. Also, if the nails are very thick, the Urea Occlusion technique is more effective than removing the nails, or Laser, in getting the nails to a more normal starting point. See the separate post on Urea Occlusion. Please remember that Lamisil is not benign, and can cause serious side effects. So, have a long conversation with your prescribing doctor. I am definitely recommending now that patients consider laser treatments (even though expensive) first before considering Lamisil. 

http://www.drblakeshealingsole.com/2010/10/toe-nail-fungus-carmol-40-urea.html

I am a "do-it-yourself" type of person and I have been doing soaks of the affected nails for several months now; also, after I do the soaks, I trim the nails (they were a bit softened up by the soak) and cut them way back (up to the cuticle and even beneath it) with some nail trimmers that I have. The nails don't look as ugly that way, but they are still quite unsightly. So, my question for you is this: Is there any way I can get some Carmol 40 Urea and try this myself?
Dr Blake's comment: have your primary care doc order it, and see all the photos on my post. You should be able to do it yourself within reason. 

 I know that I could follow the examples given in your photos. I would go through a podiatrist but I am not a wealthy man and I am afraid that visits to one of those (if I could even find one out here who was open-minded enough to consider this regimen) would wipe me out financially. I don't have health insurance with my job.

Can you tell me how far above the cuticle the nail bed is? The fingertip with the affected nail looks a bit swollen and is a shade or two darker in color than the other fingers.
Dr Blake's comment: The nail bed goes 6-7 mm further towards the arch from the cuticle.

I don't expect free advice from you, and I would be happy to pay you for your counsel and/or any suggestions that you can give me.

Thank you for putting all of this information on your website—it's all very interesting. Your efforts to enlighten others are appreciated!
Dr Blake's comment: Hope this helps.

Sincerely,

Toenail Fungus News About Lamisil (terbinafine)

RE: Life-long Maintenance Regimen for Onychomycosis (Carl Solomon, DPM) From: Bryan Markinson, DPM Dr. Solomon laments the lack of studies for exactly how little terbinafine we can give and still achieve efficacy. This has been beautifully done and published in 2004 in a very well known study on onychomycosis in the dermatology world but little known in podiatric medicine. I say “little” because even though I have written about it in several different venues for several years, podiatrists still react incredulously. I encourage all to read the following: Nardo Zaias, MD; Gerbert Rebell, MS, The Successful Treatment of Trichophyton Rubrum Nail Bed (Distal Subungual) Onychomycosis With Intermittent Pulse-Dosed Terbinafine.ARCH DERMATOL/VOL 140, JUNE 2004. The study concludes that one 250mg tablet daily for seven days, repeated at three months intervals,(total of 28 250mg doses annually), is virtually as effective as 90 day continuous dosing. That’s 70% less drug and a two month and three week holiday between pulses. I will e-mail a copy of the study to anyone requesting it. Bryan C. Markinson, DPM, NY, NY, bryan.markinson@mountsinai.org Dr Blake's comment: So, if you are being offered oral daily Lamisil (terbinafine), consider going a safer route with this pulsed version. Lamisil has now replaced Sporonox for the treatment of severe toenail fungus in many circles. Remember that Lamisil is not benign and can cause serious side effects. Please have a long discussion with your prescribing doctor before taking, and I am presently recommending laser treatments (although expensive), first before any though on oral anti-fungals.

Onychomyosis: Toe Nail Fungus

The photo demonstrates the use of a small piece of gauze laid down on the toenail with fungus. The gauze is big enough just to cover the nail. The gauze is soaked in white vinegar, squeezed to remove excess, and then laid on top of the nail. Paper or scotch tape is used to hold the tape in place for several hours in the evening, 3 to 5 times per week. This is done for the 6 to 9 months it takes to allow a new nail to grow out. Hopefully, you are happy with the fungus free new nail. Vinegar is 5% acid and fungus can not live in it. Once per week it is good to pumice the top of the toenail (s) to thin out as much as possible over a 6 month period. 

Laser for Toenail Fungus

http://www.lagunabeachindependent.com/2011/09/07/podiatrist-offers-high-tech-toenail/

I like Dr Sabet's approach to this new treatment. His is a 3 part treatment which sounds smart. First you thin the nails as much as possible. Then you laser the nails to kill the fungus. Then you apply daily for 6 months some topical anti-fungal to keep new fungus from getting into the treated nails.

     If there are any patients out there that have had this treatment that want to comment, please feel free. I have personally seen a 50% change in patients, but they had just had it (no where near the 6 months Dr Sabet recommends).

Toe Nail Fungus Treatment with Dr Remedy's Nail Polish

I just recommended this to a patient. If you have toenail fungus, and you are doing the various treatments listed in the below posts, or even anti-fungal oral meds, here is a product that allows you to polish your toenails. Even if it helps 10% I am for it. But, as you may know, one of the very important aspects of toenail fungus treatment is getting oxygen to the nail beds. Toe nail polish will block the flow of oxygen, so use when you need to, and remove more often than you would otherwise.

http://www.remedynails.com/

Toe Nail Fungus: Carmol 40 Urea Occlusion Treatment

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When toenails are very thick from fungus (called onychomycosis), or from trauma, or both, Carmol 40 Urea Occlusion Treatment can be a quick and easy way to take off the unwanted diseased nail without shots, or bleeding. Here athletic tape is cut into small pieces and applied around the nail to protect the surrounding skin. Only the nail should be exposed in the hole created. Benzoin, a skin adherent, is used on the surrounding skin before the tape is applied to further the chances that the tape will stay on for the entire treatment of 1 week.

The patient is given an RX for 3 grams of Carmol 40 Urea Ointment to bring to the appointment. Here the medication is being applied to the nail in one big glop!!

Once the medication is applied, more tape is applied over the medication in an attempt to keep it secure, and then the thumb or fingers of a glove (unsterile) is placed over the the entire toe. This creates a warm sweaty environment for the medication to penetrate the nail.

Here I am treating 3 toes on one foot and athletic tape is used to further secure the glove finger in place. Patients are especially advised to careful when removing their socks.

Is there a Funny Toe Photo Award on the Internet??

When the patients come in for their 1 week appointment, the bandages are removed, the toe nail clippers are used to remove all or most of the old diseased nail. The treatment does not remove good nail which is firmer in its attachment to the nail bed. This then starts a year of nail treatments outlined in the two posts below to get good and healthy nails if possible. Again, if the root cells are damaged, the nail will never be perfect, but they always look better.

http://www.drblakeshealingsole.com/search/label/Toenail%20Fungus

http://www.drblakeshealingsole.com/2010/04/key-points-in-treating-fungaled.html

Toenail Fungus: Summary of Various Treatments

The following are some key points in treatment.

1. Do something every day to help and change the environment the fungus lives in.
2. Develop daily, weekly, and monthly routines as the battle can take 1 or 2 years.
3. Understand that if the root cells under the cuticle are damaged, the nail will never look right.
4. Monthly disinfect your shower stall.
5. Weekly put foot powder in the ends of the shoes you wear on a regular basis, removing all inserts from these shoes and let these air out over night.
6. Weekly use a pumice stone or emery board, and file the tops of the nails to open up to air. Fungus lives in anaerobic environments. If your nails are real thick, you must keep them as thin as possible. I will have a post in the next few days on Carmol 40 Urea Occlusion Technique which is designed to remove all bad nail in these very thick nail situations. You can talk to your doctor about this technique.
7. Daily apply tea tree oil, Vick's Vapor Rub, white vinegar, or one of thousands topical anti-fungal creams/lotions. This should be done twice daily.
8. 2 or 3 times weekly use 2 cups of white vinegar in 2 cups of warm water (bigger amounts of the same ratio if needed) and soak your toes in a basin for 30 minutes. If you time it before you shower, you can get the salad dressing smell off.
9. I am presently recommending laser treatments (work 50% of the time and expensive) before any consideration of oral medications like Lamisil.
Ah, Chihuly!!
10. If you and your doctor are considering oral medications, try Lamisil pulsed. You can read about it in other posts within my blog. It is taken 7 days per month for 6 months. This is less likely to cause side effects over taking daily. However, Lamisil is not benign and can cause serious side effects. Have a long conversation with your prescribing doctor before taking. Sporonox, which used to be my go to drug for this, has been black labelled due to side effects such as this. 

If you have had enough of toenail fungus, and I do not blame you, try listening to Kapena from my recent Hawaiian trip. My gift to you.



http://www.drblakeshealingsole.com/2010/04/key-points-in-treating-fungaled.html