Caring for & Curing FUNGUS TOENAILS!

WHAT IS FUNGUS TOENAILS?

Fungus toenails (“onychomycosis”) is an infection of the toenails by a microscopic, plant-like organism. Under a microscope, a growth of fungus resembles a leafless form of ivy, minus the green color.

WHY BOTHER TREATING FUNGUS TOENAILS?

"FUNGUS TOENAILS:"   Treating fungus toenails is not just a matter cosmesis (how it looks)! Certainly no one would want to play footsies with anyone who had obviously fungus-infected toenails. Yes, fungus toenails are ugly. Yes, fungus toenails create thickened, discolored and raised nails which are difficult for most people to manage by themselves. Yes, fungus toenails can make nails brittle and loose and sometimes smell bad. But there is more.

This nail infection can and does spread to the skin (where it causes “athletes foot“) anywhere on the surface of the body. Conversely, athletes foot fungus ("tinea pedis") can spread to otherwise healthy nails and cause fungus toenails. The fungus can be spread to other members of your family via commonly shared surfaces (communal environment): in bathrooms, tubs and shower stalls. The deformed fungus nails can be sore to downright painful in shoes when walking. The nail changes caused by the fungus can deform the nail enough to cause or exacerbate ingrown toenails. Furthermore, fungus toenails can open the way to other foot and nail infections by bacteria too, leading to nail margin infections ("paronychias").

TREATMENT OPTIONS:

For more than a decade, until November, 1995, there was only one oral antifungual (ORAF) medication for the treatment of fungus toenails: griseofulvin. It was far from the ideal but was used because there were no other good choices. This all changed with the introduction of the first of two new oral antifungal agents: Sporanox™. This preparation too presented certain clinical challenges but it was far better than the older medication. Less than six months later, LAMISIL™ was introduced. Of the three, Lamisil is generally the best of the three, in my view. Both of these two, new drugs work by killing the fungus in the toenails, not just suppressing it.

Once one of the newer oral antifungals saturates the nail plate and kills the fungus, mother nature takes over. It is mother nature’s job to grow out the previously infected tissue from the toenails; this can take 9-12 months for the clearing of the great nails under the best circumstances. These medicines do not confer immunity. If the patient is not careful, it is possible for the patient to contract athletes foot and / or fungus toenails again. That is why preventative measures after ORAF treatment are so important.

There is now, since April, 2000, only one, FDA-approved, prescription only, topical nail lacquer which might be tried for MINOR fungus nail infections. It is stipulated NOT for those infections which have reached the "moon" (lunula) of the nail. It is stipulated for only one specific species of infecting organism. It must be painted on used EVERY single night for up to 48 (!) WEEKS; one morning each week it must be removed with rubbing alcohol. The fungus nails which are thickened in any way must be filed down. The company recommends that such nail debridement should be performed by a foot health provider; this is no job for the pedicurist at the nail salon. Unfortunately, its literature indicates a very low "cure" rate in comparison to the information about the oral medications. The tiny bottle which hold about a tablespoon of medicated lacquer runs over $60 (sixty) each. For more than 2 great and 4 lesser nails which are significantly infected, plan on going through 3-4 bottles perhaps. For those who cannot, should not or will not take the oral antifungals, then, perhaps, this Penlac™ MIGHT be considered. Unfortunately, its literature indicates a very low "cure" rate in comparison to the information about the oral medications.

AN OVERVIEW OF THE “PLAN” OF CARE:

• patient recognition of a problem with toenails clinical exam and diagnosis of onychomycosis
• pre-treatment photographs of involved nails
• determine patient’s need and desire for treatment in light of benefits and risks of treatment with oral agents
• possible laboratory diagnosis of onychomycosis, where the clinical appearance is not “classical”
• determine health status of patient and use of other current medications; check for interaction possibilities, particularly for Sporanox
• review financial factors (insurance coverage, manufacturer’s guarantees, out of pocket costs, etc.) for these expensive medications (especially for Sporanox)
• confer with patient’s primary care physician (PCP) if any doubts remain about the plan for care
• educate the patient in details of protocol
• start regimen (multiple Rx’s)
• monitor patient compliance, side-effects and progress to completion
• start measures to prevent recurrence of infection
• 9-12 months post-treatment, take post-treatment photo’s
• decide if any additional treatment is required.

WOMEN!:

If you are capable of becoming pregnant, then special precautions are VITAL. Oral antifungals MIGHT cause birth defects. Do NOT start the antifungals until the start of your next period and practice EFFECTIVE BIRTH CONTROL until one full month after the very last antifungal pill is taken. (Also, defer the use of antifungals until after weaning your child from breast-feeding.)

WHAT YOU CAN EXPECT:

The two, new drugs are reported to a about 80% clinical success rate following the standard 12 week course of daily treatments. My clinical findings are at least that good, if not better. Any sensitive athletes foot is usually eliminated in about 6 weeks. Little if any toenail change is noted in the first 12 weeks. Clearing of the nails is gradual and slow, first seen in the lesser nails and with time in the great nails. Twelve months after the completion of the protocol, the final results can be assessed and appreciated. In some instances, a special, short, intense course (“pulsed”) of ORAF may be indicated if the results of the original protocol is less than perfect.

Most patients are quite happy with the comfort, appearance and peace of mind that their new, clear nails afford them. They are usually more than willing to follow the preventative care recommendations to maintain their achievements.

We will be more than happy to evaluate your nail concerns and conditions too. You might want to check the feet of those very close to you too. We look forward to seeing you achieve a better level of foot health through our services.