As summer approaches and more people start to bare their feet, it’s inevitable that those with fungal nails start to think about treatment. With advertising about the new topical Jublia and other methods that people find by googling “toenail fungus treatment” it’s not surprising that this has led to a lot of confusion for the general public. Before we delve more closely into what constitutes the best treatment, it’s important to understand what nail fungus is and what causes it.
What Is Nail Fungus?
Onychomycosis or nail fungus is caused by a group of organisms called dermatophytes. These are the very same organisms that cause athletes foot. Enzymes in the fungus break down the nail plate allowing it to penetrate the nail. Although fungus also affects fingernails, toenails fungus is much more common because it loves to live in dark and damp environments–namely our shoes and socks.
How Common Is It?
Very common. According to Dr. Warren Joseph, an estimated 35-36 million Americans have onychomycosis at any given time. However, only 6.3 million patients have been diagnosed by a physician and only 2.5 million receive treatment each year. Although toenail fungus is most often considered a cosmetic problem, it can cause pain and other problems in certain patients.
Who Gets It?
Although anyone can get toenail fungus, there are several factors that can increase your risk.
- Genetics – you can inherit a predisposition to fungal toenails.
- Closed, tight shoes and cotton socks – can trap moisture and retain moisture where fungus can thrive.
- Trauma to the nail—either direct (e.g. stubbing injury) or repetitive micro trauma (i.e. running in a tight shoe)—can cause damage to the nail plate allowing fungus to get in.
- Going barefoot in public places – shower rooms and locker rooms can be a hotbed of fungus.
- Aging – as people age they are more likely to have trauma to the nail and more opportunity for exposure to fungus.
- Diabetes, HIV, and medications which decrease the strength of the immune system, increase the risk of developing a fungal toenail infection.
How It’s Treated?
Fungal toenails can be very difficult to treat. Research shows a “complete cure”— which means no fungus and pre-infection nail appearance–can be nearly impossible to achieve. So if you have fungal nails it’s important to be realistic about what treatment can do for you.
Because toenail fungus can progress, it’s important to receive treatment early on. Fungus in one nail can also spread to other nails and to the nails of loved ones. Fungus can distort and thicken your nails making them hard to cut and manage. Although many consider nail fungus simply cosmetic in nature, it can cause pain and increase the risk of ulcers in diabetic patients three-fold over diabetic patients without fungus. People with other immune disorders are also at higher risk of developing onychomycosis.
Ensuring It’s Fungus
Your physician will test your nails by sending nail clippings to a lab if not totally sure it’s fungus upon visual inspection. Ugly toenails are often the result of fungus but not always. Trauma to the nails from playing sports or wearing tights shoes, aging, and immune disorders such as diabetes can often cause nails to become discolored, thick, and brittle. People with seasonal allergies may have a tendency to develop skin conditions such as eczema and may also develop changes in the nails that mimic fungus.
Oral medications are still widely used by many physicians to treat fungal nails — however, many patients and physicians and naturopaths are aware of the potential liver side effects from these powerful drugs and would rather rely on other non-toxic methods.
You may have tried some common topical treatments such as tea tree oil or thyme oil with a positive response. These topicals have anti-fungal properties and may help reduce fungal load and improve nail appearance. FDA approved topicals –efinaconizole (brand name Jublia), ciclopirox nail lacquer (brand name Penlac), tavaborole (brand name Kerydin) may also have the same effect. However, any topical used alone may have a low success rate when it comes to complete cure. Although these may be helpful to patients with extremely mild onychomycosis, other treatments are often necessary to improve nail appearance and destroy the fungus.
Laser treatment for fungal nails is painless and non-toxic. Laser penetrates the nail down to the nail bed where the fungus lives. Many patients are choosing this method after trying other methods that have been unsuccessful.
Laser has shown to be about 60%-70% successful in treating onychomycosis. More research is needed to understand which patients would benefit most from this treatment. Anecdotally, lasers work best on patients who get treated early, have a strong immune system, and are younger.
However, even patients with thickened toenails can see improvement in the appearance after treatment.
To increase the likelihood of success after laser, all patients should receive anti-fungal topicals to treat the nails and skin and keep down the fungal load. Killing the fungus in shoes is also important to prevent reinfection. Products that use ultraviolet light to disinfect shoes have shown to be 99% effective in killing the fungus.
Of course the best tactic is to prevent your nails from becoming infected in the first place. Here are some tips that will keep your toes protected.
- Keep your feet clean and dry.
- Wear shower shoes in public facilities whenever possible.
- Clip nails straight across so that the nail does not extend beyond the tip of the toe.
- Use a quality foot powder (talcum, not cornstarch) in conjunction with shoes that fit well and are made of materials that breathe.
- Wear socks that absorb sweat. Socks made of microfiber tend to “wick” away moisture faster than cotton socks, especially for those with more active lifestyles or sweaty feet.
- Use a UV shoe sanitizer or rotate your shoes if you tend to have sweaty feet.
- Disinfect home pedicure tools and don’t apply polish to nails suspected of infection.
- Avoid nail salons or make sure that salons are properly disinfecting their equipment. Or bring your own.