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Nail Fungus

feet woman

What is nail fungus?
Fungal infections of the nails (onychomycosis) can be a persistent and sometimes embarrassing problem, and occasionally can become painful. These infections develop when fungi, known as dermatophytes, burrow under nails causing them to become crusty, thick, discolored and distorted.

What are the symptoms?
The first sign of nail fungus is a white or yellow spot appearing underneath the tip of the nail, which then thickens and distorts the nail as the infection progresses. As fungi grow under and into the nail, crusting, discoloration and darkening begin. Moreover, infected nails often separate from the nail bed, which can cause pain in the tips of fingers and toes, as well as a slightly foul-smelling odor.

What are the causes?
You can pick up a fungal infection while walking barefoot at a swimming pool, in a gym locker room or shower, or even when having a pedicure under less-than-sanitary conditions. The fungus thrives in warm, dark, moist environments, like showers or sweaty shoes. Susceptibility may be heightened among those who have diabetes, an immune-deficiency condition, a history of athlete's foot, or who are prone to excessive perspiration. Foot fungus usually will travel through an opening in the skin or separation in the nail bed, and if continually exposed to warm and moist environments, will grow in abundance. Infection with nail fungus seems to occur more in toes than fingers because toenails usually are confined to the dark, warm, and moist environments where fungus thrives, as opposed to fingers, which are out in light and open air. Diminished blood circulation to the toes as compared with the fingers can also make it harder for the body's immune system to detect and eliminate infection.

What is the conventional treatment?
There are antifungal creams available over the counter, but their efficacy is questionable. The oral anti-fungal medications are much more effective, but not without bothersome side effects ranging from skin rashes to liver damage. These medications must be used with caution, especially since treatment is usually long-term. Fluconazole (Diflucan), Itraconazole (Sporanox) and Terbinafine (Lamisil) are a few commonly prescribed oral antifungal medications. They must be taken anywhere from 6 to 12 weeks as these infections are not quick to clear up.

There is a "nail lacquer" called ciclopirox that can be painted on the nail, applying it daily for a week, wiping the layers off with alcohol, then beginning again. This tedious process is done for up to a year and only has a 10% efficacy rate. Any topical application tends to work better when used in conjunction with oral medications. Serious infections may warrant removal of the nail.

Doctors also advise keeping nails trimmed short and allowing time for the feet to dry after showers, baths or swimming, using absorbent socks, and discarding old shoes that may contain fungal spores.

What therapies does Dr. Weil recommend for nail fungus?
Dr. Weil has always recommended using tea tree oil, a natural disinfectant sold at health food stores, for nail fungus. Here, too, you won't get speedy results. Paint the oil on affected nails twice a day for at least two months. The nail has to grow out for the fungus to be eradicated, so you may not see results for a year. An alternative remedy is grapefruit seed extract used the same way as tea tree oil - twice a day for at least two months. Eating 1-2 cloves of raw garlic a day may also be helpful over time as garlic has significant anti-fungal properties.

The oral anti-fungal drugs for treatment of nail fungus seem to be effective but are expensive and not as safe. While cases of toxicity are rare, Dr. Weil sees no reason to take even a small risk for a problem that is usually cosmetic. In painful cases, podiatrists may temporarily remove infected nails so that a topical anti-fungal medication can be applied directly to the nail bed. In stubborn cases, an infected nail can be permanently removed.

Although Dr. Weil has seen no scientific studies showing that Vicks VapoRub works, a lot of anecdotal evidence suggests that it can help get rid of nail fungus in some cases. These informal reports, however, are highly inconsistent. Some people say it took only a few days to see improvement, others say they used it faithfully twice daily for four to six months before they noticed results. Dr. Weil sees no particular reason why this remedy would work, other than the fact that it contains camphor, which has anti-fungal properties. If you want to try it, rub a small dab of the ointment into affected nails twice a day.

Vinegar has been used traditionally to ward off nail fungus. Evidence of efficacy is sketchy at best, but you could try soaking your feet in 1 part vinegar to 2 parts warm water for 15 - 20 minutes daily.

Whatever treatment you choose, take these precautions to prevent recurrences:

  • Keep your feet as clean and dry as possible
  • Wear waterproof sandals at swimming pools or other wet public areas
  • Change your socks or hose daily
  • Clip toenails straight across and keep them shorter than the tips of your toes
  • Avoid tight hosiery, which promotes moisture retention, and wear synthetic fabric socks that wick moisture away from feet better than cotton or wool

Be especially careful of any nail problem if you have an immune-deficient condition or diabetes and have foot concerns already. What might start out as a cosmetic problem can quickly turn into a more serious issue leading to complicated fungal infections mixed with bacteria, skin breakdown, worsening pain, neuropathy, and in the case of advanced diabetes, permanent nail removal or even amputation of the toe.

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