Today we are excited to welcome back guest blogger, Hai-En Peng, DPM, FACFAS who is sharing information about the various treatments for nail fungus.
“My nails are so ugly!” This is one thing that I constantly here in my office. Patients are coming in droves complaining that their “nails are ugly” or that inevitable “one more thing doctor…” as I leave the room – “Is my nail supposed to look like that?” In the age of looking good and the move to show off our body, not only do our bodies have to look good but so do our nails. Once we notice that there’s something not right in our nails, we move very quickly to cover it up whether its nail polish or putting on a closed toe shoe and seek all sorts of advice on how to get rid of the ugly spot in our nail. What is it in our nail that causes all sorts of distress? Nail fungus!
What is nail fungus? In short, the fungus gets inoculated in our nail bed causing an infection. How does it get in the nail? It can be through an injury, pedicures, severe athlete’s foot, or your body becomes weak and more prone to fungal infections. The infection causes the nail plate to discolor in all sorts of colors from yellow to brown to sometimes green.
Once it begins to discolor the nail, the nail begins to become brittle and break off. As the infection progresses, it can cause the nail to loosen and become thick. It eventually can lead to permanent damage of the nail. It can also lead to ingrown toenails and become so thick it’s difficult to trim and even fit into shoes.
“Ok doc, I have nail fungus…how in the heck do I get rid of it?!?” Nail fungus has to be one of the most frustrating things we treat here in the office. Most times people come in and they’ve already tried a whole host of stuff from creams to liquids to soaks, etc. In order to provide clarity on treatment, there are basically 4 categories of treatment.
1. Topicals
2. Oral medication
3. Laser
4. Surgical
Topicals – This is probably the easiest and most available method of treatment. Is it always effective? In my hands, it has a very low chance of success, but it can work. It requires a lot of dedication and diligence. There are a lot of products out there on the market from creams, lotions, sprays, soaks, and special nail polish. The special nail polish is something to note. If your nail fungus is mild, you may want to try a great product called Dr.s Remedy nail polish. This is a nail polish that is all-natural and takes all the toxins out found in normal nail polish. It comes in tons of great colors and contains natural occurring anti-fungals such as tea tree oil and garlic bulb extract. Other good topicals to try are Tineacide which applied everyday can be very effective in getting rid of nail fungus. There are also prescription strength topical gels and creams as well as pharmacies that compound special topical super creams to treat fungus. There are even home remedies such as Vicks vapor rub, dilute bleach, and dilute vinegar soaks that have been reported to help.
Oral medication – This is probably my #1 way I treat my nail fungus. Why? It is the most effective way to treat the fungus and has a high chance of success. Is it 100%? No, but a majority of people get rid of their fungus and are very pleased with the results. The best oral drug for fungal treatment is Lamisil or the generic terbinafine. Depending on the doctor, you may need to get bloodwork before, during, and after treatment. Why do we get bloodwork? There is a very, very rare chance that it could affect your liver. Has it happened to me? (Knocking on wood) so far so good, I have not had to stop the medication. Other potential side effects are an actual allergy to the drug, GI upset, and a temporary loss of taste/metallic taste. These are also very rare. Most patients tolerate the treatment very well. How long is the treatment? You take 1 pill everyday for 3 months and as an added bonus, I use a topical in combination.
Laser – This treatment is the hottest fad on the market today. It’s been around for quite awhile, but only recently have companies started to make special machines tuned to treat nail fungus in the toes/hands. Depending on who you talk to, this has a high variability in treatment success. So there’s no guarantee that it’ll work. Secondly, this treatment is not covered under insurance and treatments can be upwards to $695 to $1000+ depending on where the doctor is located. Thirdly, you may need follow-up treatments if it doesn’t work the first time. The laser itself is very safe and does not hurt. The treatment is about 45-60min to get the full effect on all the affected nails. It’s very easy to find doctors that have this technology, just search the internet, listen to radio, or even TV to find someone in your area.
Surgical – This option is the last resort option. Why? You’re at the point where you just want the nail gone. This is reserved for people that have tried everything under the sun. This person has failed topicals, failed Lamisil, doesn’t want to come every few months to get the nail debrided down, and even has failed laser treatment. Now before I go into the surgical option, the prior listed options debridement of nail (if necessary) can help the effectiveness of treatment. Basically, surgery can be anything from partial to total nail removal. Why partial? This is usually due to the fact that the fungus affected one side of the nail causing an ingrown nail. If the whole nail is involved, it can be removed permanently either chemically or surgically. This basically takes out the infection in the nail bed. The procedure can be done in the office or sometimes if multiple nails need to be removed, it can be done in the operating room.
Don’t fret if you have fungus in your nails. As you can see, there are a variety of treatments available. Regardless of which treatment you choose, please seek your local podiatrist for further information.
Dr. Hai-En Peng is a board certified foot and ankle surgeon and practices in Thousand Oaks, CA at Advanced Foot & Ankle Medical Center. You can follow him on Twitter (@DrHPeng), Facebook, and LinkedIn. Please visit his practice website at www.advpodiatric.com for more information.
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