Toenail Fungus Among Us
Why are toenail fungus so hard to treat? There’s so much to unpack on this topic and I’ll dive deeper into why it’s so challenging to treat this condition and current options for treatments.
Toenail fungus is an infection of the skin (nail bed) under the toenail by fungal organisms. They might show up alongside Athlete’s foot affecting the nail edge and gradually spreading to the whole nail causing it to be discolored, thick and even painful if ignored.
If there was a silver bullet to cure toenail fungus, we wouldn’t be here or one of us would have become very rich! But you and I know there are no shortage of products claiming to be the cure all for toenail fungus.
Treating toenail fungus is actually more complex than meets the eye. As a foot & ankle specialist, I see and treat this condition regularly. Most of the time it is successful with the tight protocol I’ve been using with my patients. While for some, it remains a challenge.
Here’s why treating toenail fungus is so challenging:
Fungus is everywhere and it’s invisible to the naked eye. That means you can’t easily detect it to clean it. It’s in the house, showers, public facilities, in your socks and shoes. You can’t even detect it on your nail clippers or in shared nail polish at salons (yes they survive in there too!).
Genetic predisposition or as some may say, blame our parents. Some people have the gene that makes them more susceptible to catching toenail fungus.
Immune compromised. Other medical conditions like diabetes, circulation disorders, and chemotherapy treatment lowers the immune system so the body can’t easily ward off infection compared to a strong immune system. Immunity is tied to diet, stress and lifestyle as well so it’s important to control what we can while we can.
Fungus mutates. There is an increasing rate of fungus resistance to common medications because it has the ability to morph to evade treatment. That also means that after successful treatment, recurrence of infection is possible. So staying vigilant in avoiding circumstances that is likely to increase reinfection is key in prevention (avoid barefoot walking in shared facilities, wearing old or shared shoes, avoid frequent periods in warm wet conditions, etc).
Incomplete treatment. Some people choose to self treat with over the counter products but quit after a a few weeks of not seeing improvement. Or people receive a prescription without knowing the specific organism and/or they aren’t followed up for maintenance care. To reach a therapeutic dose, it may take over a year of topical agents to penetrate past the nail to kill and shed the fungus, while oral medication may range from 3-7 months, depending on other factors and the severity of the nail infection.
So is there hope? Absolutely.
Fortunately, there are sophisticated lab testing that can be done with just a nail clipping to prove the presence of fungus and determine which one it is. From there, we can use targeted therapy with the correct medicine. I often recommend a prescription plus a topical antifungal medication. For those concerned about the pill, I recommend getting lab testing on your liver to ensure it’s healthy enough to detox the prescription. Only 1 in 100,000 healthy livers experience elevated liver enzymes with the medication, and it’s reversible by stopping the medication. If there are other medical conditions that is contraindicated with the pill, we can look to other means or offer routine foot care for maintenance.
Laser therapy is an option for those who may not or don’t want to deal with a pill. It generally costs more than the prescription (out of pocket expense) and is available in limited areas.
Removal of the toenail is an option for severe cases to provide comfort from the thick nail. This can be done temporarily or permanently.
Lastly, you are connected to your toes so paying close attention to your general health and perking up your immune system is always part of my treatment protocol. Toenail fungus may be reflecting a weak immune system so a comprehensive podiatric evaluation is always a good idea.
