Sunday, July 14, 2024

Ask Dr.Louise 6/29/22


Q:        My toenails are getting really thick and yellow. Are there any non-prescription products that can help?

Fungus infection of the toenails, called onychomycosis, often starts small, with little white spots on one toenail. As it takes hold, it changes how your nail grows out.

It’s common to have fungus attack your feet, causing Athlete's Foot or tinea pedis. Sometimes the fungus stops there, but if the infection spreads, it can burrow below your skin to where your body forms new toenails, called the nail plate.

When fungus infects your nail plate, your nails can grow out yellowed, thickened, and deformed. Sometimes the toenail will even get crumbly. As toenails grow thicker, it can get harder to keep them trimmed, and nails that grow sideways or slant upward wear holes in your socks and make it hard to find shoes that fit.

You can easily find non-prescription antifungal products for athletes' foot. Unfortunately, they don't usually help toenail fungus because they only treat the skin. With a toenail infection, you need the treatment to penetrate below the skin to attack the fungus growing inside the nail plate.

Onychomycosis is very difficult to cure and often reappears. The prescription medication considered the most effective only eradicates the infection in 50% of cases. And of those cured, 1 out of every 5 will have it return within 2 years.

It also takes a lot of patience to treat onychomycosis. Infected toenails take 12 months to grow out, so any successful treatment of onychomycosis takes a long, long time: a minimum of 3 months for oral treatment and 10-12 months for topical treatment.

What can you do?

Prescription pills for onychomycosis are effective, but serious side effects can limit their use. Topical antifungal products are safe but less effective because they must penetrate into infected nail bed tissue to work.  

Topical treatments can succeed in mild cases that affect only part of a nail or just a couple of toenails. With significantly thickened and deformed nails, prescription antifungal pills may help.

Sometimes the best way to treat a severely deformed toenail is for your doctor to remove it altogether. Afterward, you take a prescription antifungal pill for 12 weeks to treat the underlying infection.

Hopefully, your nail will grow back normal.

Topical treatments may help less severe cases of onychomycosis, but they must be used daily for at least 10 months. Filing off the top layer of the nail may allow topical treatments to penetrate more deeply into the nail plate.

A new topical product for onychomycosis called Karesal® is showing promise. It contains urea, lactic acid, propylene glycol, plus glycerol as a thickening agent.   

In a recent trial, over 75% of patients using Karesal® daily noticed benefits within the first week. Over 90% of the trial participants reported at least some visible improvement over the first 4 weeks, which is significantly better than currently available products. 

Home remedies like tea tree oil or soaking your feet in full or half-strength vinegar for 15-20 minutes daily may help mild cases of toenail fungus. Toenails grow slowly, and it takes months to see any improvement.

Even when toenail fungus has been killed off, don't be shocked if it comes back. That's because the conditions that helped the fungus get a toehold on you are often still there: warmth, moisture, and darkness.

5 Tips For Treating Nail Fungus Successfully:

1.         Don’t ignore Athlete's Foot.

If the fungus causing “athlete’s foot” has not been removed from your feet, it can spread to your toenails.

2.  Keep your feet dry.

Wear loose shoes or sandals and change your socks frequently. Fungus thrives in warm, dark, and moist places. Your chances of a successful outcome are better if you make it as difficult as possible for the fungus to survive.

3.         Scrape off extra toenails first.

Filing off any excess toenail can help topical treatments get down into the nailbed, improving your odds of success.

4.         Be persistent.

Apply your topical treatment of choice daily for a minimum of 10 months. If your symptoms don’t improve during that time or worsen, consult your doctor. Sometimes removing the nail is the best option.

5. Don't quit too soon.

Once your skin symptoms have disappeared, keep using the medication twice daily for at least another two weeks. This helps the fungus get entirely out of your skin. If you leave any tinea fungus alive inside the skin layers of your feet, it can multiply and spread, putting you right back where you started.

Dr. Louise Achey, Doctor of Pharmacy, is a 43-year veteran of pharmacology and the author of Why Dogs Can’t Eat Chocolate: How Medicines Work and How YOU Can Take Them Safely. Get clear answers to your medication questions at her website and blog, Ó2022 Louise Achey

E26, Ask Dr. Louise


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