The Physiology Of Toe Toenail Fungus
The Physiology Of Toe Toenail Fungus Over six million Americans have toenail fungus. The medical term for toenail fungus is “onychomycosis,” pronounced on * EE * ko * my * KO * sis. “Onycho” means pertaining to the nails and “mycosis” refers to a disease caused by a fungus. The fungus causes the nails to become thickened and yellow. Sometimes they appear white and splotchy, and sometimes yellowish-brown. The nails can curve in at the sides and thicken substantially at the center. Many times the nails can be uncomfortable, cause pain or result in ingrown toenails. Diabetics, and those with depressed immune systems, have a higher risk of developing toenail fungus. Others with an increased risk of developing toenail fungus are the elderly, athletes and individuals with sweaty feet. The risk of developing toenail fungus increases with age. Athletes have a higher risk because of more wear in occlusive shoes combined with repeated nail trauma. This is especially true for hikers, runners, backpackers, soccer, basketball and tennis players. Fungus likes to grow in moist, warm areas. This increases the chance of infection for those with excess sweating of their feet, also known as hyperhidrosis. The Physiology Of Toe Toenail Fungus
Treatments The Physiology Of Toe Toenail Fungus
There are a number of treatments for onychomycosis. Unfortunately, many are not very effective. The most aggressive and effective way to treat the fungus is with oral anti-fungal medications. The most common oral anti-fungal medications are Itraconazole (Sporonox ®) and Terbinafine (Lamisil ®). Both medications are expensive and insurance companies tend to consider onychomycosis a cosmetic problem. If you are diabetic, your insurance company may consider onychomycosis a medical problem, and will cover the treatment. If you are experiencing pain or have developed ingrown toenails as a result, then your insurance company may cover treatment. The medication needs to be taken once daily for 3 months. The effectiveness of the medications ranges from 60 to 80%, with a recurrence rate of about 10-15%. Complete cure rates have been reported as low as 28%. Lamisil® appears to be more effective and has fewer drug interactions than Sporonox®. The Physiology Of Toe Toenail Fungus
With both medications, there is a long list of benign side effects including nausea, vomiting, abdominal pain, diarrhea, rash, headache, taste disturbances and dizziness. A recent study published in the American Journal of Geriatric Pharmacotherapy found the most common side effects with three months of Lamisil®, tin individuals over 65 years of age, were nausea, sinusitis, joint pain and high cholesterol. Serious problems can develop, which is why many doctors will recommend other therapies first. The problems are rare and occur less then 0.5% of the time, but include serious liver diseases like hepatitis and acute hepatic necrosis.
Topical Therapy The Physiology Of Toe Toenail Fungus
Topical therapies are much safer, but also much less effective and sometimes quite expensive. Popular prescription topicals include Ciclopirox laquer (Penlac ®), Carmol® 40 and Keralac® Nail Gel. Don’t expect miracles from these medications, but they can help decrease discoloration and thickness, prevent progression and are a great adjunct therapy. The Physiology Of Toe Toenail Fungus
Over The Counter and Home Remedies
There are many OTC (Over The Counter) products which can be purchased online or at the drug store. A few include Tineacide®, which combines lavender oil and tea tree oil, Lamisil® topical nail treatment, Dr. Scholl’s® Nail Management Kit, and Restore® which is, in my opinion, one of the best medications you can purchase over the counter. Some home remedies that can be used include melaleuca oil (tea tree oil), bleach, grapeseed extract, and Vics VapoRub®. I have had many patients claim complete cures with Vics VapoRub®, popularized by Dr. Gott, but I have yet to see any complete cures with Vics treatment. Vics tends to decrease the thickness of the nails and will sometimes contribute to peeling off of layers of the nail. Most topicals, prescription medications, OTCs and home remedies, tend to have similar effectiveness. One key is to purchase a product that is a gel, solution, laquer or spray. Creams tend to not be as effective. Roughen up the nail surface with a file before application for better penetration. Use treatment daily and plan on going through therapy for 6-8 months. Make sure you take steps to prevent the fungus from worsening, spreading and re-infecting. Follow these steps: The Physiology Of Toe Toenail Fungus
1. Place an anti-fungal powder or spray in the shoes every other day.
2. Make sure you rotate your shoes often and keep them in a cool dry place. Use a shoe dryer in the winter if necessary.
3. Change your insoles frequently, and make sure they dry out between use. The Physiology Of Toe Toenail Fungus
4. Try using an antiperspirant spray on your feet before your workout, if your feet sweat excessively.
5. Wash your shower mat regularly in hot water, or step out of the shower, onto a towel, which is washed after each use.
6. Bleach out the shower on a weekly basis. Bleach works better than antimicrobial cleaners.
7. Make sure your shoes fit well. Ill-fitting shoes can lead to jamming at the toes. Jamming at the toes leads to microtrauma at the nails and increases the chance for fungal infection.
8. If you belong to a gym or health club, wear sandals in the locker room and don’t walk around barefoot. Don’t keep your shoes in the gym locker where they cannot dry out. The Physiology Of Toe Toenail Fungus
9. Ladies, avoid wearing toenail polish. Toenail polish can increases chances of and/or worsen a fungal infection. If you can’t bear to go without polish, keep them painted for only 3-4 days, remove all polish and then go without polish for 2-3 days. Repeat this cycle through the summer.
10. Cut your toenails straight across. Cutting too short can cause breaks in the skin. This will increase the chance for fungal infection. Don’t let the toenails grow too long or they will jam against the shoe and cause bleeding under the nail, again increasing the chance for fungal infection.
How to take care on the infection ?
Here are some things you can do to take care of your nails if you have a fungal infection:
· Keep your nails cut short and file down any thick areas. The Physiology Of Toe Toenail Fungus
· Don’t use the same nail trimmer or file on healthy nails and infected nails. If you have your nails professionally manicured, you should bring your own nail files and trimmers from home.
· Wear waterproof gloves for wet work (like washing dishes or floors). To protect your fingers, wear 100 percent cotton gloves for dry work.
· Wear 100 percent cotton socks. Change your socks when they are damp from sweat or if your feet get wet. Put on clean, dry socks every day.
· Wear shoes with good support and a wide toe area. Don’t wear pointed shoes that press your toes together.
· Avoid walking barefoot in public areas, such as locker rooms. The Physiology Of Toe Toenail Fungus
These are just some simple steps to do for your infection. The first step to beating nail fungus is getting a diagnosis. Your doctor will likely examine your nails first. Knowing the cause of your infection helps determine the best course of treatment.When your doctor diagnose your infection ,he will (most often) prescribe you some oral antifungal medication.It’s quite impossible to beat fungus without proper medications.
These days there is one very effective drug to treat nail fungus. Lamisil (Terbinafine hydrochloride) is prescribed for the treatment of onychomycosis of the toenail or fingernail due to dermatophytes. Terbinafine is in a class of medications called antifungals. It works by stopping the growth of fungi.The fungus under your nails is attracted to keratin, one of the substances in your nails and skin. The fungus feeds on keratin deep under the nail in the nail bed. Terbinafine is also attracted to keratin. It can be there to attack the infection. The Physiology Of Toe Toenail Fungus
Surface treatments may not be able to reach it in sufficient amounts, so terbinafine hydrochloride is given orally in tablet form, which is absorbed through the bloodstream to reach the infection. Lamisil Tablets are the #1 prescribed treatment for nail fungus infection worldwide.And because nail fungus infection can be so tough to treat, the medicine from Lamisil Tablets will stay in the nail bed months after your prescription is done and continue fighting the infection so you can grow clearer, healthier nails.Terbinafine comes as a tablet to take by mouth. It is usually taken for 6 weeks for fingernail fungus and once a day for 12 weeks for toenail fungus ,but you won’t see the end result of treatment until the nail grows back completely. It may take four to 12 months to eliminate an infection.
The Physiology Of Toe Toenail Fungus
The Bottom Line
Toenail fungus is very difficult to treat. If you have fungal toenails that cause pressure, pain or infection, consider talking to your doctor about prescription medications or nail removal. Make sure you take precautions to prevent re-infection and take multiple approaches to eradicate the problem. If your fungal toenails are only unsightly and don’t cause any discomfort, try a weekly application of an over the counter topical along with methods to prevent re-infection.
Christine Dobrowolski, DPM is a podiatrist and owner of Northcoast footcare, Inc [https://www.northcoastfootcare.com] an online resource for foot care products and foot health information.
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If the toenail fungus is severe, you can use prescription medications. A doctor can prescribe these medications or recommend over-the-counter medications. The recommended treatments for toe fungus are oral and can be found here. The most effective treatment is what they use in space in the space station. You can also try medicated nail polishes to treat the fungus. If you’re not satisfied with these methods, you can visit a dermatologist.