Skip to main content

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.
Labels:

Popular posts from this blog

NSAIDs

Advil and Motrin are ibuprofen, then you have Aleve (naproxen).  Those are the over-the-counter ones.  Prescriptions are Mobic (meloxicam), nabumetone, indomethacin, Toradol (ketorolac), diclofenac, Lodine, and the list goes on.  All of these medications are in a class called non-steroidal anti-inflammatory drugs (NSAIDs). I'm giving you this list because there is mounting evidence that these medications a) don't work as well as we'd thought and b) have some very serious long term side effects we're finding out more about. NSAID's act by reducing the amount of prostaglandins you make in order to reduce inflammation.  However, prostaglandins have a ton of other effects and are involved in the maintenance of just about AIDs and also stronger if they are taken every day and/or around-the-clock.  every other organ system that you have.  The effect is stronger with higher doses of NS NSAID's work best and are best indicated for times when something is r...
Read more

Kidney Stones

I've written about this previously , but it's often hard to explain to people what a 10 is on the "1-10" pain scale if they haven't been in that spot before.  For women who have had children, they generally know what a 10 is, but for men it's a little harder.  When I was a medical student on my psychiatry rotation, we had a patient calmly sitting there saying his pain level was at a 10 and our resident, who was an ex-military sniper with a large skull tattoo on his forearm and a crosshair through the eye, calmly leaned forward and asked, "so if I lit you on fire and ran you over with my truck, you could not be in more pain than you are now, correct?"  The patient changed his answer. Getting to the point, a kidney stone is about the close I can come to describing a 10/10 pain to people who haven't gone through childbirth.  The fundamental issue is similar - your body is trying to move a big solid thing through an opening that was not really desig...
Read more

Pain

Sorry to be a pain I would say about 90% of the comments I hear from people about their pain threshold is that they think they have a high pain tolerance.  Which is statistically impossible unless I just attract people who have a high pain tolerance. We traditionally ask people to rate their pain on a 1-10/10 scale and while we hear a lot of 9's and 10's, I would say that, having been present for a number of them, a 10/10 would be giving birth to a first child.  For those who haven't experienced that, my old psychiatry resident described it as "so if I lit you on fire and ran you over with my truck, you would not be in any more pain than you are now" (he was also a former Marine sniper which might explain that). But this is pretty pervasive throughout the medical system and got me wondering as to how people's understanding of what their pain threshold was matched up to what it really was.  Fortunately, there were researchers who had a yen to poke peopl...
Read more