The term onychomycosis is used to identify fungal infection that attacks the nail, and the treatment process is really demanding. This fungal infection mainly hit on the toenails attacking mainly the big toe nails. Also, the infection goes further to attack the skin close to the nails. This skin area around the feet is called athlete’s foot or tinea pedis. Although not common, it is possible for the infection to spread across to other nails.
When it comes to fungal infection, the attack on the toenails are much more frequent that fingernails. It has been proven that the further people up in age, the more likely they are prone to the attack of fungal infection. Also, studies have shown that about 2-14% of adults do suffer from onychomycosis. There are certain circumstances under which the attack of fungal infection can occur in the life on any individual.
These circumstances also include:
1. When there is poor circulation around feet and leg area.
2. When an individual is suffering from Diabetes Mellitus (reports say that up to 26% of patients suffering from diabetes mellitus have onychomycosis)
3. Presence of trauma on nails
4. When an individual finds it hard cutting his/her toenails rightly.
5. When there is the depression of the immune system. This depression occurs mainly after chemotherapy, during use of some immunosuppressant medications and HIV infection.
It is relieving to note that onychomycosis is not considered lethal. Once the nails are under the attack they get really hard to cut. Also, the sufferer would be experiencing an amount of discomfort, too. Affected nails sometimes get caught by the clothing of the sufferer. And it also has a way of making the nails look awkward and hard to accept cosmetics. That is why those with the infection fight hard to get rid of it so their nails grow beautifully well again.
However, there are certain guaranteed and successful ways to deal with onychomycosis; and there are some other unsuccessful ways you need to steer clear from. It is worth knowing that medical doctors, homeopaths and a lot of people suffering from onychomycosis have tried as much as possible to find a cure for the fungus. Nevertheless, no one has come up with a flawless cure for the fungus. So there are presently good treatments you can try that are really promising.
Dermatophyte is the term used to describe those fungi responsible for nail infections. They are so called because they develop in the skin. One other known cause of onychomycosis is Candida- which is also known as yeast.
How an infected nail looks depends on the place where the infection kick-started. For most attacks, fungus starts from the end or sides of the nail. This will result into the nail coloring yellow and thickened at the same time. There will also be presence of debris underneath the nail which people do identify to be fungal infection. It can also lead to a phony white appearance of the nail so much so that the nail takes the look of white powder. This happens when the fungal infection originates from straight above the nail. However, with people suffering from depressed immune system, the fungal infection can begin and get into the nail. With this kind of attack the nail grows out with a lot of fungus existing in it. How hard the treatment becomes generally depends on the extent the fungus has travelled.
Diagnosing Onychomycosis
You need to be diagnosed very well before implementing treatment. It is noteworthy that some other infections can take the looks of onychomycosis, even to the extent of damage and color changes in nails. This is so with people suffering from psoriasis. So it is important you see a doctor would proceed to take a sample of the debris lodged underneath your nails. The debris would be taken for examination under the microscope, after which it is sent to be cultured. Sometimes it would take more than one examination and culturing before the diagnosis is perfected. You need to go through this process before taking oral medication.
There is no much risk involved if you want to make use of nonprescription medication, providing the medication is not labeled to be dangerous. However, it is not wise to rule out the place of a doctor before you start as you may end up treating something else. The doctor’s diagnosis helps to keep things in their right perspective so the treatment becomes sure.
It has been shown that all the treatments for onychomycosis, whether by prescription or nonprescription medication, by a doctor or by do-it-yourself method, using surgical methods or medicines, prove to be less effective than treatment for other fungal infections in areas like the skin. This is because the fungal infection tends to thrive very well around nails.
Before starting on any form of treatment on your feet for onychomycosis, you need to first ascertain the condition of the feet. An antifungal cream proves to be the best treatment approach for Tinea Pedis or “athlete’s foot”. You can get the cream as a prescription or over-the-counter. Naftin (naftifine), Loprox (ciclopirox olamine), Lamisil (terbinafine), Nizoral (ketoconazole), Mycelex (clotrimazole), and others, with the inclusion of generic formulations are all effective treatments for onychomycosis on the feet. You should apply a moisturizer on any dry skin portion and calluses should also be smoothed. It is important that toenails be trimmed, too.
Try to keep your feet thoroughly dry always, especially after taking your bath. Change all absorbent cotton socks once they get wet after being worn.
You can do well to wear flip flops or sandals into a shower you suspect could be the cause of the infection. For example, dorm showers could be a source since they are public and may not be kept clean as private ones. After shower hour in the dorm you should wash your feet with soap and dry them up. Always wash your bath mats and towels in warm water and keep them dry too.
Try to see to it that any member of the family suffering from tinea pedis is properly treated. Also, if there are problems like diabetes, they should be controlled as much as possible.
Different problems lead to fungal infections of the fingernail. Fungal infection can also affect the skin of the hands; and that should be treated too. Those suffering from fungus attack on their nails do have wet hands much of the time. This can actually be resulted by things like dish washing at home, etc. So it is important to use rubber gloves during cleaning exercises.
It is possible that there is more than just a fungal infection if the damage on ones fingernails could be traced to the fixation of artificial fingernails or other similar materials. This is why it is more challenging trying to diagnose onychomycosis for fingernails than for toenails. However, the best bet is to pay the doctor a visit.
Getting treatment from a Physician
Treatment starts by ensuring your hands or feet are well cared for as we have already mentioned. However, help regarding this can be gotten from a foot specialist (podiatrist) or skin specialist (dermatologist).
When it comes to fungal infection of the toenails, the first step is to make sure the nails are trimmed and thick toenail materials removed. However, it is noted that the nails could become so hard that it looks impossible trimming them. You can see a doctor for that as they have a special instrument for dealing with such nails. Podiatrists do have burrs that they use in filing down such nails.
It is possible with some persons that all they need to get well again is the trimming and cutting to shape of their toenails. They just need regular visitation so as to keep their nails within limits. Doing so is most important for those down with poor circulation, diabetes, and elderly ones who have bad sight. If not taken good care of, the feet and nails can pose a great danger as they are prone to severe bacterial infections.
There is yet to be a study that would show to us the natural account of onychomycosis. Since onychomycosis doesn’t seem to be a lethal problem, all most people need is just the trimming of their nails and some motivation.
The aim of all treatments for onychomycosis is to kill the fungus and make room for new set of nails to emerge. However, it could take up to 6 months for the complete emergence of new nails, 12 months for toenails to grow again completely, and 18 months for the great toenail to grow out into completion. This is why it is not easy to know if you have been cured until the duration is reached.
Topical Medication
It does seem fashionable trying to get rid of toenail fungal infections by using same antifungal medications that are applied to the skin. Although there are other medications used by people in other countries, the only one approved for use in the United States is ciclopirox olamine 8% (Penlac). And it is a lacquer.
For effective use of Penlac, you need to smear it over the whole nail area and the skin around the nail each day. Also endeavor to take it off once every week alongside the debris and separated nails.
You can also employ Loprox, Lamisil and Naftin creams for the treatment of onychomycosis. However, only few studies have been carried out with regard to these creams effectiveness on the treatment of onychomycosis. There is the presence of topical medications in other countries that would someday be available for use in the United States.
Urea cream can also be of assistance when there is need to make a topical medication get some penetration into the nail. Urea is also known to dissolve toenails, too.
In essence, there is a slim chance of getting a perfect cure using topical preparations. Also, they would also be used over months, and sometimes runs into years. However, if a doctor or podiatrist is employed to do the trimming down and cutting of thickened nails, after which topical treatment is administered, the overall cosmetic result could satisfy some people. Podiatrists can go as far as boring a hole into the nail to make allowance for the penetration of medication. Doing so is not that painful as the mental picture may suggest. Going through topical treatment could be the only room opened to anyone who does not buy the idea of taking oral medication for fungus.
Surgery Treatment for Fungal Infection
For every method of treatment for onychomycosis, there should be the trimming and removal of debris from the nails. Before now, people use to believe that the removal of the nail at the inception of therapy, particularly the big toenail, increases the chance of being free from the infection. However, they no longer follow that rule. They only do so when every other thing fails to work, while the nail is bringing about a huge problem due to its size and shape.
Oral Medication for Fungal Treatment
Treatment using Sporanox
Sometime ago, people relished the thought that they have landed the perfect cure for onychomycosis through the method of oral medication. This process involves getting an antifungal medicine into the blood, which would them stream it to the base of the nail, then underneath the nail; thereby making certain that the death of the fungus is imminent. However, oral medications do not live up to such high expectations. Secondly, the side effects they are known for tend to make the healing process worse than the disease itself. This will depend on other medical challenges underneath, the seriousness of the infection and the medication.
Terbinafine (Lamisil) has been proven to be the most commonly sought out oral medication treatment for onychomycosis. It is known to kill most of the fungal organisms that attack nails both during studies in the lab and with real patients. The usual does is 250 milligrams each day for the space of six weeks if used in treating fingernails, and 12-16 whole weeks when treating toenails.
However, the common side effects with usage of terbinafine are stomach upset, headache and rash. Severe side effects like white blood cell reduction and severe rash are known to be experienced by less than 1% of users. However, the most challenging side effect is the damage done to the liver; although known to be mild and somewhat reversible. It is known that for one out of 50,000 exposures, liver abnormalities can just be enough to cause symptoms, while the event of liver failure is far less common than that. But it is advisable not to take terbinafine if you have liver disease. You must undergo liver function test before you begin therapy. A lot of doctors run the test again after 4 to 6 weeks into the treatment. About 3.4% of patients using terbinafine do stop usage in the long run due to side effects.
You can also use Itraconazole (Sporonox) for the treatment of fungal infection. You should take 200 milligrams for each day for 12 weeks if you are treating infections for your toenail. There is also the “pulse therapy”, where you take 200 milligrams twice each day for one week out of one month, for just two months if you want to treat fingernails and three months if treating toenails. However, about 5-10% of patients using Itraconazole develop nausea, liver damage and/or vomiting. The drug can also lead to congestive failure of the heart. So it is wise to steer clear the drug if suffering from heart failure. There are lesser side effects with the “Pulse Therapy” than with daily intake of Itraconazole. But, even with the pulse therapy, the liver could be so damaged to warrant a liver transplant.
Another known treatment used for onychomycosis is Fluconazole. It is taken just once each week. If treating for fingernails, the intake would run for 3 months, while for toenails is 6 months. However, it is not as efficient as terbinafine or Itraconazole.
It is never concluded that any of these treatments have succeeded in the curing of the fungal infection until there is the emergence of new set of nails. However, it is known that terbinafine do have a higher success rate than itraconazole. You can always check the difference by the nail appearance or nonexistence of the fungal elements. The rate of cure is normally measured as high as 80% and as low as 50%. It is noteworthy that due to the presence of underlying problems or damage of the bed of the nail, the nail may fail to look normal. To deal with occurrence of relapses, it is better to apply creams to the nails after oral therapy takes place.
Cost of treatment is on the high side. To cure onychomycosis using terbinafine, the estimated cost is from $2,500 to $8,000. Even at that the reoccurrence rate after cure is put at 30%.
Substitute Treatments and Home Remedies
Looking for an alternative yet positive treatment to fungal infections is reasonable since the cost for using prescription medications is high, and the success rate tends to be not encouraging. However, some of these alternative treatment processes have been mentioned; such as taking care of the skin and nails.
Tea tree oil has been proven to be an efficient herbal treatment for onychomycosis. In fact the success rate is also encouraging. The oil has been put to several studies and is now being used as a prescription medication for genital warts. However, the clinical trials for the use of tea tree oil in treating fungal infections are few and promising too. But large scientific studies into the issue are yet to be published.
For one of such clinical trials, tea tree oil was combined with an antifungal called butenafine hydrochloride in a randomly organized double-blind study of 60 patients who were down with toenail infections. The treatment involved usage of the cream and constant trimming of toenails for up to 8 weeks. At the 16th week, up to 80% of the patients given the ingredient were said to have been cured. However, the placebo was tea tree oil, which was said to not have cured any patients. This is a potent example how tea tree oil could be used with another local cream but not by itself alone.
Home remedies also used involve saturating the nails in water, or vinegar with baking soda, bleach and strong tea. However, the application of bleach could be dangerous. Dilute the bleach to avoid burns due to chemicals. The appearance of onychomycosis could possibly be improved if any of these home remedies are used in company of adequate care of the nail, such as trimming and cleaning off the debris. Though tea tree oil is a home remedy at the time, it is sure to become prescription medication later in the future. This is because since it is effective, it could around interest from doctors and researchers too.
Although drinking of tea tree oil is considered a formidable treatment for onychomycosis, nothing yet about this process is concrete for the treatment of fungal infection at the time.
There are also two known active substitute treatments for fungal infection that contains tea tree oil. These are Zetaclear and Funginix.
Recent treatments for onychomycosis
Hitherto, doctors are still concerned about better ways of curing onychomycosis. Photodynamic therapy has been employed for further studies into the matter. This involves the use of light in curing fungal infections. Doctors have given a success report in the use of this process after treating two patients with it. The affected toenail area of the patients were penetrated using a substance they call 5-aminolevulinic acid (ALA). The toenails were also penetrated using urea, after which the toenails involved were later recovered using plastic film and aluminum foil to shield out light. Before the treatment was started, light was employed to ensure the ALA has penetrated the nail as the area was left exposed. After all these, they used a pulsed laser light for the actual treatment of the infected nail. The treatment was said to have lasted for 6 to 7 repeated treatments which were also painful. The nails looked cured after treatment with no fungi able to grow from the nails already cured. Reevaluation after 3 to 6 months still revealed normal nails.
There are several methods by which light or heat can be sent to infected nails. One of the lasers capable of treating nail fungus is called “Noveon.” It is said to be a dual wavelength that is near-infrared diode laser. This wavelength is known to destroy fungi without harming normal tissues of the body. In a recently done study, 26 persons with infected toes were treated. They did the treatment for day 1, 14, 42 and 120. They later followed all of them for at least 180 days. Up to 85% of them were said to have improved due to the clearness of the growth of their nails. The study was carried out to make sure the treatment method will prove to be both effective and safe for humans. There are also some other laser systems which are presently undergoing scrutiny.
There are lots of lasers being investigated whether they would be perfect for curing or controlling onychomycosis. And results do show some will actually pass the test. Treatment of onychomycosis using laser may not completely cure the infection but will certainly lead to a better control of it, and could be valuable when used with other therapies. For the sake of heat and light energy delivery, plastic surgeons do possess different lasers and devices. It is believed that the near future holds something positive in the advancement of lasers for the treatment of infections. However, it will certainly be very expensive to afford.
As much as others are looking in the direction of lasers and some other oral medications that may bring results, other researchers are continuing in their pursuit for herbal and home remedies for safe and cost-effective treatment for onychomycosis.
Comments on this entry are closed.