Onychomycosis – refers to nail infections by fungus, including yeasts and molds. Toenail onychomycosis is most commonly due to dermatophytes, a type of fungus (i.e. Trichophyton rubrum and T. mentagrophytes)
Risk factors for the problem include swimming, athlete’s foot, diabetes, genetics, and living with family members who have the disease.
Besides being unsightly, the nails can be difficult to cut and also can increase the risk of bacterial infection. Pain can be an issue as well, as nails can become sensitive to pressure.
Yeasts, like Candida Albicans, can also cause some cases of nail fungus, especially on the hands. People who immerse their hands in water a lot are at risk.
Some fungal infections can discolor the nail black – (dematiaceous fungi – pigment-producing molds)
As a result of these infections, the nails get thickened, discolored, with crazy shapes and debris under the nail.
Two recent approved topical therapies that appear to have excellent effectiveness have come to the market.
Kerydin (Tavaborole) topical solution can be applied to the nail daily for 48 weeks. No nail removal is required and the solution is not absorbed to any degree by the body. About a third had significant improvement without adverse reactions to any large degree. It is expensive (~400$)
Efinaconazole (Jublia) topical solution is another new arrival to treat the standard nail infections caused by T. Rubrum/T. Mentagrophytes. It is a topical triazole that blocks the fungus from producing it’s cell membrane. Applied at a drop a day to the affected nail for 52 weeks, 40% had mycological cure with minimal side effects, but at a cost of $450 a month.
Oral treatments that are mainstay include Terbinafine (Lamisil) daily for 12 weeks and itraconazole daily for three months. Their effectiveness is about 30%-40% with more side effects.
Alternative therapies with some possible efficacy include applying Vicks Vapor rub (a mixture of menthol, eucalyptus oil, camphor, and thymol) to the nails every day for up to a year. This has worked well for quite a few people.
Tea tree oil is another alternative topical therapy with unproven results.
Still, oral therapies are still the best options as of yet. Oral Lamisil (terbinafine) cures 40% to 60% of patients…compared to less than 9% for Penlac (ciclopirox) and 11% for clotrimazole 1% topical solutions (less effective topical agents also on the market).
Key preventative measures include wearing flip-flops around a shared shower or pool, wash and dry feet thoroughly every day , do not clip your nails too low to the base, and avoid nail polish.
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