Nail Fungus

Craig Kraffert, MD

Nail fungus is an unsightly, common condition that usually presents in mid-life or later years. Generally, nail fungus involves the toenails and presents as a yellowing, crumbling or thickening of the nails, especially at the edge nearest to where the nails are cut. This sometimes results in discomfort, but usually is painless.

Large toenails are most frequently affected, but other toenails can be involved. Many times, several toenails are severely involved while other nails are spared. It is common to see one foot affected while the other foot is completely clear.

Sometimes fingernails are affected and have a similar appearance. Not uncommonly two feet and one hand will be involved with nail fungus and the other hand will be uninvolved. The exact reason why this occurs is unknown.

Nail Fungus and Fungal Scaling

Nail fungus is often seen in association with fungal scaling on the feet and occasionally on the hands. This fungus is typically not the blistery, itchy, ‘athlete’s foot’ described in some commercials. Rather, it is a chronic infection, which is recognized by thickening of the skin on the soles of the feet, with scaling and occasional cracking.

Treatment for Nail Fungus

Treatment for nail fungus has advanced significantly in recent years. Safe and effective medications are available and are generally taken for a minimum of three months, but more typically, for up to twelve months. During that time, the medicine incorporates into the nail tissue. This prevents the fungus from continuing to grow into the nail. As the nail grows out normally, the diseased nail is displaced and removed. Sometimes periodic dosing every week or two after the fungus has cleared is suggested. This sort of prophylactic regimen will make it less likely that the fungal infection will recur.

Nail fungus is thought to result from a long-lasting infection with fungus of the feet extending slowly into the nails. Because of this, doctors often recommend that patients with nail fungus continue to use antifungal creams on the feet daily after showering, even after the pills have eradicated the nail fungus.

Reducing the Risk of Nail Fungus

The risk of fungus infection of toenails is reduced by the same methods used to reduce the risk and severity of fungus skin infection on the feet (athlete’s foot). To keep feet dry and healthy:

1) Avoid wearing shoes indoors and consider wearing open footwear when appropriate.

2) Change shoes daily. Alternate between at least three pairs of shoes throughout the week to allow time for them to dry out.

3) Change socks midday if they become damp.

4) Avoid high top boots unless needed for work or other activities.

5) Consider applying Zeasorb-AF powder to feet daily before putting on socks. Zeasorb-AF is available at your local pharmacy.

6) Treat any foot fungus promptly. Some patients require daily application of anti-fungal creams to keep fungus away.