Week 1 – Hi my name is John and if you are like me one day you looked down at your feet and thought wow my toenails look pretty gross. Could be at a pool party, walking on the beach or just wearing your flip flops out in public. For me I love training in martial arts. In the martial arts gym you are always barefooted. No shoes allowed! It was there one day that it hit me, amongst all these 20 somethings with clear nails my nails looked yellow and crusty. It was really embarrassing and I vowed to clear them up once and for all.

Nail fungus never really appears out of the blue… its a gradual thing… get a crack in your nail… walk around the shower in the gym barefooted… wearing your shoes constantly without letting you toes breath and next thing you know your nail start getting little cracks and discolored. My story is that I took a break with martial arts training to have a family and to work on my career and so after 5 years decided to starting training again.  I never really cared what my feet looked like, however that changed when I got back into martial arts.

In the gym you are training in close quarters, whether you are grappling, wrestling or sparring so being clean and cleanliness in general is of a high concern. You don’t want to be that guy that has terrible body odor or super bad breath…

Now I’m no spring chicken but I’m not “old” either I’m in my late 30s but when I stepped onto the mat I noticed right away how gross and yellow my big toenail looked. Now I looked at my feet a millions times before that day stepping onto the mat, but never really noticed or cared. Yet here I was the “older” guy in the gym looking quite the part with my yellow nails and all.

From that day forward I always hid my toenail with black tape when I was in the gym. From time to time someone would ask me why I was wearing the tape and I would usually say “oh I jacked up my toes hitting the heavy bag” or “tweaked them while sparring”… at this point no one evens bothers anymore… as they must be thinking his toes are permanently screwed up!

If you take a look at the picture you can see why I usually wrap them up. They look gross!

So I have to do something… I can’t always wear tape around my toes and summer is coming up! So I’m going to detail here my experience in trying the various methods of curing my nail fungus on this blog. Following along with me and leave your comments below!

Week 2

So my strategy is just to go to local drug store and pick up a cheap bottle of anti-fungal solution from CVS. I’m using undecylenic acid. Also I’m filing my toenail down. It way too early for any real results but I think filing down the crusty parts is better than nothing at all.

Week 4

Not much has changed.  Just plugging away and applying the CVS treatment daily as well filing the yellow parts down.  I think the root base of the nail is not yellow but it seems that the nail as it grows out develops a yellow tinge as well as gets flaky and not healthy looking.

My plan is to finish the bottle out in another few weeks before switching up my treatment options.

The post My Personal Journey in Curing Nail Fungus for Good – A Weekly Treatment Diary appeared first on ToenailFungusTreatments.com.

The good news is that you can heal your nail fungus cheaply and naturally without much effort. Baking soda is one of the most common substances in your house, but it is scientifically proven to stop the spread of nail fungus. This will help keep it to one finger or toe, and it will stay localized to just one place on the nail. Tea tree oil is another topical medication that has anti-fungal properties to kill off the bugs in your nail. Used together, these all natural remedies provide a safe, effective way to manage a nail fungus problem.

What is Nail Fungus?

Nail fungus is often an embarrassing, difficult condition. Whether you have it on your fingernails or toenails, you can often encounter difficulties in treating the fungus. Some of the symptoms of nail fungus include nail discoloration and a loosening of the nail. In fact, your nail can even fall off because of the fungus underneath it. Your nails can become brittle and change in shape entirely due to the condition. The most common signs are a thickening of the nail itself and yellowing of the nail bed. Sometimes the yellow color can manifest as streaks. You can have crumbling to the outside of the nail or dirt that accumulates under the nail bed.

Those who tend to get nail fungus are people who have Athlete’s foot, jock itch, or ringworm. You also increase your risk by getting manicures, pedicures, having an injury to the nail, or having constant moisture around the nail bed. Closed shoes are another known culprit for nail fungus.

How Alkalizing Substances Fight Nail Fungus

Baking soda is not an anti-fungal, per se. In fact, studies into baking soda’s mechanism of action show that it does not kill off any fungus that is present. Instead, the presence of baking soda keeps fungus from growing and spreading out of control. It is fungal-static, which means that it inhibits the growth and spread of the fungus to other nails.

Part of the reason that baking soda helps control fungus is that it changes the pH value of the skin and nails. When the pH is changed from a very acidic, sweaty environment to a dry, alkaline environment, fungus cannot grow. Fungus needs the acidity and the wet environment to continue to proliferate, and if you apply baking soda, you remove these properties and help cure your nail fungus.

Baking Soda as a Solution

Since baking soda works against the fungus that is living in your nails, you can use it in a number of ways. One way to use it is to take a cup of baking soda and add it to a foot bath. You can soak your feet – or hands – in the baking soda water for 30 minutes, twice per day to help discourage the growth of fungus under your nails. This often helps the mixture get underneath the nail bed, and it is effective for nail fungus that is not treatable in other ways.

The second way to use baking soda is to make a paste of baking soda and lukewarm water, and then you apply this paste to your nail. Try to work the paste into the cuticle and under the nail bed. Allow the mixture to stay on your nail for at least 20 to 30 minutes. You can do this twice per day to help control the fungus.

The last way to use baking powder is to help control the moisture on your feet. After the two methods used above, you should make sure that your feet are very dry. You may even consider using a hair dryer to discourage the further growth of fungus. Putting baking soda in your socks before wearing shoes can help you control the amount of sweat and moisture that builds up on your feet.

After using baking soda for a week or so, you may notice your nail turning white. This is a common side effect of baking soda use, and it can help if your nail fungus has discolored your nail bed. Sometime, the nail will actually fall off after treatment, and you will see that a new nail is growing underneath. This is the main goal of baking soda therapy, but don’t force your nail to fall off. Consider seeing a doctor regarding your nail fungus if you are a diabetic.

Tea Tree Oil Solutions

If baking soda doesn’t kill fungus but helps to stop its spread, you need something that has proven action against it. One of the most powerful natural remedies for fungal infections is tea tree oil. Derived from the plant Melaleuca alternifolia and steam distilled, tea tree oil has anti-bacterial and anti-fungal properties that have been recognized for centuries. Even better, this treatment is all natural and is applied topically. This is in stark contrast to the medications that doctors prescribe for you that are ingested and often have side effects that can sometimes be worse than the condition.

You can use a course of baking soda on your nails to stop the fungus, and then use 100 percent tea tree oil to kill off the fungus that already exists. You should take two to three drops and place them on the nail bed, allowing them to absorb into the skin and cuticle. You can even take a drop of the oil and direct it underneath the nail bed. With the combination of these two natural treatments, you should see changes in your nail fungus condition within a week. You can easily avoid costly prescription medications and have the nails you always dreamed of.

References

Medline Plus; Fungal Nail Infections; Linda J. Vorvick, MD; October 2010

https://www.nlm.nih.gov/medlineplus/ency/article/001330.htm

Master Gardener; Baking soda: will fungi fail and roses rejoice?; Linda Chalker-Scott, Ph.D.; 2009

https://www.puyallup.wsu.edu/~linda%20chalker-scott/horticultural%20myths_files/Myths/magazine%20pdfs/Baking%20soda.pdf

Mayo Clinic; Tea Tree Oil; 2012

https://www.mayoclinic.com/health/tea-tree-oil/NS_patient-teatreeoil

The post Can Baking Soda Cure Nail Fungus? appeared first on ToenailFungusTreatments.com.

If you want to get rid of your nail fungus, you are going to have to stay dedicated to the task and try as many different remedies as you can. Don’t give up too soon on something, though. It can take months to see any improvement in nail fungus, even with doctor prescribed treatments. With home remedies, you have to use the treatments consistently and loyally, even when it seems like it won’t work. Of course, your best course of action is to prevent nail fungus from the start.

Tips for Using Topical Nail Fungus Treatments

If you have a topical nail treatment for your nail fungus, you are ahead of the game, but you can do a few things to make that treatment even more effective than merely rubbing it on your nail and leaving it alone. Topical nail treatments need to penetrate the hard, brittle nail that the fungus has created. Unfortunately, nail is not absorbent, so if you have thick nails, that topical solution is just sitting on top of the nail and not attacking the fungus. For starters, keep your nails clean and dry at all times. Fungus and bacteria in general love a warm, wet environment. If you have sweaty feet, use an anti-fungal foot powder to keep your feet dry.

• 1. Don’t use nail polish because this only acts as an additional barrier for the topical treatment to penetrate.
• 2. File your nails down and rough up the surface of the nail with a nail file to allow the treatment to penetrate down to the tissue.
• 3. In extreme circumstances, you can have the nail removed entirely so that the medication can kill off the fungal infection. The toenail will grow back after eight to ten months. Permanent toenail removal is not often recommended for fungal infections unless they are causing a great deal of pain.

How to Prevent Nail Fungus Infections

If you do get your nail fungus under control, you want to prevent further infections. In fact, you want to prevent spreading the infection to your other nails because you will have even more difficulty getting rid of the infection if it spreads. For instance, pay attention to the spaces between your toes. They can often harbor bacteria and lead to the fungal infection spreading from one toe to the next. Keep your socks and shoes clean, as well. You should change your socks at least one per day, but change them more if you have sweaty feet. Your shoes should be well-ventilated and fit your feet well. Too tight and they can lead to moisture and more fungus growing.

Always trim your nails straight across to prevent them from pushing against footwear. This can cause trauma and an entrance pathway for the fungus. File down thickened parts of the nail to keep them clean and dry. If your hands are exposed to water frequently – such as a dishwasher – wear rubber gloves to protect your nails from fungus. People who bite their nails or pick at the skin around their nails are more prone to a fungal infection because the teeth can open up an infection pathway and the mouth introduces bacteria into the wound.

Always wear shoes in public showers or other places where bacteria may be present on the floor, and give up the artificial nails that trap bacteria beneath the nails. If you must get a manicure, be sure to go to only a reputable salon that takes proper hygienic measures. Most importantly, wash your hands immediately after working with your infected nail. Do not touch your other nails after cutting, treating, or otherwise dealing with the infected nail. Wash your hands, and then move on to care for the other nails.

Simple Home Remedies to Treat Nail Fungus Infections

You can do a great deal of different soaks, solutions, and topical applications of home remedies to help heal your nail fungus infection. One of the most common home remedies that can be used in conjunction with other treatments is the use of vinegar. You can soak your feet in a vinegar solution that is one part vinegar to two parts water. You should keep your feet soaking for at least 15 to 20 minutes to allow the solution to penetrate the nails and tissue more thoroughly. Another variation on this soak is to use apple cider vinegar. Experts suggest a 50/50 lukewarm water to apple cider vinegar bath. Again, soak for 15 minutes. You can also apply vinegar directly to the toe two to three times per day. No matter how you use vinegar, make sure you wash and dry your feet thoroughly when you are done with your soak. Any moisture that is left behind is a breeding ground for the fungus and will have the opposite effect you are looking for.

Another popular soak is to use mouthwash to help kill off some of the fungus under your nail. Wash your feet first by taking a bath, then pour antiseptic mouthwash into a basin and soak your nails in it for 30 minutes. You will need to wash your feet or hands with soap and water after your soak, and make sure to dry well, too. Disinfect the basin that you use for your soaks to prevent the fungus from growing in it between soakings. You could end up reinfecting yourself or possibly infecting other nails.

Vick’s VapoRub is another home remedy that is often used to fight nail fungus. Experts recommend creating grooves in the infected nail with a nail file to aid absorption. You simply put a glob of the VapoRub on the nail bed and let it absorb. This treatment can be used a few times a day for several days, but different references have different instructions for the VapoRub remedy. You might have to try several techniques to find something that works.

You can find several outlandish treatments for nail fungus out there, but they are worth mentioning if they help. You can make a solution that is one part pine cleaner and one part soy sauce. Using a dropper, apply this to the affected nail after washing your feet or hands. Another possible treatment is garlic. One remedy calls for sleeping with garlic cloves in the ends of your socks or using a garlic paste to apply it directly to the nail. Whatever you find to help with you nail fungus, if you start to feel pain, irritation, or redness, stop using the treatment and contact your doctor. If you cannot get any relief from your nail fungus situation and it is becoming painful, you may need to see your doctor for more definitive treatment that may include prescription medication.

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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 https://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.

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

The post From Toenails to Tumors: Itraconazole in the Treatment of Nail Fungus and Cancer appeared first on ToenailFungusTreatments.com.

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).

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What is it?

You can have your nail completely removed (this is called avulsion) or partially removed (this is called debridement). This can be done either with minor surgery or with an ointment that softens the nail so that it can be removed easily.

Surgery: Your doctor will first numb the skin around and under your nail with a shot of a local anesthetic. He or she will then use a tool to separate your nail from the surrounding skin and nail bed (this is the area under your nail). Once the nail is removed, your skin underneath should heal in a few weeks.

Removal with an ointment: Your doctor will cover the skin around your nail to protect it and then put an ointment on the infected part of your nail. Your nail will then be covered with a plastic dressing, which you’ll need to keep dry. After a week to 10 days, your nail should be softened enough for your doctor to remove it. The skin that was under your nail should heal in a couple weeks.
After your nail is removed, your doctor will probably recommend putting an antifungal cream on the nail bed or taking antifungal pills. This is because the fungus lives on the skin under your nail, rather than on the nail itself.

If you have a fingernail removed, it should grow back in about six months. If you have a toenail removed, it may take 12 to 18 months to grow back.

If you keep getting infections, your doctor might recommend completely removing the nail and then putting a chemical on the thin layer of skin at the base of your nail (your cuticle) to stop your nail from growing back.
How can it help?

We don’t know. There hasn’t been much good-quality research on whether removing all or part of the nail can get rid of fungal nail infections.

We found one study that compared antifungal pills (terbinafine, itraconazole and fluconazole) with other types of treatments, including removing part of the nail and putting antifungal medicine directly on the nail.1 It found that people who used antifungal pills were more satisfied with their treatment than people who had part of their nail removed or put medicine on their nail.

What are the Side Effects

Once your nail is removed, there’s a chance the skin underneath could become infected while it heals. To prevent this, doctors recommend keeping the skin clean and dry, and putting on an antibiotic cream.

If all or part of your toenail is removed, it’s possible that the corner or side of the nail could regrow into the skin on that toe. This is called an ingrown toenail. A mild ingrown toenail can be treated with remedies at home, such as soaking your foot in warm salt water and then putting cotton underneath the ingrown part to help it grow above the skin. A more severe ingrown toenail, however, will need to be treated by your doctor.

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It is imperative to treat nail fungus quickly once an infection starts.

Most nail infections are caused by dermatophytes, called that because they only infect the skin (or dermis) and skin structures like nails. Trichophyton rubrum and Trichophyton mentagrophytes cause most of the infection, with T. rubrum responsible for as many as 90% of onychomycosis cases. Candida (yeast) as well as certain molds can also infect nails.

Diagram of Toenail Fungus

How to Treat Nail Fungus

There are a number of ways to deal with onychomycosis. They almost always include cutting away as much of the affected nails first. These include:

• Topical medicines – creams, ointments or lacquers applied to the toenails.
• Oral medicines – systemic therapy where the medication gets into the bloodstream and then to the nails. Like Lamisil
• Removing most or all of the toenail, then using local therapy as the new nail grows out.
  Removing the toenail permanently by killing the toenail root.
• Using some other technique along with topical medicines to try and force the medication into the nail. This has included drilling holes and using heat.
• Alternative and complementary medications, like tea tree oil.
• Laser therapy, which is used to try and kill all the fungus, often along with removing as much of the thickened toenail as possible beforehand.

With the right treatment, you should be able to get rid of a nail infection caused by fungus, even if you’ve had it for years or it’s very bad. But you may have to be patient. It could take months to clear up.

Key points about treating fungal nail infections

• To get rid of a fungal nail infection, you will probably have to take a treatment, sometimes for up to six months.
• Fingernail infections tend to clear up quicker than toenail infections. You may need to take medication for only six weeks for a fingernail infection.
• Some Prespcription Medication can sometimes damage your liver (though this is rare) and you may have a test to check if your liver is healthy before starting a nail fungus treatment.
• Normally doctors recommend pills for this condition, but there are also treatments you can put on an infected nail. If the problem is mild, you might be given a nail varnish or use tea tree oil that kills the fungal infection.
• If your infection is severe or keeps coming back, your doctor might recommend removing part or all of your nail. But this treatment is rarely used.
• If your nail infection doesn’t bother you, you may wish to leave it alone.

There are lots of things you can do to avoid getting a nail infection again. To find out more, see How to keep from getting a fungal nail infection.

Treatments for fungal nail infections

Which treatments work best? We’ve carefully weighed the research and divided treatments for fungal nail infections into three categories.

For help in deciding which treatment is best for you, see How to use medical research to support your treatment decisions.

Benefits very likely outweigh harms

Itraconazole pills (brand name Sporanox): These are antifungal pills. They treat nail infections caused by a fungus.

Terbinafine pills (brand name Lamisil): These are antifungal pills. They treat nail infections caused by a fungus.

Benefits likely outweigh harms

Fluconazole pills (brand name Diflucan): These are antifungal pills. They treat infections caused by a fungus. But fluconazole isn’t usually given to people with nail infections.

Ciclopirox lacquer: You might want to use this antifungal nail polish if you don’t want to take pills and your infection is mild. The brand name of ciclopirox used for fungal nail infection is Penlac Nail Lacquer.

Needs further study

Griseofulvin pills (brand name Grifulvin V): Griseofulvin is an antibiotic. It doesn’t seem to work as well as some other pills against fungal infections. More…

Ketoconazole pills (brand name Nizoral): Ketoconazole is an antifungal drug that isn’t used very often because it can cause liver damage. More…

Terbinafine cream or spray: You can use an antifungal drug called terbinafine as a cream or a spray. The brand name is Lamisil. More…

Removing part or all of your nail: If your infection is severe or keeps coming back, your doctor may suggest removing some or all of your nail. But this isn’t done very often. More…

For most people, nail fungus is not a health risk, but more of a cosmetic problem. Many are very unhappy about the appearance of toenails that are infected by fungus. The longer the infection lasts, the more discolored, thickened, ingrown, and deformed the nail.

Affected toenails can cause slight discomfort to more severe pain, depending on how thickened, ingrown and malformed your toenail or toenails become. The amount of discomfort also depends on which toenails are affected and what kind of shoes you wear.

If you are diabetic, fungal nail infections can become a more serious problem. Diabetics often do not have normal sensation in their toes and feet. That means they may not feel the discomfort of an ingrown nail with onychomycosis. If you are diabetic, an ingrown nail can lead to a bacterial infection in the surrounding tissues. So can any cuts you might accidentally make when trying to trim your toenails. If you do not feel the pain of an infection, it can become serious before you realize it.

If you have poor circulation in your legs and feet (called peripheral artery disease or PAD) or an abnormal immune system, onychomycosis may also cause similar problems for you. Therefore it is imperative to treat nail fungus quickly once an infection starts.

Most nail infections are caused by dermatophytes, called that because they only infect the skin (or dermis) and skin structures like nails. Trichophyton rubrum and Trichophyton mentagrophytes cause most of the infection, with T. rubrum responsible for as many as 90% of onychomycosis cases. Candida (yeast) as well as certain molds can also infect nails.

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Penlac is a topical anti-fungal in the form of a nail polish. The main ingredient in Penalac is a broad spectrum anti-fungal called Ciclopirox, this anti-fungal works by penetrating the nail and delivering the medication to the nail bed were the fungus lives and grows. The idea behind the Penlac is killing the fungus at the base of the infection will eliminate all infection, without having to resort to systemic medication that has the potential to cause irreversible damage to your organs. It is recommended that the individual applies the medication to the affected nail/s and surrounding tissue daily for up to 12 weeks.

However, if you prefer to stay natural there are several natural topical treatments available on the market. You can purchase any of these natural remedies over the counter at a drug store, or online. There are several products that stand out against many of the rest; one example of this is Zetaclear. Zetaclear can be purchased online with a money back guarantee and offers many success stories for you to read, it offers a natural fungicide and many other natural products to promote healing and healthy skin and nails.

Basically, many of these natural topical products offer the same exact medication, and the only real difference is the price. Every single product should have a list of ingredients available on the website for you to read. Read these ingredients and do some investigating. There are a few ingredients that any toenail fungus medication should have and they are, an active fungicide to kill the fungi, and it would also be helpful if the product promoted the healing of your nail. Remember, if you are simply looking for a natural fungicide you can buy Tea tree oil at any health food store, or pharmacy. Research has shown that a spray, lacquer (polish), or thick ointment is far more effective than a cream.

Your form of treatment is completely up to you, and your doctor. If you should choose to treat yourself with natural medication research several products online, and choose one that you are comfortable with. Keep in mind that natural medicine is powerful, but prescriptive medicine can offer better results if the infection is severe. Contact your doctor and talk it over with them, he or she should be able to tell you if your infection is within the realm of natural treatment. What ever treatment you choose always keep yourself informed of all possible interactions and side effects, after all no one knows you better than you!

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Many doctors have noted that in the beginning stages of this condition it is common for the fungus to live along side the toenail, and if left untreated slowly progress inward, or under the nail. Some symptoms at the beginning of this fungal infection include a white or yellowish spot on the nail; it is not a common occurrence to have pain at this stage of the infection. It is this lack of pain that often causes this symptom to be overlooked, therefore allowing the infection to progress.

The next stage of the infection is a bit more noticeable, although it can occur rather slowly. At first you may notice a dullness followed by a yellowing, and your toenail may actually change shape. This change in the shape of your toenail may actually be caused by the thickening and/or crumbling of the edges that occurs. This thick yellowing of the nail is often the trademark of the condition. At this stage of the infection most people experience some degree of discomfort, this may be associated to the fact that the toenail can actually separate from the nail bed.

When the condition progresses enough to result in a separation of the nail and the skin, exposing the nail bed, this can result in a serious infection. If you notice a foul odor, or pus oozing from the toe, it is imperative that you seek medical intervention to prevent a serious infection.

A common misconception is that the micro-organism that causes this infection is rare and only found in dirty places. This micro organism is not bias, if there is a warm damp environment to be found, than you can bet that there are spores there waiting to be picked up on some ones hands or feet. This interaction between you and the fungus usually takes place on a daily basis, the problem occurs when you give the fungus a desirable environment to live in.

The fungus that usually causes these infections is known in the medical community as dermatophytes. There are other causes of fungal nail infections such as yeast and mold however, dermatophytes are the most common cause. Certain factors may make an individual more susceptible to toenail fungus. These factors include:

• A malfunctioning immune system
• Peripheral artery disease
• Trauma to the foot that includes the toenail
• Abnormal skin PH
• Poor hygiene
• Previous fungal infections of the nails

Fungal infections of the nails are not life threatening or debilitating. However, these infections can become painful and affect self esteem, due to the appearance of the nail. Because toenail fungus can be difficult to treat, prevention is of the utmost importance. If you have concerns that you may have a toenail fungus contact your doctor, he or she can examine your toes and run some tests to give you a definite diagnosis.

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The plant is native to Australia, and has been used for years by the people of Australia in treating and preventing infections. The plant itself does posses antimicrobial properties, and while it is thought that the plant has much potential many of the studies using tea tree oil on humans have centered around fungal infections only. The only problem with that is, the treatment of fungal infections is so long and tedious that many individuals give up mid trial, and drop out. The drop out of even one individual in these clinical trials can leave the results null and void, or at the very least marked unclear data.

Mayo clinic aside, the overwhelming response by the general public is astounding. Performing a simple search for tea tree oil will bring you to thousands of forums discussing the effectiveness of the herb on toenail fungal infections. These are not people trying to sell you a product these are people simply ecstatic that they cured their problems naturally, and inexpensively. It is very important to say that the effectiveness of the herb may vary from person to person, and will no doubt depend greatly on the severity of the infection.

It is recommended that the individual use 100% tea tree oil when available, and apply it to the surface of the nail, as well as the surrounding tissue affected. Filing or removing parts of the affected nail will help in getting the melaleuca oil to the fungal infection in the nail bed. Also, If you plan on treating your fungal infection with tea tree oil it may benefit you to purchase some melaleuca oil soap or shampoo, and wash your feet several times a day with it. After washing your feet dry them very well, and then apply the medication directly to the affected toes. Careful not to over do it, as it may cause irritation.

It is imperative that you know tea tree oil is strictly a topical treatment, and you should never ingest it as it can cause severe toxicity. Also, if you experience an allergic reaction to the medication discontinue use immediately, and wash the affected areas thoroughly. As with any herbal remedy contact your doctor before starting a therapeutic regimen, tea tree oil may be a natural medicine but none the less it is a medicine, and your doctor must be advised of its use! This is especially important if you have a skin condition such as eczema. Keep in mind that a fungus grows in a dark damp environment, preventing this desirable environment and using the tea tree oil will aid in your recovery.

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