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Onychomycosis / nail fungus

I have a joke about nail fungus, but it has to grow on you

Lots of people get nail fungus.  It's easy to pick up in the environment just walking around the problem with nail fungus, also called onychomycosis, is that it is very difficult to get rid of.  Your nail beds get very poor blood supply, and fungus is amazingly resilient and tough to kill, so any treatment to help improve it or get rid of it takes a very long time.  If you've ever dealt with dry rot or mold in your house, you know that you have to completely remove anything it's even come close to touching.

For most people, there is no actual harm that comes from having nail fungus.  The only time we see that is either when the amount of fungus under a nail gets so substantial it starts causing pain due to the pressure or sometimes when it creates small breaks in the skin around the nail that lead to a skin infection called cellulitis.  Outside of those two circumstances, treatment is generally purely aesthetic.

Anecdotally, I hear more people apologize for showing me their feet than pictures of their poop.  So I get that we as a society can be sensitive about our feet.  I don't understand why that is, but I get it, exemplified by when my 5 year old told my wife to "wash my nasty nasty feet" when she was in the bathtub.

Let me give you a rundown on the treatments out there:

- Doing nothing.  Research has shown this works 3-5% of the time

- Topical over-the-counter anti-fungal creams like Lotrimin (clotrimazole) or Lamisil (terbinafine).  Used nightly (rubbing under the nails), this works about 10% of the time, if you do it every night for 10-12 months

- Apple cider vinegar and Vicks VapoRub have been shown to have variable efficacy too, probably in line with the topical antifungals, and appear pretty safe to use.

- Prescription topical treatments like Jublia or Penlac work 15-30% of the time, again taking 10-12 months, and while reports vary, I think it can cost $300 a month.

- Oral systemic anti-fungal medications work 30-50% of the time but usually takes about a year to see the results.  Very very rarely, these pills can cause some liver damage as well so we will usually have people do lab work before and sometimes during the course of treatment (typically 3 months of daily pills).

Given that it is generally a benign problem to have, I usually recommend using a topical therapy to improve the appearance of the nails, rather than taking the chance that the oral medicine will work without causing side effects, also knowing that there is a good chance of nail fungus recurring in the future.

Here is some more information for you about how to treat nail fungus without using pills and if you decide to do it, please know you need to be able to stick with it for at least 6 months and in some cases a full year.
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