- Diseases, Disorders & Conditions
Curing Nail Fungus
What is nail fungus?
Warning: The following hub is intended for entertainment purposes only. Always consult your medical provider for any treatment or information about any medical condition. In this hub several medications are reviewed. The author has no relationship with any seller, producer, or user of any medication mentioned in this hub and received no renumeration from any such entity.
Nail fungus, also known as onychomycosis, is a disease caused by microscopic plant-like organisms, known as fungi (the plural of fungus) growing in the skin and tissue under your nails. The result of this infection is deformed and discolored toenails or fingernails. The nails can be severely itchy as well. But the problem is not just cosmetic. Nail fungus can increase your risk of other infections, which can be serious and even life threatening, especially if you also have diabetes or other chronic diseases. Fungus can spread from your nail areas to the rest of your body. Many cases of skin fungus such as tinea cruris ("jock itch") originally spread from the infected nails.
Nail fungus seems to be an increasing problem. Some doctors think that is due to our modern infatuation with wearing "sneakers" at all times. Sneakers tend to be damp and musty and don't "breathe" well making perfect conditions for fungal growth.
It's really important to note that the fungus is not in the actual nail or "nail plate" but is living in the skin under the nail, or the "nail bed." This will have vital implications for the treatment of nail fungus discussed below.
Treating Nail Fungus
Nail fungus is not one of those diseases that gets better on its own. Once you have it, it almost never goes away. The only way to get rid of it is to treat it.
Now, 50% of all nasty, discolored and deformed nails are caused by fungus. That's a lot, but it also means that 50% of nasty nails are not caused by fungus. Since all the effective treatments are expensive and can have side effects, the first step in proper treatment is to get a proper diagnosis. It is not recommended that you treat yourself for nail fungus without a laboratory test to prove that that is what you have.
What are the effective treatments? To make a short story shorter, they are oral antifungal medicines. That is, pills that you take by mouth. You cannot treat nail fungus properly by rubbing something on your nails or soaking them.
Why is that? Because, the fungus is not living on the nail itself on the surface. Instead they are living under the nail in the skin of the nail bed. Rubbing something on the outside of your nails to treat nail fungus is like trying to take a shower by sitting inside your house when it's raining. The water hits the roof, while you remain snug and dry. In fact, on the microscopic level of a fungus, it's more like trying to get wet from a rainstorm in a town 20 miles away!
So rubbing scented Vasoline (such as "Vick's") on your feet will not work, nor will vinegar, despite what the internet or your Aunt Fanny has to say. Ciclopirox (Penlac) which you paint on your nails, works about 20% of the time but you have to use it for almost a year to see results, which can be pretty expensive for what you get. Paying someone to rip out your nails and then putting something on the nail bed can work, but usually is unnecessary because there is now a better way.
The better way is the oral antifungals. Unfortunately, all current oral antifungals can have a bad effect on your liver, so if you have liver disease you usually cannot use them. They can also interact with some other medications, or be harmful in combination with certain other health conditions. If you cannot take oral antifungals, you will either have to live with the fungus, or try the mostly ineffective or invasive treatments mentioned above.
The first oral antifungal to be used widely for nail fungus was griseofulvin (US brand name Grifulvin). Griseofulvin has some drawbacks. You have to take it for one and one-half to two years two-three times a day, it interacts with other medications, can hurt your liver, and mostly doesn't work at all. It never cures fingernail fungus and after all that, only about 20% of toenail fungus. Frankly, if you are diagnosed with nail fungus and your doctor tries to prescribe you griseofluvin, say "Thank you very much," and hurry out the door to a doctor that has had some medical education after 1980.
Your two modern, reasonable options (for US residents) are itraconazole (brand name Sporanox) and terbinafine (brand name Lamisil).
Itraconazole works about 40-60% of time. However, it is usually taken on a weird schedule, one week of medicine, then four weeks for two rounds, which confuses a surprising number of people, and interacts with lots of other medications.
The best option is terbinafine. It is taken once a day for 3 months, and it only really interacts with two medicines, rifampin and coumadin. Lots of people with toenail fungus are on coumadin, but as with other medicine effect with this drug, the dose can simply be adjusted to account for the effects of the terbinafine. Terbinafine cures nail fungus about 90% of the time, and for almost 60% of users their nails will look good when they grow in after treatment.
Oh yeah, did we mention some of the other unfortunate aspects of nail fungus? Even after treatment works, your nails may not look normal again. Recurrence is common. This may be due to incomplete eradication (there was still some fungus hanging around and it grew back) or re-exposure combined with a person who is susceptible to fungal infections.
Unfortunately, fungus is everywhere. If you have nail fungus, you shouldn't walk around barefoot in locker rooms, swimming areas, saunas and so on; if you don't have it yet you probably shouldn't either, because somebody with it might not be following this advice. Some doctors advise you to throw away all your footwear if you have contracted nail fungus--if you can afford it. At least wash everything that can tolerate it in strong soap and hot water, and dust or spray your shoes all over with antifungal powder or spray.