DR. MOHLER: Thickened, yellow, discolored toenails? There’s a fungus among us!
No sandals this summer because of your ugly toenails?
Ten to 15 percent of all Americans, a third of diabetics and half of the population over age 70 are afflicted with onychomycosis — toenail fungus. Although it is usually considered a cosmetic issue, thickening of the nail may cause pain, ulcers and breaks in the skin that can lead to infections.
Toenail fungus is hard to get rid of. Any time, there are dozens of treatments for an illness, it is predictable that none of them work well. This is certainly true for this disease. Even when the treatment for toenail fungus does work, the fungus frequently recurs.
What treatments are available? Oral antifungal drugs like Lamisil (available as generic terbinafine) or Sporanox have been the standard treatment for many years. They work 30-50% of the time, but are fraught with headaches, rashes and liver damage. Twenty years ago, I treated one of my partner’s wives for a persistent skin fungus infection with Sporanox. Two weeks into the treatment, she became ill and turned yellow. Her liver tests went through the roof. After 10 anxious days, her jaundice improved and I have never prescribed oral antifungal drugs again.
OTHER THERAPIES AVAILABLE
Surgeons like to take the infected nail off (“a chance to cut is a chance to cure”) and treat the base with a topical anti-fungal.
Vitamin E, tea tree oil, Campho-Phenique, Listerine have been tried.
A small study recently showed that rubbing Vicks Vapor Rub into an infected nail helped some people.
Some have proposed dipping your toes in beer. This is probably safe, ineffective and a waste of good beer.
Laser therapy, the newest approach to toenail fungus, has been approved by the FDA, but the evidence supporting its efficacy is scanty. The FDA is allowing nail therapy practitioners to promise only “temporary increase in clear nail.” A course of therapy runs $700-$1,500.
For the last 20 years I have talked most patients with ugly, painless toenail fungus out of doing any treatment.
The treatments available are not very effective, are dangerous or expensive, or all of the above.
Cut your toenails straight across and keep them short.
If you go to a salon, take your own clean tools.
Dr. Mohler has practiced family medicine in Grand Junction for 38 years. Email him at email@example.com.
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