Nail fungus is a fungal infection of one or more of the nails on the fingers or toes. These infections typically begin as a yellow or white spot underneath the tip of the fingernail or toenail, and then progress deeper into the nail. They can cause the nail to discolor, thicken, and even crumble at the edges. Fungal nail infections are often difficult to treat and may recur following successful treatment.

Many over the counter (i.e., non-prescription) anti-fungal treatment options are available, however some are not very effective at treating true nail fungal infections. Oral prescription medications, such as Lamisil and Sporanox, can be  an effective means of treating fungal nail infections as well as tea tree oil, but treatments can take as long as four months to fully work. Other treatment options include a prescription antifungal nail polish called Penlac, however this make take up to one year to show improvement. In addition, some topical medications may be used along with a prescription medication.

Overview of Dr. Paul’s Piggy Paste

A recent addition to the market of over-the-counter nail fungus treatments is a product known as “Dr. Paul’s Piggy Paste.” This product is not touted as a means to treat the fungal infection itself, but rather as an easy way to improve the appearance of toenails that have been thickened and discolored by the presence of nail fungus.

According to an article published in May of 2010 in the Bloomington, IL newspaper Pantagraph, the physician-inventor of Dr. Paul’s Piggy Paste – Dr. Paul Kinsinger – concedes that the product cannot be touted as a treatment for toenail fungus, citing the fact that Piggy Paste has not been through the clinical trials needed to substantiate such claims. However, he does use anecdotal evidence from use in his own medical practice – as well as sales of the product – to support his assertions that the product works to improve the appearance of nails affected by fungal infections.

The concept for Piggy Paste originated from Dr. Kinsinger’s experience with the well-known historical practice of soaking toes in a solution of half vinegar (acetic acid) and half water for approximately five minutes a day for nine months, which has anecdotally been shown to clear up toenail fungus. Realistically speaking, however, most people who suffer from toenail fungus do not have the time to devote to doing this every day. So, Dr. Kinsinger simply decided to make the process easier. He worked with a compounding pharmacy to develop a product that delivers the vinegar to the toe in an easily absorbable paste. He then worked with the pharmacist to finalize the formulation for individual prescriptions. Dr. Kinsinger recruited more than 100 of his own patients who had toenail fungus to apply a pea-sized amount of the paste to each affected nail and cuticle once per day, and then cover with a bandage for a minimum of two hours. According to Dr. Kinsinger, 81 patients saw their nails clear within three to four months and new nails grew in without fungal spores.

Ingredients of Dr. Paul’s Piggy Paste

It is important to note that Piggy Paste is not specifically marketed to treat the nail fungus itself, only to improve the appearance of affected toenails and new nail growth. Accordingly, there are no conventional anti-fungal ingredients in Dr. Paul’s Piggy Paste, such as those commonly found in over-the-counter antifungal medications (e.g., terbinafine [the active ingredient in topical Lamisil]).

As listed on the product’s website, the ingredients in Dr. Paul’s Piggy Paste include: propylene glycol, ethoxydiglycol, acetic acid (vinegar), thymol (a common ingredient in mouthwash), hydroxypropylcellulose, dimethyl sulfoxide (DMSO), menthol-USP, and butylated hydroxytoluene (BHT). Acetic acid, thymol, and menthol appear to be the active ingredients, with DMSO acting to deliver the ingredients to the nail bed, and the remaining ingredients present to provide the paste-like medium.

Active ingredients:

Acetic Acid (Vinegar)
When fungus invades a nail, it alters the pH balance of the nail and surrounding skin. The acidity of vinegar helps to restore the pH balance to more natural levels, as well as to relieve the itching and pain caused by the fungal infection. Since the fungi that frequently infect nails do not like acidic environments, the vinegar essentially creates an environment that is no longer hospitable to the growth of the fungus and ultimately halts the growth and spread of the fungus.

Thymol and Menthol
Thymol is the primary essential oil from in the herb known as thyme. Menthol is an oil-based extract from mint plants. Both thymol and menthol have antibacterial and antifungal properties, and are common ingredients in over-the-counter medicated chest rubs such as Vicks® VapoRub®, as well as a common ingredient in toothpastes and mouthwashes. Their antibacterial and antifungal properties have fostered their reputation as effective ingredients in products designed to treat nail fungus.

Numerous anecdotal and layman’s reports have testified to the effectiveness of thymol, menthol, and medicated chest rubs in general, as a means of treating fungal nail infections. The scientific literature also lends some support for their use. For example, a 2003 study by Ramsewak et al. investigated the effectiveness of a medicated chest rub similar to Vicks® to prevent the growth of fungal nail infections. They found that both thymol and menthol were two of the most effective ingredients at preventing the growth of the fungi that were studied.

In Dr. Paul’s Piggy Paste, the combination of acetic acid, thymol, and menthol – with their ability to restore pH balance to the nail and kill existing fungal spores – likely work together to enable the new nail to grow out clear and free of fungus.

Inactive ingredients:

Propylene glycol
Propylene glycol has many uses; however, in the medication and cosmetics industry it is typically used to maintain moisture and is also used as a solvent.

Ethoxydiglycol
Ethoxydiglycol is a cosmetic-grade solvent that is used in many skin care preparations as a carrier for active ingredients.

Hydroxypropylcellulose
Hydroxypropylcellulose is typically used as an ingredient in prescription artificial tear compounds designed to treat insufficient tear production and other eye problems. It can also be used as a thickening agent and as an emulsion stabilizer.

Dimethyl sulfoxide
Dimethyl sulfoxide, or DMSO, is a natural byproduct of the wood industry. When used topically, it can help to speed wound healing, treat inflammation, and toenail fungus. Although it does not, however, have antifungal properties, DMSO is incredibly penetrative and helps to drive anti-fungal medications down into the nail bed and surrounding tissues. It is likely that it plays this role in this formulation of Piggy Paste.

Butylated hydroxytoluene (BHT)
Butylated hydroxytoluene is an antioxidant compound typically used as a fragrance in cosmetic products.

References

http://www.mayoclinic.com/health/nail-fungus/DS00084

http://www.piggypaste.com

http://www.disabled-world.com/artman/publish/article_377.shtml#ixzz1frXECJRo

Ramsewak RS, Nair MG, Stommel M, Selanders L. In vitro antagonistic activity of monoterpenes and their mixtures against ‘toe nail fungus’ pathogens. Phytother Res. 17(4):376-379.
http://www.atsdr.cdc.gov/toxfaqs/TF.asp?id=1121&tid=240 (Propylene Glycol ToxFaQs™)

http://www.drugbank.ca/drugs/DB00840

Over the years we’ve had the opportunity to collect testimonials from people who left comments on ToenailFungusTreatments.com, who have used different types of nail fungus remedies. After analyzing them, we’ve created some useful suggestions for those who want to eliminate nail fungus.

Of course, nothing is ever 100% guaranteed, but if we can learn from others with similar problems, we have a better chance of crossing off one more problem we have from the list that seems to accumulate many problems as we age.

How Doctors Heal Patients

In fact, I was thinking about doctors and how they learn. I know that if you ask any doctor who he or she learned the most from, they will say their patients. In the practice of medicine, a doctor who pays the most attention to the results that their patients are receiving, and makes appropriate adjustments is often the most successful – both with people and against disease.

Recognizing this feedback loop was very valuable, we started collecting reports on remedies from our readers and have been able to create some basic guidelines for anyone with nail fungus problems who wants to use these treatments to get clear nails again.

Guidelines From Our Readers about Nail Fungus Remedies

Remedies for nail fungus are plentiful. Lamisil, a prescription and over-the-counter medication, is often recommended by medical doctors; both general practitioners and dermatologists. Home remedies such as tea tree oil, hydrogen peroxide, vinegar, or even Vick’s Vapor Rub could work. Even Star Trek technology has hit the nail fungus scene and doctors may use laser to zap the fungus into infinity. All of these remedies have good possibility of being successful.

Whatever remedy you use, remember that it’s not enough to focus on the remedy itself. You still have to clean the nail – and do it right. And you still have to thoroughly wash your feet daily.

The treatments must reach the nail bed. The fungal infection starts at the nail bed, not on the nail itself. Nail beds are composed of a thick keratin layer and your remedy must penetrate this to get those fungi predators that are lurking below the surface, knowing that they are well out of your reach. Develop a fungi killer mentality, as if you will be relentless about any of their lives!

General foot care is imperative: always trim and file down your nails. Also, don’t hide your feet, as difficult as it may be. Keep your nails and toes well-ventilated. And as much as you want to paint your toenails, don’t do it. Healing will need the area to be undisturbed.

Testimonials Give You a Breadth of Information Not Found Otherwise

With these in mind, let’s examine testimonials on each of the above-mentioned remedies and learn a little background on the fungus, why the remedies work and other great tidbits of info. Now, just for the record, I did make spelling and grammar changes just to make them easier to read.
Tea Tree Oil and Zetaclear

Have you ever thought that it’s possible that our Creator might have realized that sometime in life we could get nail fungal infections and created a natural remedy for it?

The amazing thing is that almost every culture has a different remedy for nail fungus, and all of them have the potential to work. Some of these remedies become popular and carried to other cultures; some may even make newspaper headlines, and others may even be recommended by medical doctors.

Tea tree oil is one such remedy. Patients at the Mayo Clinic often ask about this treatment, which is why they have a page about it on their website at www.mayoclinic.com However, there’s always a problem with natural remedies being recommended by doctors and hospitals who are funded by pharmaceutical companies: a natural remedy such as tea tree oil cannot be patented and doctors and pharmaceutical companies stand to lose money by recommending it.

So don’t expect the Mayo Clinic to be your source for all the positive results obtained in studies. If you received positive results you wouldn’t have a need for an office visit.

Nevertheless, the Mayo Clinic does report that Tea tree oil has been used traditionally to prevent and treat infections and has antiseptic properties. They counter this with a “lack of definitive available evidence”.

The fact of the matter is that the words, “traditionally used to prevent and treat infections”, is in itself a badge of effectiveness. This means that over decades the remedy has been used. And people don’t keep using something that doesn’t work, do they?

Zetaclear is a natural tea tree oil based remedy; it’s simply essential oils combined together for the purpose of supporting healthy nails.

Here are some testimonials on the use of tea tree oil in nail fungus infections:

Ugly Toenail Transformed to Beautiful and Perfect

“I have been using tea tree oil from Melaleuca on my toenail (great toe only) for about six weeks with amazing results! I apply it every night after soaking my feet in the bathtub. I started out by pulling the nail out so the oil would go under the nail as well as on top of it.

Now the nail is really loose in the affected areas, which I am clipping off a little at a time. A beautiful new perfect looking nail is growing up from the bottom! The toe is still pretty ugly but after watching it get worse and worse for the last few years, I am THRILLED! P.S., I went to a podiatrist before starting the treatment and he didn’t even want to discuss anything except oral Lamisil. I decided to try the tea tree oil and I am so glad that I did!”

Results Seen Over 7 Months

I have been using zetaclear and tea tree oil for toenail fungus for about 7 months now. I paint it on my nails every day, and have kept my toenails filed down thin so it will penetrate. The nail fungus looks MUCH better…”

Restored Hope that Healing is On Its Way

“Incredible!! My dermatologist couldn’t be bother & wanted me to spend big $ for the podiatrist. Vicks & OTC did not work for months! Tea Tree Oil after a month has had a positive effect. Still at it!! But hopeful now!”

Tea Tree Oil Works!

“I have had a nail fungus for several years. The fungus discolored about half of my big toenail. I have been using tea tree oil daily for 8 weeks. The discoloration has moved up the nail and the fresh nail is natural colored. I believe that it will take about 6 more weeks to eliminate the fungus completely.”

Discovered that Naked Nails are Necessary for Healing

“I’ve had fungus on both big toes and both little toes for years. Let it go for years, ignored it, and kept getting pedicures for YEARS!!!! Well, over a year ago I decided to try formula 3 which didn’t do much.

Just about 3 mos. ago I started DMSO and tea tree oil. Well, it’s working. I apply with a nail polish brush from a nail polish bottle and mix equal amounts of the DMSO and tea tree oil. My nails take a long time to grow but are finally almost grown out and what a difference.

I had a dermatologist tell me a couple mos. ago that it’s really difficult to get rid of nail fungus infections and to just forget it and get them painted. Wow, nice doctor!

The jury is still out on an absolute cure but they are definitely improving and I feel it’s almost cured! Don’t get a pedicure and get them painted. This will only prolong the infection and actually will be a waste of your time. Your nails must remain naked the whole time you’re treating them.”

Worked on Intestines Simultaneously with Probiotics

“I cut my nail down as far as I could with nail clippers, then filed the top, too. I used a metal file to clean under the nail after every shower. I then put tree tea oil on it in the form of Zetaclear. The bottle had a brush in it. I began taking probiotics and I think this is what did the trick. It is a very expensive bottle – $60 for a small bottle, but after 3 months it is gone!”

Never Give Up on Nail Fungus

“I had nail fungus for many years. I tried ALL of the remedies including tea tree oil, Listerine, oregano oil, bleach, hydrogen peroxide and others. Finally tried a product called Zetaclear. This stuff cleared my nails in only a few months. Good stuff.”

Vick’s Vapor Rub Works for More than Chest Ailments

Vick’s Vapor Rub is a unique combination of petroleum jelly and oils along with active ingredients that can fight the infection, such as menthol. Let’s find out what happened when people used it on their nail infections.

Test Between Lamisil Versus Vick’s Vapor Rub

“I’ve had toenail fungus for 25 years. My wife asked her doctor to prescribe oral Lamisil but an assistant mentioned he was doing a study on Vick’s Vapor Rub. She took the Lamisil and I decided to try Vicks. She totally cleared up hers in 3 months and so did I!

I got complacent and stopped Vicks after 6 months and the fungus returned in 6 weeks. Hers did not return. So Vicks requires a lifetime commitment.

Here’s the method of how to do it:
First, wash your feet very well.
Then exfoliate any dead skin from under and around the nails, where possible.
Apply Vicks under the nail where possible and slather on top of nails.
Whenever possible go barefoot, but the Vicks can leave grease stains, so be careful where you walk.
Apply twice a day.
Don’t stop for a day. Be committed and scientific about the process and I’m sure some of you will have the same results.”

Some Remedies Take Time and Effort

“The doctor is right. It’s the camphor in Vicks or other products that kills the fungus. But it takes work and time. Apply the Vicks to a nail that has been roughed up with a coarse emory board. Apply the Vicks with a q-tip and then put a band-aid over it; otherwise, it is soon rubbed off. Depending on the severity, this will take several months of constant daily application of replacing the band-aid daily. I’ve done it and it worked perfectly on a nail that had been infected for 20+ years.”

“For Vick’s to work you must use it everyday, it can take up to six months. Use a toothbrush to apply, making sure that you get into all the little crevices.”

Weak Immune System Can Predispose You to Fungal Infections

“I suffer from a faulty immune system and am prone to frequent fungal infections. One of the best treatments for nail fungus is to use an emery board to thin the entire nail. I try to make sure that I do it while the nail is a little damp to avoid creating too much nail dust with fungal spores in it. I do this the first time and again as needed to keep the nail thin and more permeable.

Then I begin to rub in Vicks VapoRub. Store brands are acceptable but I tend to still go for the name brand. I continue to apply the Vicks twice a day for several weeks and it works. It has all sort of natural oils in it that create an inhospitable environment and kills the fungus.

Remember to swab around the nail and all your nails just to be sure that you catch anything that may be starting up. These fungi eat keratin, the hard material that nails and hair are comprised of. A toenail infection can spread to fingernails, and even to hair. It is also very contagious and spread between family members.

I recommend having the afflicted family member wear flip-flops in the shower and for good measure I will pour a little white vinegar in the shower/tub after someone takes a shower.

Another affordable way to deal with nail fungus is to thin the nails with an emory board and using a cotton ball swab the nails with Listerine. These approaches are more affordable and less complicated than the beer method, etc. Best of luck to you all.”

Fungal Nail Infections Can Spread to Other Nails

“When I was in rehab after hip surgery, they cut my toenails, and I didn’t want to criticize them but they went from one toe to the next after trimming the big toenail that had the terrible fungus. It didn’t take long for every nail to show the beginnings of a fungal infection.

That was 4 years ago and I’ve battled it ever since… until 2 weeks ago, when I rubbed Vicks Vaporub under and over every nail. I am so pleased with the outcome. They look sooooo much better now. They aren’t totally clear, but it’s improving everyday. Please try it and report your findings on here in about two weeks. Good luck.”

Vinegar: The Kitchen Remedy that Housewives Love

Vinegar is really an acid; it’s called acetic acid. Acetic acid can destroy the dermatophytes, microbes that feed on the skin, and cause nail infections. The official term for nail infections is onychomycosis.

When using vinegar, soak the affected nails of the hands or feet in a solution of 1 part vinegar to 2 parts water for only 20 minutes a day.

This is the same procedure that you can use for Listerine; just replace the vinegar with Listerine.

Soak with Vinegar and Forget the Rest

“I wish I would have started vinegar baths WAY sooner. I let my big toe get worse and worse, just covered it with nail polish until it was just hollow with fungus underneath, and then turned black with bacterial infection.

Then I tried a holistic remedy that included oregano extracts and a lot of other agents that dried it out a lot and now it has cracked in half down the middle.

Finally I read up and discovered most chat rooms promote vinegar. I have been soaking my foot twice a day for about a month, and the three affected nails are (slowly) growing in smooth and pink. But the big toe has just a fraction of a nail right now – with the two sides of the old nail flapping over it like shutters. I am keeping it there, and tape it closed with a band-aid during the day just to protect the nail bed. My advice is to soak with vinegar, and forget the rest.”

Fungal Spores are Like Eggs Waiting to Hatch

“Apple Cider Vinegar actually changes the pH balance of the foot. This creates an environment that the fungus cannot survive in. Think of a human surviving in an environment without oxygen. Same thing.

Spores can and will survive, waiting for the right conditions to exist however; so this pH balance will have to be maintained or the fungus will once again come to life. Like eggs waiting to hatch.”

3. Hydrogen Peroxide Cleans Wounds and Fungus

Hydrogen peroxide is nothing but oxygen and hydrogen molecules together. It’s an oxidizer that is capable of being used as a cleaning agent, as bacteria is killed when it comes into contact with the peroxide.

Hydrogen peroxide is a translucent, colorless liquid, slightly more viscous than water.

Use Precautionary Tactics As Well

“I have used peroxide with great success. I have not fully gotten rid of it, but my condition is much, much better. I try to pour some on the infected nail every time I get out of the shower. After I cut my toenails, I pour some on the nails as a disinfectant.”

Remedies Combined are Better than Remedies by Themselves

“I found the best remedy for my fungus: mix a 50/50 combination of apple cider vinegar and 3% hydrogen peroxide. Apply to the nails until no more fizz bubbles come out. Then mix it in a 50/50 combination of water and bleach. If the fungus is really bad, add more bleach and soak your toes in this mixture for 30-40 seconds. Then rinse and dry your toes.

Next mix tea tree oil with petroleum jelly (vaseline) and apply it to the nail. Cover with a band aid so it’ll stay on all day long. The fungus will be gone within a week.

Quick tip: I filed down my nail to make it thinner so the mixtures would hit the fungus directly, this works faster.”

Lamisil, Doctor’s Choice for OTC & Prescription Medication

The medical profession generally uses terbinafine hydrochloride (Lamisil) for nail infections, which are technically called onychomycosis. Lamisil works by inhibiting the enzyme responsible for creating the cell wall of the fungi. Without a cell wall, fungi can’t live or reproduce.

Direct Attack on Fungi To Prevent Reproduction Works

“I have used a combination of Lamasil applied in the PM and Nail Rx applied in the AM for about 6 months on my large toenails. It is working very, very well. All of the new toenail growth is clear and appears fungus-free.

I will keep using it until all the old yellow nail grows out, which may take another 6-12 months. Lamacil and Nail Rx have different active ingredients, so I thought I would have a better shot using both patience and regularity; fungal spores are only vulnerable for a short time after they hatch, and the spores multiply only about once a month. It can take a long time to get them all.”

Push the Topical Creams Under the Nail for Best Results

I’ve been using Lamasil topical cream for my big toenail infection. While using a nail file to push the cream under the nail, 2 months later with once a day application, the nail is clear colored and there is no more curving and burrowing in the skin. Also have been using iodine and pushing it under the nail. All the topical solutions do penetrate the nail, so lift the nail up a bit with a file and push the iodine or Lamasil in there. Hope it works for you also.”

5. Laser Treatment: Is Star Trek Technology Working Yet?

“I spent nearly $600 over a 4-month period for three laser treatments on a single toe with no improvement. It was ineffective and not worth the $$. I’d recommend saving your money and avoiding laser treatment for toe fungus until more R&D is done. It did not work for me, and I only have fungus beneath one of my large toenails.”

Very Expensive Medical Treatment Didn’t Profit Her

“I have had the three Pinpoint laser treatments for nail fungus with little improvement. Some of the least infected nails have improved some but not the ones with more fungus. I know every patient is different but before you spend $1000 or more, be ready for the fact that you could be very disappointed. Spent $1000 to wear sandals but the bad nails still look bad. Save your money.”

Expensive Laser Treatment Zapped Her Wallet, Too

“I had Pinpointe Laser treatments. I had two treatments within 10 months and I thought my toenails were improving, but they are NOT. I’m so upset I could cry. The cost to me was a little over $1000 and I had to drive over 2 hours in order to have the treatment done. I feel. I think I’m just doomed to have this forever. BTW, I also purchased Steri-Shoe when I had my first treatment.”

If you use a combination of different treatments, you have a greater chance of success. This is because an individual only attacks the fungi on one level. For example, the antimicrobial effects of tea tree oil will have one specific effect on the fungus and take a certain length of time to work. However, if you added a second treatment that interfered with the reproduction of the fungi, now you’ve initiated a second line of defense against the infection.

Imagine what would happen if you added a third remedy and possibly a fourth. Attacking the fungi from four different perspectives can give you results in a shorter period of time. And that’s really what you want, isn’t it?

There is no such thing as a quick cure for nail infections. That’s because the nail is slow-growing, taking about six months to grow fully out. Any infected part of the nail must grow out. Thus, you need a lot of patience.

Once the new nail growing out is not infected, you have cured it. Below is my best treatment for toenail fungus. I want you to have it and be able to show your pretty feet to the world again!

Tom’s Toenail Fungus Treatment

1. Always dry feet and toes thoroughly after bath/shower. No pedicures at all and keep nails short. Use a fungicide powder like Lamisil or Desenex and be sure it gets into all nail corners.

2. Alternate two or three remedies and use twice a day. I like Lamisil cream, Fungi cure (paints on) and tea tree oil which is the best anti-fungal in the world. Alternating really helps because it keeps surprising your fungus with a new attack.

3. Acid footbaths (like Listerine or vinegar) help but they are no substitute for continuous topical applications, like described above.

4. The internal meds are very dangerous. You don’t need them if you are patient and keep at it. If you must take something, take acidophilus which is great for you anyway.

With all these new ideas for how to eliminate toenail fungus presented in this article, your head may be spinning with the possibility of a bright future. The best way to start is to select two or three remedies and use them together. Keep a journal of what your strategy is and your daily progress. Write the guidelines in your journal so you recall them now and in the future. Your journal can help others who have toenail fungal infections,

Since there are thousands of people suffering from toenail fungal infections, referring back to your journal for specific details can make a big difference in their lives. And that’s what life is all about – overcoming obstacles so that others may also benefit!

A normally functioning immune system is typically capable of fighting an infection and controlling it, perhaps with the aid of a medication. At some point during a person’s lifetime they may experience a suppression of the immune system for one reason or another, which then allows the dormant fungus to become active causing health complications.

Onychomycosis, or nail fungus, is a gateway for fungus to cross the skin barrier. Normal health tissue is able to prevent invasion by dermatophytes or other harmful organisms, but if it is weak or compromised it opens up opportunities for the organisms to infect other areas of the body. For those that have a weak immune system a fungal infection can lead to pneumonia, septicemia and permanent organ, lung, or bone damage. In worst case scenarios, a seemingly simple nail infection can lead to death.

When the nails of an individual are infected, there is the risk that scratching the skin can inadvertently introduce the fungus into the tissue and blood stream. Scratching too hard, or accidentally scratching that annoying bug bite can have a strong health consequence.

Another big worry is that fungal infections take a long time to grow, and as such, they also take a long time to heal. This healing process is further compromised when the immune system is not functioning correctly. A longer period of recuperation means there is additional time given to opportunistic organisms to invade the body, creating secondary infections and further complicating the body’s ability to mend. Keep in mind the full period of recovery from toenail fungus for a healthy individual is 12 to 18 months, in immunocompromised persons this time is doubled.

Anyone who has an infection should be assessed by a health care provider, this is especially important for those who are immunosuppressed. The medical treatment plan should be followed carefully and until completed in full. It is often the desire of individuals to stop treatment early because they are feeling better or notice results, this is a very poor idea. The therapy required to clear a fungal infection from the body can take over a year in some cases, but is essential to limiting the negative health effects that can occur.

There are a number of different treatment options that have become available to people. Oral prescriptions and topical treatments such as lacquers, oils, and creams have been developed by pharmaceutical companies. There are also a number of natural home remedies that have gained favor with the medical profession. Once you have been diagnosed with a fungal infection discuss your treatment preferences with your medical provider to best create a plan that you will be willing to comply with. Also become familiar with how to avoid onychomycosis.

Nail fungus (onychomycosis) is the most common affliction of the nails, characterized by abnormal nail color, texture, and thickness. Nail fungus is caused by an infection of one of several possible species of fungi, with humidity, improper footwear, nail trauma, genetic predisposition, and immunosuppression considered contributing factors4. Both continuous and pulse itraconazole treatment regimens have demonstrated efficacy against nail fungus. A clinical response can be observed after several months of systemic treatment with orally administered itraconazole in over 80% of patients. Long-term remissions are observed in the majority of patients, although a small percentage of patients that have been successfully treated do ultimately relapse. Factors affecting treatment outcome include the site of infection (fingernail vs. toenail) and the species underlying the infection5,6. The efficacy of itraconazole in achieving clinical response and long-term cures of nail fungus is likely attributable to its ability to be absorbed into the nail and remain there at therapeutic levels for at least 6 months after completion of treatment5,7.

In addition to its use in the eradication of nail fungus, itraconazole has been used for treatment and prevention of systemic fungal infections in immunocompromised cancer patients8. However, recent studies have suggested that azole anti-fungal compounds may also be directly effective against certain types of cancer and prolong patient survival. Econazole kills leukemia, breast cancer, and colorectal cancer cell lines in a dose-dependent manner and slows the growth of colorectal cancer in mice9-11. Ketoconazole also suppresses the growth of colorectal cancer in mice, and potentiates the activity of nocodazole, a known chemotherapeutic agent12. Moreover, combination chemotherapy including ketoconazole increased the response length and overall survival of patients with androgen-independent prostate cancer13.
Intriguingly, accumulating evidence suggests that itraconazole may in fact be an even more potent chemotherapeutic agent than econazole or ketoconazole. Several recent studies have demonstrated that itraconazole specifically targets key molecular pathways involved in cancer. Itraconazole was shown to inhibit the mammalian target of rapamycin (mTOR) pathway, a signaling network regulating cellular growth and proliferation that is frequently activated in tumors. Inhibition of mTOR signaling by itraconazole is dependent on the aforementioned ability of itraconazole to block metabolism of lanosterol, which is also a precursor of cholesterol in humans. Proper synthesis and transport of cholesterol within the cell is required for mTOR pathway activation14.

The Hedgehog (Hh) pathway, normally involved in embryonic development and stem cell regulation, is another signaling cascade that is aberrantly activated in a variety of human tumors. Itraconazole was recently identified in an unbiased screen for small-molecule antagonists of the Hh pathway, with inhibitory activity over 10 times more potent than any other azole anti-fungal. Interestingly, unlike the mTOR pathway, the role of itraconazole in Hh pathway inhibition is not dependent on its role in cholesterol biosynthesis, but on its ability to compete with natural activators of the essential Hh pathway component Smoothened (SMO). Experiments in mouse models of medulloblastoma and basal cell carcinoma harboring activating mutations in the Hh pathway further demonstrated that itraconazole could suppress the growth of Hh-dependent tumors15.
Another key feature of tumors is their ability to induce angiogenesis, or the formation of blood vessels, to obtain their own blood supply. Itraconazole was also identified in a screen for small molecules that block proliferation of the cells that constitute the inner lining of blood vessels. As with the Hh pathway, the inhibitory activity of itraconazole was unique among all azole anti-fungals. In addition to inhibiting cell cycle progression of endothelial cells in vitro, itraconazole was shown to suppress growth factor-dependent angiogenesis in mouse models of blood vessel formation, indicating its potential use as an anti-angiogenic compound16.
Itraconazole has also been linked to regulation of cellular processes that protect against cancer. Cytokines are small molecules that serve diverse functions within the body’s immune system and during cancer progression. Certain types of cytokines that are released in response to infection and inflammation can activate immune cells capable of killing tumor cells. However, other types of cytokines that promote proliferation and survival of normal blood cells can be exploited or produced by cancer cells. Itraconazole is a modulator of cytokine activity that can both increase production of cytokines involved in host defense and lower levels of cytokines that promote leukemic cell growth17,18.
Another important component of the body’s defense against cancer is the production of antioxidants that protect tissues from the potentially cancer-inducing effects of carcinogens, mutagens, and naturally occurring free radicals. NAD(P)H:quinone oxidoreductase 1 (NQO1) has been shown to be a direct target of itraconazole. The major role of NQO1 is the maintenance of cellular levels of antioxidants, but NQO1 also contributes to the stabilization of tumor suppressor proteins. Itraconazole treatment increases NQO1 levels, and therefore may promote both cellular detoxification and tumor suppression19.
Together, these studies suggest that itraconazole, an anti-fungal compound currently used to treat nail fungus, may also be a novel chemotherapeutic and chemoprotectant agent. Because the anti-fungal effects of itraconazole have been extensively studied for over 25 years, its safety and potential side effects are already well characterized. Excitingly, the doses of itraconazole already used to treat nail fungus and other types of systemic fungal infections result in blood serum levels well within the range needed to achieve the observed anti-cancer effects15,16. Clinical trials to determine the effect of itraconazole in treating lung cancer, skin cancer, prostate cancer, breast cancer, and leukemia are now underway20.

References

1 Drugs@FDA – FDA Approved Drug Products website http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm

2 Odds FC. Intraconazole – a new oral anti-fungal agent with a very broad spectrum of activity in superficial and systemic mycoses. Journal of Dermatological Science 5(2): p. 65-72 (1993).

3 Vanden Bossche H, et al. Anti-Candida drugs – the biochemical basis for their activity. Critical Reviews in Microbiology 15(1): p. 57-72 (1987).

4 Welsh O, et al. Onychomycosis. Clinics in Dermatology 28(2): p. 151-159 (2010).

5 Gupta AK, et al. Itraconazole for the treatment of onychomycosis. International Journal of Dermatology 37(4): p. 303-308 (1998).

6 Hay RJ, et al. An evaluation of itraconazole in the management of onychomycosis. British Journal of Dermatology 119(3): p. 359-366 (1988).

7 Matthieu L, et al. Itraconazole penetrates the nail via the nail matrix and the nail bed – an investigation in onychomycosis. Clinical and Experimental Dermatology 16(5): p. 374-376 (1991).

8 Cronin S and Chandrasekar PH. Safety of triazole anti-fungal drugs in patients with cancer. Journal of Antimicrobial Chemotherapy 65(3): p. 410-416 (2010).

9 Ho YS, et al. Molecular mechanisms of econazole-induced toxicity on human colon cancer cells: G0/G1 cell cycle arrest and caspase 8-independent apoptotic signaling pathways. Food and Chemical Toxicology 43(10): p. 1483-1495 (2005).

10 Soboloff J, et al. Sensitivity of myeloid leukemia cells to calcium influx blockade: application to bone marrow purging. Experimental Hematology 30(10): p. 1219-1226 (2002).

11 Zhang Y, et al. Purging of contaminating breast cancer cells from hematopoietic progenitor cell preparations using activation enhanced cell death. Breast Cancer Research and Treatment 72(3): p. 265-278 (2002).

12 Wang YJ, et al. Ketoconazole potentiates the antitumor effects of nocodazole: In vivo therapy for human tumor xenografts in nude mice. Molecular Carcinogenesis 34(4): p. 199-210 (2002).

13 Scholz M, et al. Long-term outcome for men with androgen independent prostate cancer treated with ketoconazole and hydrocortisone. Journal of Urology 173(6) p. 1947-1952 (2005).

14 Xu J, et al. Cholesterol trafficking is required for mTOR activation in endothelial cells. Proceedings of the National Academy of Sciences 107(10): p. 4764-4769 (2010).

15 Kim J, et al. Itraconazole, a Commonly Used Anti-fungal that Inhibits Hedgehog Pathway Activity and Cancer Growth. Cancer Cell 17(4): p. 388-399 (2010).

16 Chong CR, et al. Inhibition of angiogenesis by the anti-fungal drug itraconazole. ACS Chemical Biology 2(4): p. 263-270 (2007).

17 Bruserud Ø. Effects of azoles on human acute myelogenous leukemia blasts and T lymphocytes derived from acute leukemia patients with chemotherapy-induced cytopenia. International Immunopharmacology 1(12): p. 2183-2195 (2001).

18 Inoue H, et al. Modulation of the human interleukin-12p40 response by a triazole anti-fungal derivative, itraconazole. Scandinavian Journal of Infectious Disease 36(8): p. 607-609 (2004).

19 Korashy HM, et al. Induction of the NAD(P)H:quinone oxidoreductase 1 by ketoconazole and itraconazole: a mechanism of cancer chemoprotection. Cancer Letters 258(1): p. 135-43 (2007).

20 ClinicalTrials.gov: A service of the National Institutes of Health.

http://clinicaltrials.gov/ct2/results?term=itraconazole+cancer

Fungal infections of the toenails are much more common than infections of the fingernails. It has been estimated that anywhere between 2 and 14% of adults have onychomycosis, and as people age, they are also more likely to have the infection. It is more likely to occur to the nails of people under a number of circumstances, including those who have had:

• Nail trauma
• A depressed immune system, such as after chemotherapy, HIV infection, or certain immunosuppressant medications
• Diabetes mellitus (as many as 26% of diabetics have onychomycosis)
• Poor circulation in the legs and feet
• Difficulty cutting their toenails correctly

Onychomycosis is not dangerous. The affected nails become thick and difficult to cut. People with affected toenails may experience discomfort. This is especially true for the big first toenail. The pressure of shoes on it can be painful. Affected nails can get caught on clothing. There is a definite cosmetic problem with onychomycosis, especially of the fingernails. Most people want to get rid of the infection and make the nails appear more normal.

Fortunately, there are a few good or guaranteed ways to treat onychomycosis and a few treatments to avoid. This is not for lack of trying. Medical doctors as well as homeopaths and people experiencing the problem have all tried many different ways to get rid of the fungus. While no one has found a perfect cure all,  there are a few treatments that are worth trying as the results are promising.

Most of the fungi that cause nail infections are called dermatophytes, meaning that they like to grow in the skin. Candida, commonly called yeast, can also cause onychomycosis.

The appearance of an involved nail depends on where the infection begins. Most of the time, fungus gets into the sides or end of the nail. This results in a thickened and yellowed nail with debris underneath that most people recognize as a fungal infection. It can also penetrate from straight above the nail, which causes a superficial white, powdery appearance. Fungus can get into the nail from where it begins, especially in people with depressed immune systems. In these cases the entire nail will grow out with fungus in it. The more of the nail that is involved, the harder it is to treat.

Diagnosis of Onychomycosis

Before starting any treatment for this condition, you want to make sure that you are diagnosed properly. Other things can look like onychomycosis, including but not limited to nail damage as well as the changes in nails seen in people with psoriasis. Ideally you should see a doctor, and the doctor should take a sample of the nail and the debris beneath to look at under a microscope and to send for culture. Sometimes the microscopic examination and culture have to be done twice to get a definite diagnosis. You should be positive of the fungal infection before you start on any oral medication, if that is what you decide to do.

If you want to try over-the-counter medication or home remedies first, if they aren’t dangerous, there is not much risk. However, since there are other conditions associated with abnormal nails, if you don’t see a doctor, you might be delaying the diagnosis of some other illness.

Treatment of Onychomycosis

All treatment of onychomycosis, whether traditional or alternative, in a doctor’s office or at home, using medicines or surgical techniques, is less successful than treatment of other fungal infections, for example, in the skin. The fungus seems to be quite successful at living in and around nails.

Before specific treatment of onychomycosis of the feet begins, there must be a general assessment of the feet. Tinea pedis or “athlete’s foot” should be treated with an antifungal cream. This can be obtained over the counter or as a prescription. Lamisil® (terbinafine), Nizoral® (ketoconazole), Mycelex® (clotrimazole), Naftin® (naftifine), Loprox® (ciclopirox olamine) and others, including generic formulations are all effective. Calluses should be smoothed and moisturizer applied to any dry, cracked skin. Toenails should be kept short.

The feet need to be kept dry. This means thoroughly drying feet and toes after bathing. Absorbent cotton socks should be worn and changed when wet.

If it is suspected that a common shower is the source of the infection, for example, at a college dormitory, flip flops or other sandals can be worn into the shower. The feet showed by washed thoroughly with soap, dried, and the above suggestions continued. Towels and bath mats must be washed frequently in warm water.

If family members have tinea pedis, they should also be treated.

Any treatable underlying problem, such as diabetes, needs to be controlled as well as possible.

Fungal fingernail infections are associated with different problems. There can be fungal infection of the skin of the hands, which should be treated. People with fungal fingernail infections often have wet hands a lot of the time. This can be work related or due to many activities at home, from doing the dishes to keeping the bathrooms clean. White cotton gloves can be worn under rubber gloves when cleaning.

If damage has been done to fingernails due to artificial nail application or other materials, it is possible that there is more than just a fungal infection present. It is harder to be sure of a diagnosis of onychomycosis of the fingernails than toenails. A visit to the doctor is probably a good idea.

Treatment by a Physician

Treatment must begin by making sure the hands and/or feet are being taken care of properly, as mentioned above. A primary care doctor, or podiatrist (foot specialist) or dermatologist (skin specialist) may be able to help with this, depending on what the person needs to have done, what the person expects, and what the experience of the physician is.

Usually in the case of fungal infection of the toenails, trimming and removing extra thick toenail material is the first thing that needs to be done. Sometimes the nails are so thick and hard that it is virtually impossible for a person to trim them at home. Doctors have special instruments that enable them to cut off more. Podiatrists have burrs, which are kind of like sanders and can file down the nails.

For some people, getting the nails trimmed and back to something like a normal size and shape may be all the treatment that is needed. They may just need regular visits to keep the nails trimmed. This is especially important for people with diabetes, poor circulation, and elderly people with bad vision. The feet and nails can become a source of serious bacterial infections if they are not taken care of.

There are no studies to show what the natural history of onychomycosis is. Does it always spread? It does not seem to cause any serious problems. So for some people, nail trimming and reassurance is all that is necessary.

All treatments attempt to kill the fungus and allow uninfected nail to grow out. It takes approximately 6 months for fingernails to completely regrow, 12 months for toenails to grow out, and 18 months for the great toenail to grow out. A person cannot know if the fungal infection has been cured for that amount of time.

Topical Medications

It seems reasonable to try to treat toenail infections with the same type of antifungal medications used on the skin. The only topical medicine approved for use in the United States is ciclopirox olamine 8% (Penlac) which is a lacquer. There are other medications available in other countries.
Penlac needs to be put on the surface of the entire nail and the skin around it every day. Once a week, it is removed along with debris and unattached nail.

Naftin, Lamisil, and Loprox creams may also be used for onychomycosis. There have only been small studies done using these creams. There are topical medications available in other countries that may at some point become available in the United States.

The use of urea cream may help any topical medication penetrate the nail. Urea can also dissolve the toenail.

There is very little chance of an actual cure with topical preparations. They must also be used for months to years. However, if a podiatrist or doctor can significantly trim and pare down the thickened nail, and topical treatment is used, the cosmetic result may be satisfactory for some people. Podiatrists may also drill a hole in the nail to allow medication to get underneath. This is not as painful as it sounds.

Topical treatment may be the only choice for anyone who cannot take oral medications for fungus.

Surgery

As described above, trimming the nail and removing debris should be part of all onychomycosis treatment. It was believed that removal of a nail at the beginning of therapy, especially the big toenail, might increase the chance of a cure. This is no longer done routinely. It is only done when everything else fails and the nail is creating a significant problem because of its shape and size.

Oral Medication

At one time it was thought that oral medication might be the answer to the problem of onychomycosis. Getting anti-fungal medicine into the bloodstream would deliver it to the base of the nail, and under the nail, making sure to kill all the infection. However, oral medicines do not work as well as expected, and their side effect profile may make the cure worse than the disease. It depends on the severity of the fungal infection, other medical problems that underlie the condition, and the medication itself.

The most commonly used oral medication, and the treatment of choice for onychomycosis is terbenafine (Lamisil®). This medication has been proved to kill most of the fungal organisms that infect nails in the laboratory as well as in actual patients. The dose is 250 mg a day for six weeks to treat fingernails, and 12 to 16 weeks to treat toenails.

Common side effects of terbenafine therapy include headache, rash, and upset stomach. Serious side effects occur in less than 1% of patients, including severe rash and reduction in white blood cells. The most worrisome side effect is liver damage, which is usually mild and reversible. Liver abnormalities that are enough to cause symptoms only happen in approximately one out of 50,000 exposures, with complete liver failure much less common than that. However, anyone with liver disease cannot take terbenafine. Liver function tests should be done before beginning therapy. Many doctors repeat these tests after 4 to 6 weeks. About 3.4% of patients who take terbinafine stop the medication because of side effects.

Itraconazole (Sporonox®) is also used. 200 mg a day can be given for 12 weeks to treat a toenail infection. There is also “pulse therapy.” This means giving 200 mg twice a day for one week out of a month, for two months to treat fingernails and three months to treat toenails. 5% to 10% of patients develop nausea, vomiting and/or liver damage. Sporonox can also cause congestive heart failure; patients with existing heart failure cannot take it. In general, there are fewer side effects with pulse therapy than daily therapy. However, even with pulse therapy there can be liver damage bad enough to necessitate a liver transplant.

Fluconazole has also been used to treat onychomycosis. It only needs to be taken once a week, for a total of 3 months for fingernails or 6 months for toenails. It does not work as well as terbinafine or itraconazole.

Whether or not any of these treatments have cured the fungal infection is never known for many months, until the fingernails or toenails have grown out. Terbenafine had a higher cure rate than itraconazole. The outcome can be measured by appearance of the nail or absence of fungal elements. The “cure” rates have been measured as low as 50%, and as high as 80%. Even when the fungi are gone, the nail may not appear completely normal because of some other underlying problem or damage to the nail bed. There are also frequent relapses. The use of creams applied to the nails after oral therapy may help prevent relapse.

The cost of this treatment is high. It is estimated that the cost to cure onychomycosis with terbinafine is from $2,500 to $8,000. There is still a 30% chance of recurrence after a cure.

Alternative Treatments and Home Remedies

Considering the cost, side effects, and low success rate of prescription medication, looking for alternative treatments seems very reasonable. Some alternatives have been mentioned in terms of general care of the skin and nails.

One herbal remedy that seems to be very successful in treating onychomycosis is tea tree oil. Tea tree oil has been studied for a number of skin problems and is already available as a prescription medication for genital warts. Tea tree oil can kill the fungi that cause nail infections in the laboratory setting. There have been some small clinical trials of tea tree oil in treating nail fungus that show promise, although rigorous, large scientific studies have not been published.

In one trial, a combination of a known antifungal (butenafine hydrochloride) together with tea tree oil was used in a randomized, double-blind study in 60 patients with fungal infection of toenails. Treatment included the cream as well as clipping and removing as much toenail as possible, for 8 weeks. At 16 weeks, 80% of participants given the active ingredients were said to be cured, in that their symptoms were better and involved toenail removed. The placebo in this case was tea tree oil, which did not cure any patients. This is an example of a possible way tea tree oil might be used along with another local cream but not by itself.

Other home remedies have included soaking the nails in vinegar, or water with baking soda, strong tea, and bleach. Bleach application can be dangerous. The bleach would have to be diluted to avoid chemical burns. When these home remedies are used along with care of the nail, such as cutting it correctly and removing debris, they may improve the appearance of onychomycosis. Tea tree oil is a home remedy at the current time; it may become a prescribed medication in the future. Any promising home remedy can interest doctors and researchers enough to look into it further.

Tea tree oil taken orally is also considered an alternative treatment for onychomycosis, but there is little evidence at this time that drinking tea tree oil does anything to cure the fungal infection.

There are 2 alternative treatments whose active ingrediants contain tea tree oil, Zetaclear & Funginix.

New Treatments for Onychomycosis

Doctors continue to look for a good way to cure onychomycosis. Studies have been done using photodynamic therapy. This is a way of using light to cure the infection. Doctors recently reported successful treatment of two patients. The affected toenails of the patients were pretreated with a substance called 5-aminolevulinic acid (ALA). They were also pretreated with urea, and the involved nails were covered with plastic film and aluminum foil to shut out light. Before treatment, the area was uncovered and light was used to make sure the ALA had penetrated the nail. A pulsed laser light was then used to treat the involved nail. The treatment was slightly painful for about a day. Treatment was repeated once a week for 6 to 7 treatments. At the end of treatment, the nails appeared cured. No fungi could be grown from the nails. Reevaluation at 3 to 6 months still showed apparently normal nails.

There are many different ways of delivering heat or light to infected nails. There are a number of different lasers capable of treating nail fungus. One is called the “Noveon.” It is a dual-wavelength, near-infrared diode laser. This particular wavelength kills fungi without damaging normal tissue. In one recent controlled study, 26 infected toes were treated. Treatment took place on days 1, 14, 42 and 120. All were followed for at least 180 days. 85% were judged improved because of clear nail growth. This study was done to make sure the treatment was both safe and effective. There are other laser systems under investigation.

Many laser systems are being tested or will be tested to see if they can help cure or control onychomycosis, and it appears that some of them will. Laser treatment will probably not completely cure the infection but help control it, and may be useful along with other therapies. Plastic (cosmetic) surgeons often possess a wide variety of lasers and devices that deliver heat or energy. It is likely that the best type of laser treatment will be found in the relatively near future. However, this treatment will always be expensive.

While some will be looking at lasers and other possible oral medications, other researchers will continue to evaluate herbal remedies and home remedies to look for safe and inexpensive treatment for onychomycosis.

References

Roberts DT, Taylor WD, Boyle J. Guidelines for treatment of onychomycosis. British Journal of Dermatology 2003; 148: 402–410.

De Berker D. Fungal Nail Disease. New England Journal of Medicine 2009; 360: 2108-16.

Choi S. Fungal Infections. Manual of Dermatologic Therapeutics 7th edition. 2007. Arndt KA, Hsu JTS, editors. Lippincott Williams & Williams. Philadelphia, PA 2007.

Elizabeth T, Meireles F, Gadelha Rocha MF, et al. Successive Mycological Nail Tests for Onychomycosis: A Strategy to Improve Diagnosis Efficiency. The Brazilian Journal of Infectious Diseases 2008; 12(4):333-337.

Syed TA, Qureshi ZA, Ali SM, et al. Treatment of toenail onychomycosis with 2% butenafine and 5% Melaleuca alternifolia (tea tree) oil in cream. Tropical Medicine and International Health 1999; 4(4): 284-287.

Martin KW, Ernst E. Herbal medicines for treatment of fungal infections: a systematic review of controlled clinical trials. Mycoses 2004; 47: 87–92.

Rehbock, D. Common Nail Conditions that are treated by the podiatrist. SA Pharmaceutical Journal – January/February 2009: 32-36.

Watanabe D, Kawamura C, Masuda Y, et al. Successful Treatment of Toenail Onychomycosis With Photodynamic Therapy. Archives of Dermatology 2008; 144(1).

Landsman AS, Robbins AH, Angelini PF, et al. Treatment of Mild, Moderate, and Severe Onychomycosis Using 870- and 930-nm Light Exposure. Journal of the American Podiatric Medical Association 2010; 100(3).

Soaking nails affected with nail fungus in a mixture of dark beer and acidophilus can be a highly effective treatment, eliminating the fungus and preventing the growth of new bacteria. Acidophilus is an extremely useful bacteria that can help to ward off infections. In combination with the alcohol found in beer, acidophilus creates an acidic climate that nail fungi cannot survive in.

So how exactly does the beer soak method work to cure nail fungus?

The alcohol in the dark beer acts to soften the affected nails and surrounded nail bed. The white vinegar that is included in the mixture helps to provide a beneficially high acidic level. Environments containing high levels of acidity prohibit harmful bacteria such as fungus from growing and surviving, while allowing beneficial bacteria such as acidophilus to grow and thrive. In simple terms, the white vinegar helps to kill the fungus while allowing the acidophilus to grow and fight the remaining fungus. Read on for a step-by-step guide to using the acidophilus beer soak method for nail fungus infections.

Ingredients Required for the Soak
• Bowl or tub large enough to soak hands or feet
• 4 cups white vinegar
• 2 pints dark beer such as Guinness Stout or another very dark variety
• 1 acidophilus sachet: should contain approximately125 billion acidophilus organisms, this is the standard amount per sachet.
• Nail file

Directions for Using the Soak
1. Mix the white vinegar, dark beer and acidophilus together in the bowl or tub.
2. Soak the hands or feet in the mixture for approximately 30 minutes.
3. Remove the hands or feet from the soaking mixture.
4. Wash hands or feet thoroughly with soap and warm water before patting dry.
5. Use this soak twice a day, covering and storing in a cool place between uses.
6. This mixture can be used for up to 48 hours before the active ingredients will loose their effectiveness.
7. Continue to use this soaking mixture twice a day for three to six months.

Once per week, the affected toenails and fingernails should be filed down immediately following soaking in the mixture. Once the nails have been filed, the hands or feet should be re-submerged for an additional 30 minutes in the beer and acidophilus soaking mixture. This will allow the newly exposed nail to be treated, further limiting the growth of the fungus. Also you can radically increase the chances of curing the nail fungus infection by using a tea tree oil product like zetclear in conjunction with the beer soak method.

It is important that this treatment schedule is followed precisely; any missed treatments will result in a longer over all treatment period. Users of this treatment method will begin to see results in as little as one week or in some cases, depending on the severity of the fungal infection, it may take much longer, even up to one month. When the nail fungus infection begins to be effectively cleared up, users will notice that healthy nails will start to grow from the start of the nail bed. The new, unaffected nails will be clear from the tell tale signs of yellowing and thickness. It should take approximately twelve weeks for the new healthy nails to completely grow in and fully replace the nails that were effected by the fungus. If the skin surrounding the nails becomes sensitive during treatment, one may reduce the soaking sessions from twice a day to just once per day.

There are a number of home remedies that have been tried over the years to treat onychomycosis and fungal nail infections. The problem with all of them and even with topical prescription medicines is that the remedy is not always able to penetrate the nail to the site of the infection. This keeps many home remedies from being very effective on onychomycosis. Also, there are no clinical trials that have looked at the various home remedies in the treatment of nail fungus. On the other hand, there is very little risk associated with the popular home remedies and most are inexpensive. Also there is some anecdotal evidence that they could work for some people.

Just as with prescription onychomycosis treatments, if the nail bed and lunula are affected, topical, over-the-counter, home remedies will not be effective. An oral medication is required and, currently, these medications are only available with a prescription.

One of the popular, inexpensive treatments that has been tried is to soak fingernails or toenails in Listerine. Listerine contains ethanol, thymol, eucalyptol, and benzoic acid. Listerine is known to kill bacteria and has recently been shown to have antifungal properties. In fact, this treatment was potent against Candida infections which cause one of the four main types of onychomycosis. Therefore, Listerine could theoretically eradicate a nail fungus infection if it could penetrate to the site of the fungus.

No clinical trials have been performed looking at Listerine and onychomycosis but proponents of the treatment suggest soaking fingernails or toenails in Listerine for 10 minutes each night. Listerine’s ability to kill dermatophytes is less impressive and less well known. Since most onychomycoses are caused by dermatophytes, Listerine may not be universally effective.

Another onychomycosis along these same lines is vinegar. Vinegar, also known as acetic acid, can potentially destroy the dermatophytes that cause onychomycosis. The process is the same for Listerine—people that would like to try this remedy should soak their fingers or toes in one part vinegar and two parts water for 20 minutes per day. Treatment should be continued until symptoms resolve or the skin around the nail becomes irritated. There is no advantage to using apple cider vinegar versus other vinegar types since they all contain acetic acid primarily. Also, over-the-counter preparations that contain acetic acid as their primary ingredient are not more or less special than plain vinegar.

One of the more promising home remedies for onychomycosis is Vicks VapoRub. Again, there are no clinical trials supporting this treatment, however physicians have witnessed improvements in some people using this ointment. Why might this home remedy work where others fail? In the case of Vicks VapoRub it is as much about the carrier as it is about the active ingredient. The oils and petroleum jelly in Vicks can dissolve and soften the nail when used repeatedly over time. This allows the active ingredients like menthol to penetrate the nail and fight the fungal infection.

The only really way to use Vicks VapoRub is topically; the precise “dose” and duration of therapy is anyone’s guess. Many people apply it to their affected toenails or fingernails at night and wear a sock or glove to keep the Vicks VapoRub next to the nail. Unfortunately this also tends to hold moisture next to the nail and moisture promotes fungus growth. If you are going to use Vicks VapoRub and a sock or glove, make sure the covering is 100 % cotton and “breathes” to prevent moisture accumulation.

One natural product that has fairly impressive antifungal activity is tea tree oil or Melaleuca alternifolia. When used in vitro (meaning in a dish), tea tree oil was able to kill or inhibit all of the major causes of onychomycosis including Trichophyton rubrum, Trichophyton mentagrophytes, and Candida species. There have been two clinical trials of tea tree oil on onychomycosis one showing a 20% cure rate and the other showing a 0% cure rate. Apparently 100% tea tree oil needs to be used to see an effect. While cure was only achieved in a fraction of patients (or none) nail appearance improved in many more.
Interestingly tea tree oil was very effective in treating tinea pedis, a superficial fungal infection of the foot. In this case the topical agent can easily reach the offending fungus.

One topical treatment that contains Tea Tree Oil is Zetaclear.

Another herbal preparation that has some antifungal activity is Camellia sinensis or green tea extract. In a dish, this herb was able to kill Candida glabrata. It is affect on dermatophytes is unknown and there have been no clinical trials to determine if it has an effect on patients with onychomycosis.

References
Hammer KA, Carson CF, Riley TV. In vitro activity of Melaleuca alternifolia (tea tree) oil against dermatophytes and other filamentous fungi. J Antimicrob Chemother 2002;50:195-199.
Hart R, Bell-Syer SE, Crawford F, Torgerson DJ, Young P, Russell I. Systematic review of topical treatments for fungal infections of the skin and nails of the feet. BMJ 1999;319:79-82.
Turchetti B, Pinelli P, Buzzini P et al. In vitro antimycotic activity of some plant extracts towards yeast and yeast-like strains. Phytother Res 2005;19:44-49.

Onychomycosis, or a nail fungus infection, is defined as a fungal infection of the nail bed, nail plate (what we think of as the nail itself) or the area very closely surrounding the fingernail or toenail. Most cases of nail fungus are caused by a dermatophyte called Trichophyton rubrum. Many other cases are caused by Candida albicans, which is a yeast. These organisms can invade deeply into the nail or stay near the surface. They can begin their infection process near the cuticle or at the tip. (Nail Fungus under a microscope)

Onychomycosis is responsible for one third of all fungal skin infections and half of all nail infections. Even so, that means that half of all nail infections are not caused by fungi. Therefore it is important to distinguish between a nail fungus and a bacterial infection of the nail. A fungal infection is treated with an antifungal while a bacterial infection is treated with an antibiotic.

Fungal nail infections can cause a number of abnormalities in the nail. Almost all cases of nail fungus will include white, yellow, or white-yellow crust in or on the nail. This is the fungus itself. The white-yellow patches can be in the form of streaks that are parallel to the finger. Alternatively, the lesion can appear across the tip or the cuticle. When the crust spreads, it can cover the entire surface of the nail.

If the fungus penetrates underneath the nail plate (the nail itself), which is often does, it can form irregularities in the nail bed. The bumpy nail bed is less able to hold onto the nail and so it becomes loose. Since dermatophytes consume keratin and produce destructive wastes, the nail can become pitted and misshapen. This may cause ridges and grooves in the nail.

If the nail fungus infection becomes severe or contains Candida, the nail folds and skin surrounding the nail may become red and swollen. These are signs of inflammation which can cause discomfort and even pain. The skin may express (ooze) pus, which is a whitish material common of white blood cells from the immune system.
Pus is usually a sign of bacterial infection and, if it is present, may be a “red herring” for the physician trying to make the diagnosis.

A nail that is expressing pus may be assumed to be caused by a bacterial infection, as is often the case. If you are experiencing pus it is particularly important to get a correct diagnosis for the nail infection. In addition to bacterial nail infection, there are a number of diseases that can mimic a nail fungus. Examples of mimickers include hallopeau acrodermatitis, lichen planus, nail bed melanoma, nail bed psoriasis (may occur with fungal infection of the nail), onycholysis, paronychia, Reiter syndrome, or yellow nail syndrome. This means that one or more diagnostic tests are necessary to make the correct diagnosis of onychomycosis.

Testing for a nail fungus requires that a piece of the diseased nail be taken for further study and analysis. If the disease affects the tip of the nail, like in distal subungual onychomycosis, a small piece of nail can be trimmed from the end. Unfortunately in proximal subungual onychomycosis the nail must be removed down to the base. On the positive side, this nail removal can be therapeutic as well as diagnostic. In white superficial onychomycosis, the lesion is scraped away from the top of the nail.
Once a piece of the diseased nail is harvested, two main tests are performed on the sample. Some of the nail can be treated with a strong base, namely potassium hydroxide, and viewed under a microscope for the presence of fungi. The remaining piece of nail can be sent for a fungal culture. The sample is placed in an environment in which fungus can grow and thrive and, after a few days, the sample is checked for growth of new fungus. The presence of fungus in one or both of these tests is good evidence that an onychomycosis is present. If neither the potassium hydroxide wash nor the culture show fungus, the nail can be taken, pulverized, and sent to a pathologist for analysis. Alternatively a portion of the nail can be sent for a bacterial culture in case the nail infection is not fungal.

If you suspect that you have nail fungus symptoms, the diseased nail or nails should be looked at by a physician, ideally a dermatologist. Proper diagnosis of the illness is important for directing care and ruling out for serious problems.

References
Hainer BL. Dermatophyte infections. Am Fam Physician 2003;67:101-108.
Jaffe R. Onychomycosis: recognition, diagnosis, and management. Arch Fam Med 1998;7:587-592.
Kaur R, Kashyap B, Bhalla P. Onychomycosis–epidemiology, diagnosis and management. Indian J Med Microbiol 2008;26:108-116.

Lamisil is unable to kill other fungi that may be involved in onychomycosis like Candida albicans. Therefore Lamisil treatment is limited to dermatophytoses of the nail. For this reason it is important for doctors to accurately diagnose the organism that is causing the onychomycosis before starting treatment.

Lamisil is available as 250 mg tablets. The traditional way that Lamisil is administered is in a continuous regimen, once daily, for several weeks. If onychomycosis is affecting the fingernails, a single 250 mg dose is taken orally each day for six weeks. If onychomycosis is on the toenails, the treatment is prescribed for twelve weeks.

Recently, good results with Lamisil have been achieved using a pulse therapy regimen. In this approach, two 250 mg tablets (500 mg total) are taken each day for one week with three weeks of no drug. This one week on/three weeks off system is used for four weeks in fingernail onychomycosis and for eight weeks in toenail onychomycosis. This pulse regimen has not been approved by the Food and Drug Administration but is still used. While larger clinical trials are needed to determine if the pulse system is equally effective as continuous dosing, this approach would be less expensive overall and would minimize potential side effect risk.
The most commonly reported side effects are dyspepsia, which is also known as upset stomach or indigestion. There is also a slightly increased occurrence of headache in people taking Lamisil. People sometimes get a generalized rash when taking terbinafine (Lamisil).

Lamisil, as with all antifungal drugs, has the potential to cause liver problems. In fact, anyone with a history of liver disease will usually not receive one of these drugs to treat onychomycosis. To make sure that people do not experience liver problems while they are taking the drug, a liver function test will be done prior to starting the medication. This is a blood test that measures enzymes from the liver, among other things. The test will be repeated at four weeks to make sure no problems have occurred. If they have, Lamisil is stopped and the problem usually goes away on its own. In some rare cases Lamisil has caused liver failure.
Another rare but potentially serious Lamisil side effect is that it can cause a drop in the number of white blood cells in the blood. Because of this, doctors routinely take a blood sample before treatment called a complete blood count or CBC. This can be done at the same time as the liver function test. Then, after four weeks, the CBC is repeated to check for a drop. If there is a drop, the drug is stopped. Stopping the drug is usually enough to see this white blood cell number return to normal.
The onychomycosis drug has been linked to very severe skin reactions called Stevens-Johnson syndrome and toxic epidermal necrolysis. These are very rare Lamisil side effects, but if they occur, they can cause the skin to blister and come away from the body. Stevens-Johnson syndrome and toxic epidermal necrolysis require hospitalization and close supportive care.
Compared to other antifungal and onychomycosis treatments, Lamisil interacts with relatively few drugs. It may cause cyclosporine (immunosuppressant) to be less effective. Alternatively, the toxicity of cimetidine (acid-reducing pill) and rifampin (antibiotic) may increase.
While the drug may be safe it is not always possible to know for sure, therefore Lamisil should not be started in pregnant women or nursing mothers. Onychomycosis treatment can be postponed until after pregnancy and nursing is complete.

The occurrence of onychomycosis in children is very rare compared to the rate of occurrence in adults. However, should it occur, Lamisil could potentially be used to treat the disease. While it has not been approved by the FDA for use in children, a Lamisil treatment dose can be prescribed based on the weight of the child. Children weighing less than 25 pounds or younger than 12 years old should not be treated with Lamisil.
Lamisil treatment of onychomycosis is faster than it was with older agents like griseofulvin. While Lamisil can cure onychomycosis in a majority of patients taking the medication within several months, the nail itself is not normal for some time, even after the dermatophytosis has been eliminated.
After Lamisil treatment is complete, the drug can be detected in the nails for up to three months after the drug is stopped. It can be detected in the blood for up to six weeks after treatment cessation.
Lamisil 250 mg tablets costs the National Health Service in Great Britain £3.44. Canadian retailers charge $80 to $160 for a one month supply. In the United States the cost of Lamisil varies, but the unsubsidized cost could be as high as $400 a month or more.

References
Terbinafine (Lamisil) prescribing information
Gupta AK, Lynch LE, Kogan N, Cooper EA. The use of an intermittent terbinafine regimen for the treatment of dermatophyte toenail onychomycosis. J Eur Acad Dermatol Venereol 2009;23:256-262.
Takahata Y, Hiruma M, Shiraki Y, Tokuhisa Y, Sugita T, Muto M. Treatment of dermatophyte onychomycosis with three pulses of terbinafine (500 mg day for a week). Mycoses 2009;52:72-76.

The days of onychomycosis being considered simply a cosmetic problem are over. Nail fungus is certainly unpleasing to the eye but it can be much more than that. The emotional and social impact of onychomycosis can be significant. Those afflicted with onychomycosis avoid public places and social functions. They avoid touching friends and loved ones with affected hands which can lead to real interpersonal conflict.

Beyond the psychological suffering associated with onychomycosis, the nails of the fingers and toes provide normally provide protection against trauma. The nails contribute to the way in which we sense the world. Nails affected by onychomycosis can be painful and interfere with sensation and walking. In addition, a fungal infection of the hands and feet may lead to a process called a superinfection in which bacteria and viruses also invade and infect the tissue on top of the fungal infection.

Because of these symptoms and complications, physicians are treating onychomycosis more aggressively than they once did. Patients are increasingly requesting onychomycosis treatment from doctors as well, whether it is topical, oral, or even surgical.

Medical prescription treatments for onychomycosis fall into two main categories: oral and topical (placed directly on the infected nail). The decision to use one or the other treatment is dependent on several factors. If the lunula is involved in either distal subungual onychomycosis or proximal subungal onychomycosis, than an oral agent is the only way to eradicate the disease. Patient preference factors into the decision, too. In many cases, a combination of oral and topical drugs is prescribed because this leads to a more rapid clearance of the infection and full eradication of the onychomycosis, in general.
Despite psychological and physical discomfort, oral prescription treatment of onychomycosis should not be entered into lightly. All antimycotic (antifungal) treatments used for onychomycosis have the potential to damage the liver. In fact, if the patient has any history of liver disease whatsoever, oral prescription treatment for onychomycosis should not be used. Even without a history of liver disease, it is usually recommended that the treating physician check liver enzymes before starting oral antifungal onychomycosis treatment. For some treatments, liver function should be checked again after four weeks. Also any sign of liver disease such as jaundice (yellow skin or whites of the eyes), dark urine, pale colored stools, upper abdominal pain, fatigue or malaise should be reported to the doctor immediately.

Historically, Griseofulvin was the only oral treatment for onychomycosis. While it worked reasonably well (not great) it was associated with a lot of side effects, especially at moderately high doses. Griseofulvin also required long treatment courses and the disease would often come back once the drug was stopped. Fortunately there are newer, more effective oral antifungal onychomycosis treatments. In fact, there are three main prescriptions in use today.

Terbinafine, also known as Lamisil, is very good against onychomycosis caused by dermatophytes, which most cases are. Terbinafine is given as a 250 mg pill once a day for six weeks if treating fingernails and twelve weeks if treating toenails. Pulse therapy has been effective in some cases. Pulse therapy delivers a higher Lamisil dose but separated by times that no drug is administered. A complete blood count and liver function tests should be performed before treatment is started and after four weeks of therapy.
Itraconazole (Sporanox) is usually administered in pulse dosing. The most common treatment schedule is 200 mg orally once a day for one week per month over three months. Itraconazole can interact with a number of other medications so you must tell your doctor about all of your medications, both prescription and over-the-counter. Liver function tests should be performed before treatment is started and after four weeks of therapy
Fluconazole (Diflucan) is administered once per week (150 or 300 mg) until the symptoms resolve. Treatment may be six to nine months long before results are seen. This antifungal may interact with several other medications and must be used judiciously. Fortunately no blood tests are required when using fluconazole (though they may be performed anyway).
Topical prescription onychomycosis treatments are of limited usefulness and are usually combined with oral or surgical treatments. One of the more effective topical prescription products is ciclopirox (Penlac). This 8% topical solution is applied once a day, usually at night. While it is safer than oral antimycotics, complete cure was achieved in about 5% of those treated with ciclopirox alone.
In cases where prescription treatments for onychomycosis fail, there are a number of surgical options. They fall into three broad categories: chemical, mechanical, or surgical nail avulsion. A concentrated solution of urea (~50%) can remove the fungus and even a very thick nail. This approach is painless and can be quite effective. The nail can be mechanically or surgically avulsed (forcibly torn away) which may require local anesthesia because of the pain caused by the procedure. In people with severe disease, however, the nail may already be pulled away from the finger and avulsion is therefore less painful than it would be in the nail’s natural state. Avulsion is rarely painless, however, which should be considered in your treatment decisions. Also the finger or toe is left without a nail for a period of time after removal.

References
Ciclopirox (Penlac) prescribing information
Fluconazole (Diflucan) prescribing information
Itraconazole (Sporanox) prescribing information
Terbinafine (Lamisil) prescribing information