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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.