Onychomycosis
Dr. Jeffrey A.Oster DPM C.Ped
Onychomycosis refers to a fungal infection of the toe or finger
nail. Onycho refers to the nail and mycosis refers to a fungal
condition. Onychomycosis is very common in the toe nail and is
seen to a much lesser degree in the finger nail. It is estimated
that 50 million Americans suffer from onychomycosis. The
organisms that cause onychomycosis are usually fungus (90% of
cases) or yeast (7% of cases).
If you have a fungal infection in the nail, is it your fault?
No, not at all. Onychomycosis has nothing to do with hygiene.
There is only one way we do contribute to this condition and
that is in that we create an environment that is wonderfully
conducive to the growth of fungus. We jump out of the shower in
the morning, put on our socks and shoes for 18 hours and create
a greenhouse that promotes fungal growth.
It is safe to say that 50% of folks over the age of 50 have a
fungal toe nail infection to some degree. But this doesn't
necessarily mean that onychomycosis is due to 'old age'. But we
can imply that over the course of our lifetimes we would have
more opportunities to acquire a fungal infection of the nail.
The reason that onychomycosis and age seem to travel hand in
hand is due to accumulated trauma to the nail that occurs over
time. Trauma makes the nail much more susceptible to fungal
infections. It's also reasonable to assume that folks in
professions or social activities where they may abuse their feet
would tend to have a higher rate of onychomycosis. An example of
activities that may abuse the feet and nails would included a
mechanic dropping tools on their feet, horses or cattle stepping
on the toes or runners who constantly injure their nails. An
injury to the nail is a common precursor to a fungal nail
infection. Trauma may be something abrupt such as a can of beans
hitting the nail from the top shelf or something as benign as a
pair of ill-fitting shoes constantly rubbing on the nail.
The appearance of onychomycosis can vary but most cases begin at
the distal tip of the nail and slowly progress into the nail
over a period of months to years. The nail will thicken as the
fungus continues to grow. The filaments of fungus take up space
in the nail causing it to swell. The nail can be yellow, white
or even green to black. The nail may also grow to be chalky and
flakey.
Treatment of toe nail fungus and onychomycosis
The single most important thing that you can do to protect the
nail from fungal infections is to protect the nail from
injuries. A healthy nail acts as a protective barrier to fungal
infections. Once the nail is injured, the door of susceptibility
swings open, allowing entry of the fungus. Also, keep the feet
dry. Keeping the feet dry will inhibit the ability of the fungus
to thrive. Frequent changes of socks, the use of powder, such as
baby powder and rotating shoes so that they are worn only every
other day, can help tremendously.
Medications for onychomycosis fall into two categories; topical
and oral. There are any number of effective topical medications
available over the counter. Topical medications are most helpful
in treating early, small infections and for maintaining clear
nails. Topical medications do have a limited ability to
penetrate the nail to reach all of the fungal elements. Topical
medication inhibit the growth of the fungus allowing for faster
growth of the nail. Remember, the fungus doesn't take a day off.
Compliance is a big issue when using topical antifungals. A
number of effective over the counter (OTC) medications are
available including ClearZal Bac, Tineacide and Elon Dual
Defense anti-fungal Lotion.
Fungus can reoccur if your shoes are not properly treated,
therefore an antifungal shoe spray. Keeping the feet clean and
dry is another important part of treating fungal infections of
the skin and nail. The daily use of a drying solution will
significantly decrease the ability of a fungal infection to
thrive.
The FDA approved a new prescription strength topical medication
for treating onychomycosis in 1999 called Penlac. (Dermik
Laboratories, Collegeville, PA). Penlac is manufactured in
Frankfurt, Germany by Aventis Pharma Deutschland GmbH. Penlac
doesn't carry the side effects of the oral medications but the
jury is still out on the efficacy of this medication.
The older generations of oral antifungal medications, such as
Fulvicin or Griseofulvin, have been used successfully for years
and are making a comeback due to their economic value. The newer
generation of oral antifungals, including Sporanox and Lamisil
have been received very well by the medical community. Care
should be taken when using Sporanox due to its' potential liver
toxicity. Both Sporanox and Lamisil are expensive medications
costing several hundred dollars for the recommended three month
course of treatment.
When all else fails, the fungal toe nail can be permanently
removed. This procedure is not difficult to perform and most
patients return to their normal shoes in just a Band-Aid in
24hrs. The removal of the nail is permanent.
Which choice is right for you? Consider the following two
examples;
Case 1. Sandy is a 24 year old hairdresser who has intimate
hands on contact with her clients on a daily basis. She has
developed a fungal infection in several of her finger nails. She
is concerned that the fungal infection will have a direct impact
on her livelihood and does not want to spread the infection to
others.
Case 2. Joe is a 62 year old farmer and has a long history of
injuries to his hands and feet. His last visit to the doctor
showed signs of an increase in his liver enzyme studies
indicating an overall decrease in his liver function. Joe has
developed onychomycosis in most of his toe nails.
I think the choices for Joe and Sandy are clear but in most
cases the criteria to make recommendations for treatment of
onychomycosis are not as obvious. In those cases, patients
should consult their physician to discuss the pros and cons of
oral antifungal treatment.
About the author:
Dr.Oster is a Board Certified Podiatrist and Medical Director of
www.MyFootShop.com.
Onychomycosis refers to a fungal infection of the toe or finger
nail. Onycho refers to the nail and mycosis refers to a fungal
condition. Onychomycosis is very common in the toe nail and is
seen to a much lesser degree in the finger nail. It is estimated
that 50 million Americans suffer from onychomycosis. The
organisms that cause onychomycosis are usually fungus (90% of
cases) or yeast (7% of cases).
If you have a fungal infection in the nail, is it your fault?
No, not at all. Onychomycosis has nothing to do with hygiene.
There is only one way we do contribute to this condition and
that is in that we create an environment that is wonderfully
conducive to the growth of fungus. We jump out of the shower in
the morning, put on our socks and shoes for 18 hours and create
a greenhouse that promotes fungal growth.
It is safe to say that 50% of folks over the age of 50 have a
fungal toe nail infection to some degree. But this doesn't
necessarily mean that onychomycosis is due to 'old age'. But we
can imply that over the course of our lifetimes we would have
more opportunities to acquire a fungal infection of the nail.
The reason that onychomycosis and age seem to travel hand in
hand is due to accumulated trauma to the nail that occurs over
time. Trauma makes the nail much more susceptible to fungal
infections. It's also reasonable to assume that folks in
professions or social activities where they may abuse their feet
would tend to have a higher rate of onychomycosis. An example of
activities that may abuse the feet and nails would included a
mechanic dropping tools on their feet, horses or cattle stepping
on the toes or runners who constantly injure their nails. An
injury to the nail is a common precursor to a fungal nail
infection. Trauma may be something abrupt such as a can of beans
hitting the nail from the top shelf or something as benign as a
pair of ill-fitting shoes constantly rubbing on the nail.
The appearance of onychomycosis can vary but most cases begin at
the distal tip of the nail and slowly progress into the nail
over a period of months to years. The nail will thicken as the
fungus continues to grow. The filaments of fungus take up space
in the nail causing it to swell. The nail can be yellow, white
or even green to black. The nail may also grow to be chalky and
flakey.
Treatment of toe nail fungus and onychomycosis
The single most important thing that you can do to protect the
nail from fungal infections is to protect the nail from
injuries. A healthy nail acts as a protective barrier to fungal
infections. Once the nail is injured, the door of susceptibility
swings open, allowing entry of the fungus. Also, keep the feet
dry. Keeping the feet dry will inhibit the ability of the fungus
to thrive. Frequent changes of socks, the use of powder, such as
baby powder and rotating shoes so that they are worn only every
other day, can help tremendously.
Medications for onychomycosis fall into two categories; topical
and oral. There are any number of effective topical medications
available over the counter. Topical medications are most helpful
in treating early, small infections and for maintaining clear
nails. Topical medications do have a limited ability to
penetrate the nail to reach all of the fungal elements. Topical
medication inhibit the growth of the fungus allowing for faster
growth of the nail. Remember, the fungus doesn't take a day off.
Compliance is a big issue when using topical antifungals. A
number of effective over the counter (OTC) medications are
available including ClearZal Bac, Tineacide and Elon Dual
Defense anti-fungal Lotion.
Fungus can reoccur if your shoes are not properly treated,
therefore an antifungal shoe spray. Keeping the feet clean and
dry is another important part of treating fungal infections of
the skin and nail. The daily use of a drying solution will
significantly decrease the ability of a fungal infection to
thrive.
The FDA approved a new prescription strength topical medication
for treating onychomycosis in 1999 called Penlac. (Dermik
Laboratories, Collegeville, PA). Penlac is manufactured in
Frankfurt, Germany by Aventis Pharma Deutschland GmbH. Penlac
doesn't carry the side effects of the oral medications but the
jury is still out on the efficacy of this medication.
The older generations of oral antifungal medications, such as
Fulvicin or Griseofulvin, have been used successfully for years
and are making a comeback due to their economic value. The newer
generation of oral antifungals, including Sporanox and Lamisil
have been received very well by the medical community. Care
should be taken when using Sporanox due to its' potential liver
toxicity. Both Sporanox and Lamisil are expensive medications
costing several hundred dollars for the recommended three month
course of treatment.
When all else fails, the fungal toe nail can be permanently
removed. This procedure is not difficult to perform and most
patients return to their normal shoes in just a Band-Aid in
24hrs. The removal of the nail is permanent.
Which choice is right for you? Consider the following two
examples;
Case 1. Sandy is a 24 year old hairdresser who has intimate
hands on contact with her clients on a daily basis. She has
developed a fungal infection in several of her finger nails. She
is concerned that the fungal infection will have a direct impact
on her livelihood and does not want to spread the infection to
others.
Case 2. Joe is a 62 year old farmer and has a long history of
injuries to his hands and feet. His last visit to the doctor
showed signs of an increase in his liver enzyme studies
indicating an overall decrease in his liver function. Joe has
developed onychomycosis in most of his toe nails.
I think the choices for Joe and Sandy are clear but in most
cases the criteria to make recommendations for treatment of
onychomycosis are not as obvious. In those cases, patients
should consult their physician to discuss the pros and cons of
oral antifungal treatment.
About the author:
Dr.Oster is a Board Certified Podiatrist and Medical Director of
www.MyFootShop.com.
posted by The Editor at
5:49 AM
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