Why Is Nail Fungus So Hard To Cure

Treatment Options For Nail Fungus

Interviewer:

Most of my conversation is usually discussing medical therapy, so things that are available by prescription only. And those come in two main forms, which are topical antifungal medications, and then oral antifungal medications. There are other surgical or procedural options, so you can remove nails as well. And then there’s starting to be more interest in technologies like lasers for nail fungus.

Staying One Step Ahead Of Toenail Fungus

An established fungal infection is hard to eradicate, but you can stop its spread and improve your toenail’s appearance.

Toenail fungus isn’t a pressing health problem. Yet a fungal infection can ruin the appearance of your nails and cause pain as it lifts the nail away from the nail bed. And fungal infections are notoriously difficult to get rid of. “You may want to consider fungal toenail a condition to be managed rather than cured,” says Dr. James P. Ioli, chief of the podiatry service at Harvard-affiliated Brigham and Women’s Hospital.

How To Prevent Both Foot And Toenail Fungus

While toenail fungus and foot fungus arent the same condition, the following tips can help you prevent both, says Sundling:

• Practice good hygiene, such as keeping your feet clean.
• Alternate your shoes during the week. Your feet sweat all day long. Alternating your shoes allows them to dry out, so the fungus cant survive.
• Wear moisture-wicking socks that help dry out shoes and kill fungus. You can find these at running stores and athletic stores. If your socks are exceptionally sweaty, changing them more than once per day can help.
• Wear shoes in public places like locker rooms, pools, and gyms to limit exposure to fungus.

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What About Bleach Baths

Bleach baths are an approach dermatologists may recommend for treating skin conditions such as atopic dermatitis and recurrent Staphylococcus infections on the skin. These involve mixing a very small amount of bleach in bath water typically a half cup of bleach to a full-sized bathtub of water.

While its true that bleach baths may temporarily kill bacteria, fungi, and viruses, the effects arent long-lasting and arent likely to treat an existing toenail fungal infection.

What Is The Most Effective Treatment For Toenail Fungus

The most effective toenail fungus treatment for you will largely depend on your symptoms and situation. Your provider will consider several factors before recommending a treatment plan thats customized to you.

Overall, oral antifungal medications may offer the most treatment potential. Pairing oral drugs with topical antifungal medication may make treatment more effective.

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What Are The Risk Factors For Toenail Onychomycosis

The most prevalent predisposing risk factor for developing onychomycosis is advanced age, which is reported to be 18.2% in patients 6079 years of age, compared to 0.7% in patients younger than 19 years of age. Further, men are up to three times more likely to have onychomycosis than women, though the reasons for this gender difference are not clear . Moreover, the low prevalence of infection in people whose spouses have onychomycosis compared to the prevalence among their children suggests a genetic risk factor . Though extremely rare, one study reported four family members from seven unrelated groups with a common genetic trait who developed a dermatophyte infection of deep tissues that proved fatal .

Other risk factors include diabetes and conditions contributing to poor peripheral circulation . In fact, onychomycosis may represent an important predictor for the development of diabetic foot syndrome and foot ulcers . Patients who are immunosuppressed, such as those with HIV infection and those undergoing cancer therapy, are also predisposed to fungal nail infection . There is at least one case report of a toenail infection caused by Fusarium that developed into a fatal systemic infection in a lymphoma patient following a bone marrow transplant .

Do Fungal Toenails Need To Be Treated

Absolutely! Fungal infections of the toenails are capable of causing many problems the simplest being cosmetic. However, fungi can cause more serious problems if left untreated, such as:

• Fungal infections of the toenails can make your nails so thick that they hurt.
• Fungal infections can spread from one toenail to another, as well as to other parts of the body, like the skin on your feet, called Athletes foot, your scalp, under your arms, and your genital area.
• In people with immune problems, fungal infections can spread to your mouth or lungs.
• Fungal infections can cause cracks between your toes which can be places serious infections can start, especially in diabetics.
• Fungal infections can lead to bacterial infections under or surrounding the nail, which may need oral antibiotics or surgical removal of the nail.

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How Is Nail Fungus Treated

Treatment for a nail fungus may include topical creams, gels, nail lacquers, or oral medications . Rarely, surgery may be required. Although seldom done, removal of the infected nail can be performed to permit direct application of a topical antifungal. Oral drugs, such as terbinafine, can cure about one third of nail fungus infections.

Toenail infections are more difficult to treat than fingernail infections because the toenail grows more slowly. In addition, a damp, warm environment of a shoe or boot can encourage fungal growth.

Keep Clippers To Yourself

If you have been using a certain pair of clippers on your toes, you will very much want to disinfect or replace those as well. How best to do this?;

• Let the clippers soak in boiling water for a few minutes.
• After removing them , scrub with dish soap and an old toothbrush to clean off any remaining dead skin cells or residues.;;
• Rise, then wipe down the clippers with a paper towel soaked in rubbing alcohol.;
• Completely dry the clippers with a paper towel to avoid rusting.;

You can also use;Barbicide;if you happen to have it around.;

Now that you have a clean pair of toenail clippers, make sure to use them only on your toenails. They should be the larger kind designed for toenails, too. Sharing clippers runs another risk of fungal;infection, and;using the same pair of clippers on your fingernails and toenails can run the risk of transferring an infection from your feet to your hands, or;vice;versa.;

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How Do Dermatologists Diagnose Nail Fungus

To find out if a patient has nail fungus, a dermatologist examines your nails and nearby skin. Its important to check the skin because the fungus can spread. You may already have a skin infection caused by fungus like athletes foot.

To get rid of the infection, you will need to treat all infected areas.

Before giving you the diagnosis, your dermatologist may also take some samples. Collecting a bit of debris from beneath a nail, trimming off part your nail, or scraping off a bit of skin can be very helpful. In a lab, these samples can be examined under a microscope to find out whats causing the problem.

Are you hiding an infected nail with nail polish?

Be sure to ask your dermatologist if you can wear nail polish while treating nail fungus.

Foot Fungus: Causes And Risk Factors

A foot fungus is a fungal infection of the skin, better known as athletes foot, says Sundling. The fungus enters through cracks in the skin. Its known as athletes foot because athletes or anyone who is more active and sweats a lot is more at risk. Kids are also more at risk, because they dont tend to wear different shoes, and changing your shoes is one way to avoid foot fungus.

Foot fungus is very common. It does not mean that someone is dirty or didnt bathe, and if you have a compromised immune system, you may be more susceptible, says Sundling.

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Why Do Patients So Often Relapse

There are multiple factors that may contribute to the high rate of fungal nail infection recurrence. Patients with a genetic predisposition to onychomycosis, who are immunocompromised, or who have diabetes, are likely to experience relapse and may never achieve a permanent cure .

This may be due either to failure to eradicate the infecting fungus or to re-infection with a new fungal strain following subsequent exposure. Arthroconidia, which are chains of fungal conidia that are formed by breakage of the fungal hyphae, are considered to be the primary means of nail invasion. These arthroconidia, which have thicker cell walls than conidia formed in vitro, have been shown to be more resistant to antifungals and, thus, may remain in the nail bed as a reservoir for recurrent disease . However, the incidence of innate resistance among dermatophytes is low. Our Center conducted in vitro susceptibility testing of 140 sequential isolates from subjects who failed treatment in an oral terbinafine clinical trial. In all cases, the minimum inhibitory concentrations of terbinafine against each patient set were identical or within one tube dilution, implying no resistance development. The same results were obtained within each set with fluconazole, itraconazole, and griseofulvin . This further indicates that there was no crossresistance between antifungal agents . This study showed that failure to cure the infected nails may be due to host/family factors.

A Closer Look At The Troublesome Fungus

Toenail fungus is one of the main reasons people come to her office, and Vlahovic has studied the condition for years. Viewed through a microscope, her enemy appears rather meek. It looks like thin straws with little compartments in it but its part of an aggressive fungus family. The fungus that affects the foot in general, they are called dermatophytes. They love hair, nails and skin, so actually the same organisms that cause athletes foot can cause nail fungus.

If it gets into the nail bed, the fungus eats and digests the keratin in the nail, and that causes discoloration and thickening of the nail. Its a cosmetic condition that can become painful, but even if its not, Vlahovic argues that it is an infection that should be treated.

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Toenail Fungus Takes Time To Fix

Dear Doctor: I’ve tried all the toenail fungus cures in our drug store, and so far nothing works. Why not? What can I do? I really miss wearing sandals.

Dear Reader: You are one of the estimated 6 million people in the United States struggling with toenail fungus. It’s not only common, but, as you’ve learned, it’s a challenge as well. That’s because, although the symptoms affect the visible part of the toenail, the fungi causing the infection actually live underneath the toenail.

Toenail fungus is usually caused by one of a group of microscopic organisms called dermatophytes. Like the yeasts and molds they’re related to, these fungi absorb nutrients from organic substances. In the case of toenail fungus, the food source is the portion of the toenail known as the matrix. It’s found at the base of the nail, beneath the cuticle. The matrix is served by a network of nerves and blood vessels, and it generates the cells that become the new growth of the toenail. Although this type of fungal infection can affect the fingernails as well, it’s more common in the toenails due to the warm, moist and dark environment provided by socks and shoes.

Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health.

Nails Are Tricky To Treat

Unfortunately, fungal or bacterial infections of your nail bed are hard to treat. Prescription drugs range from 35%-65% success rate, so anything OTC would likely be even less than that, says , podiatrist in North Carolina and spokesperson for the American Podiatric Medical Association. Why are these types of issues so hard to treat? Because nails, especially toenails, have lots of layers, so there are more areas for the fungus or bacteria to penetrate, and if it gets into the cells responsible for growing the nail, its even harder.

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Preventative Steps To Take

While you cant always help your risk factors for toenail fungus, there are some preventive steps you can take:

• Bring your own sterilized instruments, such as nail clippers, to a nail salon.
• Keep your toenails short and clean to prevent nail trauma that can lead to cracking. If you have difficulty trimming your own toenails, your doctor may recommend seeing a podiatrist to help.
• Dont share personal care items like fingernail clippers or pumice stones with another person.
• Throw away or treat potentially infected footwear.
• Wear clean socks and wash socks after use.
• Wear sandals when walking in a locker room, public shower, or any other places where fungus is likely to grow.

Toenail fungal infections have a high rate of recurrence, even after youve treated them. Thats why its important to couple treatment measures with preventive ones to give yourself the best chance for keeping your toenails healthy in appearance.

What Tests Might I Have For Toenail Fungus

Your provider will probably take a small sample from underneath your nail to further analyze it. Viewing the cells under a microscope can confirm a toenail fungus diagnosis. If the initial test is negative, a scraping can be sent to see if the fungus grows out in a culture. It also helps your provider identify the type of fungus.

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Why Do All Podiatrist And Dermatologist Not Know About Toe Nail Fungus I Have Been To 5 Doctors For 10 Years But No One Can Treat Me For The Toenail Fungus What Is So Hard About This

We should also mention that some home remedies may also work. For example, a recent small study suggested that mentholated ointments such as Vicks VapoRub might be effective in treating toenail fungus, depending on the particular microbe that is causing the infection. However, more studies are needed to confirm this remedy’s efficacy.Our best advice to you is to start back at “square one:” Consult with your primary care physician and have him or her help you determine the best course of action for treatment. He or she knows your medical history and can recommend and work with a specialist such as a podiatrist or dermatologist to help determine your next step. Two important things to remember: Treating a toenail fungal infection is a long process, and not all remedies may be advisable for you based on your overall medical condition. While toenail fungus can be annoying and unsightly, unless you have diabetes, it does not pose a significant risk to your overall health .

We hope you will continue to seek medical advice and treatment, and that it will lead to the resolution of your condition.

How Do Dermatologists Treat A Fungal Nail Infection

Treatment usually begins with your dermatologist trimming your infected nail, cutting back each infected nail to the place where it attaches to your finger or toe. Your dermatologist may also scrape away debris under the nail. This helps get rid of some fungus.

To completely get rid of the infection, most people also need one or more of the following treatments:

Medicine you apply to the nail: If you have a mild infection, a medicine that you apply to your nails may get rid of the infection. This treatment helps keep new fungus out while the nails grow. Fingernails typically grow out in four to six months. Toenails take longer, usually takes 12 to 18 months.

Probably the most difficult part of this treatment is remembering to use it as often as prescribed. Some treatments must be applied every day. Others you apply once a week. To get the best results, its essential that you apply these medicines exactly as directed.

The US Food and Drug Administration has approved the following medicines that you apply to the nail to treat nail fungus:

• Amorolfine

• Efinaconazole

• Tavaborole

Side effects from these medicines are generally mild. Possible side effects include redness and swelling, an ingrown toenail, and stinging or burning when you apply the medicine. In clinical trials, none of these side effects caused patients to stop using the treatment.

The FDA has approved the following systemic medicines to treat nail fungus:

• Fluconazole

• Itraconazole

• Terbinafine

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Epidemiology Of Toenail Fungus

The occurrence of onychomycosis has been reported 23% across Europe and 20% in East Asia. In north America the statistics are found to be 14%, with fungal infections constituting the 50% of nail related diseases. Since this infection is contagious and can be transmitted directly or by using the belongings of an infected person, this serves as the reason for such wide spread rate of this infection.

Can I Wear Nail Polish If I Have Toenail Fungus

You may feel tempted to cover up a discolored toenail with nail polish. If you are using a topical antifungal, you probably should not use polish. Some providers may tell you not to wear it in any case. Polish traps in moisture from the nailbed . Because fungi thrive in moist environments, wearing nail polish may make a fungal infection worse. However, the nail continues to grow with or without polish.

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How Are Thick Toenails Treated

Although not all cases of toenail fungus need to be treated, thick toenails may be a sign that the fungus has gotten worse. Several methods are available to treat your toenails. You can try some home-based treatments first and then talk to your doctor about prescription-based options. Topical and oral medications are the mainstays of therapy.