In
the news....
Toenail Infections:
Not Pretty, Sometimes Painful
By MARY DUNWALD
Like ring around the collar or iron-poor blood, toenail fungus
is one of those problems that hardly anyone noticed until the Madison
Avenue gang brought it to public attention.
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television commercials for Lamisil, a toenail cure, now feature yellow
fungus monsters yucking it up under the nail of a big toe, and
larger-than-life pictures of rotting toenails appear in magazine
advertisements for Penlac, another treatment.
For the most part, toenail fungus is repugnant but not medically
alarming; doctors say most people who seek treatment for the problem do so
out of disgust. Yet for some, especially the elderly or those with
diabetes, it may lead to other infections. And even in healthy people, the
condition can be painful.
Yet treating the infection takes many weeks and is not always
successful. A complete cure, when it is achieved, takes a year, the amount
of time required for the infected nail to grow out completely. And the
process is expensive. Fungus medications can cost up to several hundred
dollars for a single course of treatment, and many health insurers do not
cover them.
The medical term for toenail fungus is onychomycosis
(on-ee-ko-me-KO-sis). The infection is caused by the same types of fungi
that cause athlete's foot, and the two often occur together.
"It starts in the sole of the feet when you're a child and grows from
the sole to the nail bed," said Dr. Nardo Zaias, director of dermatology
at Mount Sinai Medical Center in Miami Beach. "In teenagers, it goes into
the groin and causes jock itch and sometimes to the body, causing
ringworm.
"But the toenail is a savings bank," Dr. Zaias said. "The fungus goes
into the toenail and stays there for life."
About 20 percent of people have toenail fungus, researchers have
found, and the likelihood of getting it increases with age, rising to
about 40 percent by age 70. The fungi themselves are everywhere - not only
in locker rooms, hotel rooms and other public places but also in most
people's homes.
Toe fungus tends to run in families, because people inherit a
vulnerability to it, Dr. Zaias has found. Onychomycosis can occur under
the fingernails, but it is far more common in toes, doctors say, because
the feet are more often subject to the dark, warm, moist conditions that
fungi favor.
Smoking raises the risk of toenail infection, by restricting
circulation to the feet. So does diabetes, which also impairs circulation.
Using polish on the nails does not invite or intensify the infection,
experts say.
The symptoms of toenail fungus are easy to see - thickened or
brittle nails, often a dull color with spots of white or yellow or, in
advanced cases, brown or black. But psoriasis can cause similar symptoms.
To be certain, some doctors scrape debris from beneath the nail and
examine it under a microscope or culture it to see if fungus grows.
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Over-the-counter antifungal creams are safe and help some people with mild
infections, said Dr. Lloyd S. Smith, a podiatrist in Newton, Mass. Some
treatments contain tea tree oil, an antifungal substance derived from an
Australian plant. But in some cases, nonprescription treatments are not
powerful enough, he claims.
One prescription medication, ciclopirox, a topical treatment marketed
by Aventis as Penlac, is painted on like nail polish. Patients are
instructed to apply it to infected nails each evening before bed. Once a
week, they are to take off the accumulated layers with rubbing alcohol.
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treatment with Penlac takes 48 weeks, and a month's supply costs more than
$100. In addition, studies suggest that ciclopirox is effective in
combating the infection in less than half of all cases, and results in a
total cure in fewer than 10 percent.
Terbinafine, marketed by Novartis as Lamisil, may be the best-known
prescription treatment for toenail fungus, thanks to the company's
monster-filled commercials. Patients take one 250-milligram tablet a day
for 12 weeks. After that, the medicine continues to work for a few months.
Terbinafine helps about 2 out of 3 people who take it, doctors say, but
it cures the infection in only 38 percent of cases, according to the
package insert. Lamisil costs more than $8 per pill, and a complete course
of treatment can cost about $700.
In some cases, although considered rare, the drug has been linked to
liver failure and death, and so the Food and Drug Administration has
advised doctors to monitor liver function in patients taking it.
People with liver problems should not take Lamisil. Studies have not
been done to determine whether the drug is safe for children and pregnant
women. Nursing mothers are also advised to avoid it.
Dr. Zaias has experimented with having patients use terbinafine for
only one week out of every three months. This approach allows patients to
use less of the drug, and it works in more than 90 percent of cases,
according to a small study Dr. Zaias conducted and reported recently in
the journal Archives of Dermatology.
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Another treatment in pill form is itraconazole, marketed by Janssen as
Sporanox. It is typically taken twice a day for one week out of four. This
cycle is repeated three or four times. A one-week supply costs about $100.
Itraconazole is somewhat less effective than terbinafine. It, too, has
been linked in rare cases with liver failure, as well as with congestive
heart failure.
In the most difficult and painful cases, doctors remove the toenail to
help kill the infection. But given the cost, the risks and the time
involved in treatment, experts say it is better to try to avoid infection
in the first place - by treating athlete's foot infections as soon as they
arise, for example, and by keeping the toes ventilated and clean.
"I recommend sandals," said Dr. Lynn A. Drake, a dermatologist at
Massachusetts Hospital in Boston. "But one of the most effective
treatments in the world is to keep your nails well groomed and short."
All trademarked names are owned by their respective
owners.
More about toenail
fungus cures.
Toenail fungus warrants author 'memoir'
United Press International - USA
SAVANNAH, Ga., Nov. 22 (UPI) -- A Georgia man says it's time more
attention were paid to toenail fungus, so he has written a
book about it -- his 90th. ...
Click to read about a toenail fungus book |
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