Sunrise Family Foot Care Center

       About Nail Fungus
       Laser Treatment
       Avoiding Re-infection

Introducing: New Laser Treatment for Toe Nail Fungus

About Toenail Fungus

Fungus infections of the toe nail (onychomycosis) are one of the most common dermatologic disorders of the foot. One in every four adults has suffered or will suffer from nail fungus at least once in there lifetime. Many are athletes or are ill while others have just inherited a tendency to have nail fungus. Over half of the population age 60 or older has been affected. The condition is often ignored because the infection can be present for years tucked away in shoes and socks without causing any pain.

Onychomycosis may be caused by a variety of fungi, yeasts, or molds. They take hold under and around the nail usually at the tip, most commonly, after an injury or illness, then thrive underneath the nail on Keratin (the nail's protein), body warmth, moisture (often normal perspiration) and closeness (inside a shoe). If left untreated the infection will spread steadily from the tip towards the cuticle and can infect the whole nail and even move to other nails.

You are more likely to get toenail fungus infections if:

  • You already have untreated athlete's foot
  • Your shoes fit too tight
  • Your shoes become damp (often from perspiration)
  • The toenail has been injured
  • Walk barefoot around public swimming pools, in locker rooms or showers
  • You have excessive perspiration on your feet
  • You have HIV, Diabetes, circulatory problems or other chronic conditions affecting your immune system

Signs & Symptoms

The first sign of nail fungus is a slight change in the nail color often at the tip or corner of the nail but patches may begin anywhere under the nail even close to the cuticle. The color may be white, yellow or brown or darker and appear in patches or even streaks in the nail. The nail may become brittle and crumble or seem to chip easily. As the infection progresses nails can change shape and become thick causing a buildup of keratin and fungal debris under the nail. In some cases an odor may be present. The nail will begin to lose its luster and shine. The nail may crack or become raised from the nail bed making it difficult to wear shoes and socks comfortably. The affected nail(s) may start to grow inward causing painful ingrown nails. This may raise your risk for secondary skin or toe infections.

Why is it important to treat?

Ignoring the infection may allow it to spread to other toenails, skin on the feet and even fingernails. The nail may become permanently deformed, cause abscesses under the nail and put you at risk for other serious fungal and bacterial infections. In diabetics or other immune compromised patients it may delay healing or cause or worsen foot ulcers.

You may also infect other family members.

Treatment Options

If fungal infections are left untreated they will not go away and will get worse over time. Treatments vary depending on the nature and severity of the infection. Historically treatments of fungus toenails included topical medications, oral drugs or surgical removal of the nail plate.

White superficial fungal infections appearing on the surface of the toenail may be filed off followed by the application of topical anti fungal liquids. In fungal infections under the toe nail (subungual) topical medications pills or surgical removal were necessary.

The topical medications (anti-fungal creams, lotions, liquids, gels and lacquers) applied to the infected nails and surrounding skin have been found to be largely ineffective to cure a fungus infection. Most topical anti-fungal agents are unable to penetrate the nail plate where the fungus resides. They may provide short term relief but recurrence is not unusual after discontinuing use. Efficacy or success of cure is 10-25%. Over the counter creams, ointments, or gels generally do not help at all.

Oral anti-fungal drugs are more effective but expensive and have been known to produce side effects, in some cases effecting the liver requiring blood tests to monitor and prevent damage. Dry mouth and prolonged loss of taste are also common. Often these pills will interact with other medications causing serious drug interactions. Success rate of the oral anti-fungal agents is about 40-65%.

Removal of the nail plate is painful and debilitating and is usually reserved for severe or recurring fungal nail infections. Topical anti fungal agents may work somewhat better on the nail bed after a nail removal. Removal of the nail may be by either surgical or nonsurgical.

Nonsurgical or chemical removal is accomplished by applying a urea ointment over the nail softening and dissolving it for easy removal.

In surgical nail removal the infected nail and tissue is either totally removed (avulsed) or partially removed (debrided). Surgical removal is often ineffective and the traumatic procedure will leave a patient without a nail for months and at risk for re-infection. In some cases repeated removal may traumatically damage the nail root causing a deformed nail to repeatedly grow.

Conventional therapy for treatment of fungus toenails is prolonged and often frustrating. Even after successful treatment a fungal nail infection can return, either as a new infection or re-growth of the original fungus.

Laser treatment of toenail fungus is quickly becoming the procedure of choice. Physicians use a near infrared laser beam which passes directly through the nail and causes vaporization of the of the pathogens (fungus, yeasts or molds) causing the infection. Depending on the laser used the procedure takes anywhere from 15- 30 minutes for all ten toes. 2 - 4 treatments are necessary to kill the fungus and 9-12 months for a healthy nail to grow out.

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