The newest treatment for fungal nail infection is a paint-on lacquer. It’s less expensive and has fewer side effects, but is also less effective.

If you have what appears to be a fungal nail infection, see your doctor. The right treatment should result in toenails you won’t be hiding in the sand.

Julie had always loved summer, but this year she had mixed feelings. With thickened, dark-colored nails that had appeared on her big toe and second toe, she was self-conscious about going barefoot to the beach or wearing sandals or open-toed shoes.

A visit to her doctor confirmed a fungal nail infection. And Julie learned that she is not alone in her reluctance to bare her feet in public.

An estimated 11 million Americans suffer from fungal nail infections. Her doctor had both good and bad news about her condition. The good news was that effective treatments are now available The bad news–treatment takes time and patience. It may be next summer before Julie can feel good about wearing sandals again.

Fungal nail infections (a condition known as onychomychosis) are caused by dermatophytes, fungi that can invade skin, nails or hair. They thrive in damp, dark, moist conditions. Sweaty feet trapped in shoes, the floors of bathrooms and locker rooms or any place where people go barefoot are potential breeding grounds.

Tinea pedis (athlete’s foot) is a fungal infection of the foot caused by the same type of fungus. Left untreated, athlete’s foot can invade the nails where it is far more difficult to treat.

A fungal nail infection usually begins with a white or yellow spot on the nail. As it progresses, it spreads over the entire nail which often becomes thick, may turn brown, yellow or black and becomes cracked and ragged at the edges. The nail may lift up from the nail bed and the skin around the nail can become swollen and inflamed. When the nail separates from the bed, it sets up a breeding ground for a secondary infection.

Effective Treatment Available
Until recently, doctors didn’t have very effective treatments for fungal nail infections. In the mid 90s, however, the Food and Drug Administration approved the use of two new oral drugs, itraconazole (Sporanox) and terbinafine (Lamisil). The drugs are effective because they are absorbed into the blood at high enough levels that penetrate the nail root and the nail where they remain for a number of months. They kill the infection and stay around long enough to prevent it recurring.

Although most patients tolerate these drugs well, liver damage is a potential side effect, and they should be taken under the close supervision of a physician. Pregnant or nursing women should avoid the drugs.

Itraconazole can be taken daily for three months. Sometimes it’s prescribed at a higher dose to be used in cycles of one week on, three weeks off for several months. Studies show that the continuous dosing gives better results, however.

There are a number of drug interactions that can occur with itraconazole, some potentially serious. It can cause serious reactions for people using the antihistamine terfenadine (Seldane). It also should not be used by those taking cyclosporine, digoxin, astemizole (Hismanal) and triazolam (Halcion).

Treatment with terbinafine uses daily oral medication for three months. Terbinafine can be used safely by patients taking Seldane.

These drugs are sometimes used in combination with a cream that is applied to the nail. The cream helps control the infection and speeds the healing process.

The newest prescription drug for treating fungal nail infection is a paint-on lacquer. Penlac Nail Lacquer (cicloporix) is a clear polish that inhibits the growth of the nail fungus. The lacquer has to be applied to nails and skin daily for up to 12 months and frequent removal of debris and careful trimming of nails is important.

Penlac is less expensive than the oral antifungals which are quite expensive. It has fewer side effects than the oral drugs but is also less effective. Studies show that Penlac worked for about one third of patients. Success rates with the oral drugs are between 54 and 70 percent.

When the toenail has a very severe infection or is causing a lot of pain, the nail may be removed. A new nail normally grows back with time.

Removing the nail is not as frightening a task as it sounds. An ointment is rubbed on the surface of the nail for a number of days to loosen it. Then it can be easily lifted from the nail bed.

Good foot hygiene can help you prevent fungal infections. If you think you have athlete’s foot, you can try an over-the-counter cream, powder or spray. If it doesn’t take care of the problem in a reasonable time, see your doctor for a prescription-strength cure.

Regular use of an antifungal cream until the new nail grows in helps ensure the nail will be healthy.

Don’t Let Fungus Get a Toehold
The difficulty of treating a nail infection is reason enough to take steps to protect feet from fungal problems. Some risk factors such as advancing age, diabetes or a compromised immune system can’t be avoided, but they can increase your level of vigilance.

There are a number of basic guidelines everyone can follow to minimize the chance of fungal foot infections.

• Avoid walking barefoot in locker rooms, bathrooms and other common areas. Use protective footwear such as flip flops.
• Keep bathroom surfaces at home clean and avoid sharing towels.
• Dry feet and between toes thoroughly after showering.
• Keep feet clean and dry. If your feet get sweaty running, walking or playing sports, change into clean shoes and socks after activities.
• Avoid nylon socks and hose. They don’t breathe and encourage fungal growth.
• Wear shoes made of materials that breathe, such as leather.
• If you have athlete’s foot, treat it promptly so the fungus doesn’t have a chance to spread to nails.
• Foot powders can help lower the risk of developing an infection. They contain antifungal agents and help reduce friction and moisture.
• When you cut your nails, cut them straight across. Don’t pick at the nails or surrounding skin.
• Nail polish and artificial nails trap moisture under the nail and set up an environment for fungal growth.