FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

NEW ORAL MEDICATIONS MIGHT HEAL READER'S "UGLY TOENAILS"

Question: I have a problem with ugly toenails. My doctor diagnosed this several years ago as a fungus infection in the nails. He said that there wasn't much that would help other than surgically removing the nails -- something I didn't want to have done. Now I've seen ads for medicine for nail fungus. Does this stuff really work?

Answer: Fungus infection can occur in the toenails, fingernails or both. This condition is quite common. It has been estimated that 48 percent of the population experiences this disorder by age 70. Though this may seem like a trivial condition to someone who has never had this type of infection, it isn't. Twenty-five percent of sufferers report that fungal nail infections interfere with their professional and/or social life because of embarrassment or physical discomfort.

Fungal infection of the nails, particularly the toenails, rarely occurs alone. Many individuals know that they have athlete's foot when they have red, itching, peeling skin on their toes without realizing that the fungus causing this annoying condition is also responsible for their thickened, discolored brittle nails.

There are several types of fungus that can produce fungal nail infections, a condition we doctors call onychomycosis. The treatment for the condition depends upon the specific cause. First it is important to determine whether the "ugly" nails are a consequence of onychomycosis or some other condition that can cause an unusual looking nail. Some of these other causes include -- permanent scarring injury to the nail growth area and bacterial infection. Your doctor will have to rule these out before he or she can make a firm diagnosis of fungal infection.

The doctor can often determine that the nail disorder is due to fungal infection by the appearance of the nails and by any association with athlete's foot. More often, however, he or she will need to scrape away a portion of the damaged nail to study the scrapings under the microscope and also to have a culture for fungus performed in the laboratory. These tests will then help guide the selection of treatment for your condition. When only a single nail is involved, use of a topical anti-fungal preparation (prescription or non-prescription ones work) can be used. It may take six to eighteen months of once or twice daily treatment, and it is often ineffective.

Removal of an infected nail is still an effective treatment for onychomycosis. When surgical removal of the damaged portion of the nail -- and typically that is the entire nail -- is combined with a topical anti-fungal preparation it can be effective at preventing reoccurrence of the condition as the new nail grows in. Surgical removal, however, is reserved for very unusual circumstances today.

Your doctor is much more likely to advise the use of one of the newer oral medications that you've asked about. These medications -- which are effective in treating onychomycosis -- include Itraconazole, Terbinafine and Fluconazole. They've all been advertised to the general public at one time or another, so I can't be sure which one caught your attention. Because of the nature of this type of infection, treatment must be continued for as long as six months, but typically three months does the job satisfactorily. Treatment clears up the infection 60 to 90 percent of the time.

Be aware that these effective medicines are relatively expensive and also have a small risk of causing liver, blood and skin disorders. Also, after a successful cure, it's not uncommon for the person be re-infected within a few months. You should talk to your family doctor or a dermatologist about your "ugly" nail infection to determine the best treatment for you.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.