Toe Nail Fungus
Apr 11, 2011
By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
It looks like spring might finally be here. For me, two sure signs of spring are open toed shoes and the Perogy Cup. The Perogy Cup is a Kinsmen hockey tournament in Yorkton, Saskatchewan. We had a great time there again this year, but people in Saskatchewan are different. During the banquet for the Perogy Cup, someone asked me to dance. The person did have very nice legs, and very stylish open toed shoes, but the broad shoulders and Adams apple under the dress gave me pause. You see the Yorktonites seem to enjoy gender-bending and they call it a Queens Competition. And unlike his/her revealing dress, I couldnt help but wonder if my potential dancing partners nicely painted toenails covered up a dark secret.
About 10% of us have fungus growing in our toenails. Toenail fungus apparently accounts for one third of all fungal skin infections and one half of all nail disorders. The medical term is onychomycosis. You can get infected toenails through contact with an infected person or through contact with an infected surface like a bathroom floor where the fungus is present. It is common to get toenail fungus at the same time as you get athletes foot. Toenail fungus is more common in males, in people who are older, people who have diabetes, people with poor circulation and people with poor immune systems. It is estimated that over 30% of people between the ages of 60 and 70 have toenail fungus.
Fungus infected toenails look weird, but are not itchy or painful. In mild fungus infections the nail gets white or yellow patches on it. In more severe infections, the nails get thick, deformed and discolored. Usually we think of toenail fungus as just being ugly to look at. However, there are some non-cosmetic problems that can result from a fungal infection. The nail fungus can spread to other nails or even other parts of the body like the groin or scalp. In diabetics, the thickening nail can add extra pressure to the toes and lead to ulcers or sores. In extreme cases with diabetics, sores on the feet can lead to amputation, but that is rare.
What can be done if you have toenail fungus? First you should have a doctor have a look at the nail. There are other things besides fungus that can cause nail problems. Once a definite diagnosis has been made you and your doctor need to decide how you want it treated. In some cases, the infected part of the nail can be removed. Onychomycosis can also be treated with medication. There are both oral pills and topical medications to apply to the nail.
The two most common oral medications for toenail fungus are terbinafine (lamisil) and itraconazole (sporanox). It is difficult to say which medications work the best because the studies about toenail fungus are very small and not that well done. The studies usually talk about when the nail is fungus free. A patient has to remember that even after the nail is fungus free, it will still take months and months for the nail to grow out and the yellow, thick, discolored areas to disappear.
Terbinafine has to be taken every day for 3 months to cure toenail fungus. Like all antifungals, it rarely can cause liver damage. So your doctor should test your liver function before you go on it and repeat the liver function test in about 6 weeks. Depending on where I looked, I saw cure rates with terbinafine at about 75%.
Itraconazole is another antifungal oral medication, but it can be given as pulse therapy. That means you take the pills everyday for a week and then take 3 weeks off. You repeat this for 3 months. This pulse therapy can be more convenient for many people. Again there is the risk of liver damage and you doctor should check you out. The cure rates for itraconazole I found were around 65%.
I have a friend from pharmacy school who married a podiatrist and now lives in BC. The podiatrist he married hates all these medical treatment for toenail fungus. She especially hates the oral treatments with their risk of liver problems. She said she simply removes the offending nail in about 1.5 seconds, and the patient is cured.
If you arent sure you want to get your liver function checked or have your toenail removed there are other options. Ciclopirox (Penlac) looks like nail polish. You apply it everyday and wipe off any excess about once a week with nail polish remover. Again, it will need to be used for about 3 months. The cure rate I found was about 30%.
The Dauphin Clinic Pharmacy makes another anti-fungal nail polish. For better or worse several of the doctors have dubbed it Trevors Magic Nail Polish. It is made with the anti-fungal fluconazole. There are no large clinical studies on it, so I have no cure rate to give you, but anecdotally some patients who used it found it worked well. The big advantage of the fluconazole nail polish we compound over the commercial one is coverage. If you go over your pharmacare deductible our compounded nail polish is covered while the commercial one is not.
Which ever nail fungus treatment you choose there are some things you can do on you own to help your toenails. Keep your nails short, dry, and clean. Keep your feet dry make sure your feet (including between your toes) are completely dry before putting on shoes and socks. Wear absorbent cotton socks and change them often. Wear proper fitting shoes and rotate shoes to allow them to dry out between uses. Dont go barefoot in damp public places like public showers wear shower shoes.
So heres to spring and warmer weather. Get out and enjoy it. But lets keep the painted toes on the women. Okay?
As always if you have any questions or concerns about these or other products, ask your pharmacist.
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
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