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Why Is Nail Fungus So Hard To Cure

How Do I Treat It

Why is Toe Nail Fungus So Hard to Treat?

The mistake people make in treating toenail fungus is that they attempt to treat the toenails instead of the actual source of the infection. People will resort to topical creams, ointments, or solutions. Some cut off the part of the nail that appears to be infected, and others remove the toenail entirely. This is not a reasonable solution, since once the toenail grows back it will grow back infected since the source of infection is still present. This is why it appears that toenail fungus is difficult to cure.

Is Onychomycosis Still A Problem

The great majority of superficial fungal infections are caused by dermatophytes, which belong to one of three genera , with T. rubrum being the most prominent cause of nail infection . summarizes the prevalence of various superficial fungal infections in different geographic areas . Among superficial fungal infections, by far the most difficult to cure is toenail onychomycosis . The prevalence of onychomycosis has been reported to be as high as 23% across Europe and 20% in East Asia . In North America, the incidence of onychomycosis is up to 14% , with fungal infection responsible for 50% of all nail disease . With millions of dollars being spent annually on oral and topical prescriptions, laser treatments, over-the-counter products, and home remedies, it is obvious that people are still bothered by their fungal toenail infections and are determined to get rid of them. Unfortunately, this is easier said than done. To successfully cure toenail onychomycosis requires long treatment duration that may extend to a full year. Even then, complete cure, defined as clinical cure plus mycological cure , is often unattainable.

Distal subungual onychomycosis of the great toenail.

How Is Toenail Fungus Treated

Toenail fungus is notoriously tricky to treat. You may need to treat the condition for several months to get rid of the fungus. Still, toenail fungus often comes back.

A dermatologist or podiatrist can explain your treatment options. If you have a mild case that doesnt bother you, your provider may recommend no treatment.

Toenail fungus treatment options include:

  • Oral antifungal medication: You take prescribed medication, such terbinafine , itraconazole and fluconazole , to treat the fungi. You will need to take this medication every day for several months . Your provider may use blood tests to check for potential medication side effects. These medications can affect the liver and interact with other medications, so oral antifungals are not for everyone.
  • Topical medication: You regularly apply a medication right on the nail. The medication treats the fungi over time. Topical medications are most effective when paired with oral medications.
  • Laser treatments: Your provider directs a high-tech laser beam and special lights at the toenail to treat the fungus. Lasers are FDA approved for temporary increase of clear nail in nail fungus but is not a cure. Cure rates for laser treatment are lower than oral and topical mediations so they are not typically used as first-line treatments for nail fungus.

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What Is A Fungal Infection

Fungus, plural fungi is a class of organisms with over 144,000 known species. Fungus holds great importance for the environment and medical sector. Fungi are considered as one of the most widely distributed organisms worldwide Some are found free-living in soil or water others from parasitic or symbiotic relationships with plants or animals. Some common examples of fungi include Mushroom, mildews and mold. However, not all types of fungi are harmful but some can cause severe suffering for human beings and other living organisms.

Fungal infections are common all over the world and it only occurs when an invading fungus captures over the human body and the immune system of human is too weak to combat. Fungi are populated in our environment and are found flying freely in the atmosphere, they also divide and reproduce in the tiny spores that are present in the air. These fungi that are not visible to eh naked eye can enter into the human body through our respiratory system and can land inside to form a parasitic relationship within our lungs, throat, liver or any other hospitable part of the body causing a severe infection. In some cases, fungi also attack the intestines or the genital area of the human body causing severe hazard to health however, almost all the infection caused by fungus are curable with proper care and treatment.

Why Toenail Fungus Is So Stubborn

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A fungal infection in your toenails is typically caused by a tiny organism called dermatophyte fungus. This type of fungus thrives in warm, moist environments think public swimming pools or locker rooms where it can be easily transferred between people.

Once you pick up the infection, it can spread fairly quickly, largely because you keep your feet inside shoes, creating the perfect environment for fungal growth.

Making matters worse, your toenails are fairly thick and made up of many layers, which means the fungus can set up shop deep within these layers, making it more difficult to target. In moderate-to-severe cases, the fungus can even get into the matrix of your nail, which means any new toenail growth is already infected.

Rounding out the list of hurdles is the fact that your toes dont benefit from great circulation, so your immune system is less likely to detect and fight off the foreign invaders.

What all of this amounts to is that many people think that a toe fungal infection is coming back when it never really went away in the first place.

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Can Thick Toenails Cause Complications

Untreated toenail infections can cause some complications. Over time, the infection can get worse, and symptoms may become more severe. Toenails can thicken to the point that they cause discomfort when you try to wear shoes or even make it more difficult to walk.

If you have pre-existing medical conditions, treatment is vital so the fungus doesnt contribute to secondary infections or complications.

How Are Thick Toenails Treated

Although not all cases of toenail fungus need to be treated, thick toenails may be a sign that the fungus has gotten worse. Several methods are available to treat your toenails. You can try some home-based treatments first and then talk to your doctor about prescription-based options. Topical and oral medications are the mainstays of therapy.

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How Did I Get It

A lot of toenail fungus occurs because they are made in these environments where there is a lot of moisture and darkness. For example, if someone was sweating on their feet while wearing closed-toed shoes, that allows them to develop the fungus because fungus enjoys those types of environments. At any age someone can obtain toenail fungus, the most common age of people getting toenail fungus is people over the ages of 65. Toenail fungus is when toenails start to become discolored, thick, and break easily. Its more common for the infection to occur on toenails than on fingernails. The medical term for toenail fungus is onychomycosis.

Toenail Fungus Symptoms And Risk Factors

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Toenail fungus symptoms are not pretty. At first, you may notice small white spots and possibly a foul smell. As the condition worsens, your nail gets thicker, which makes it harder to trim or cut, and turns yellow or brown. Nail fungus can spread from nail to nail and, eventually, make your nails split and crumble.

In addition to older people, people with certain conditions like diabetes or psoriasis are at higher risk for developing fungus. Other risk factors include having a history of athletes foot, which is an infection between your toes, a propensity for sweaty feet, and those with a weakened immune system.

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What Causes Toenail Fungus And How To Prevent It

Unfortunately, the warm and moist environment inside your shoe can make you vulnerable to fungal infections. When these occur on the toenail, doctors call the condition onychomycosis. Fungal skin infections commonly called athletes foot can often affect the foot as well.

One of the you get a fungal toenail infection is when fungus invades small cracks in your toenail. Some people are at greater risk for this occurring, including those with:

  • circulation problems, especially related to the feet
  • diabetes
  • history of injury, surgery, or damage to the nail
  • impacted immune system function

Treat The Fungus Before It Becomes Hard To Treat

The best thing is to treat the fungus before it becomes so hard to treat earlier is better.

Definitely dont wait until your nails are all infected or so thick that you are having pain. And definitely take care of all fungal infections quickly if you have a medical problem such as diabetes, poor circulation, or are immunosuppressed.

When you come in for your appointment, we will examine your feet closely and let you know which options would be best for you and will prescribe the best treatment for your needs.

To schedule an appointment, visit our website or call our office. We also have a 24 hour answering service available for emergencies.

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What Should I Ask My Healthcare Provider About Toenail Fungus

If you have toenail fungus, you may find it helpful to ask your provider:

  • What type of infection do I have?
  • Do you recommend I treat it? Why or why not?
  • How long will I need treatment?
  • What steps can I take to stop it from coming back?
  • Should I be aware of any potentially serious complications or treatment side effects?

A note from Cleveland Clinic

Toenail fungus is an incredibly common infection that can be difficult to treat. The condition usually isnt painful, but it may make you feel self-conscious about how your foot looks. If it bothers you, talk to your provider about your treatment options. A trained specialist can provide guidance on whats most likely to address your concerns while protecting your overall health.

Last reviewed by a Cleveland Clinic medical professional on 12/17/2020.

References

What Are The Main Types Of Toenail And Fingernail Fungal Infections

Houston Podiatrist Toenail Fungus Frequently Asked ...

There are many types of fungal nail infections that develop over time and can be caused by a different class of fungi. Since the development of infection is a gradual process so a slight change in the texture or look of the nail should be considered seriously before it gets much worse. Some of the most common types of fungal infections that affect majorly the areas surrounding fingernails and toenails are listed below. All these nail infections are sub-classes of onychomycosis.

Distal subungual onychomycosis

The most common type of fungal nail infection is DSO caused by the same fungi that are behind the Athlete’s foot. It is the infection that affects the nail and the skin present under the nail, known as the nail bed. The infection originates from the nail bed and partial nail turns yellow or white, which is the first indication of DSO. In this type of infection debris, bacterial dirt, broken nail fragments and pieces of dead skin accumulate under the nail and as the condition worsen the nail could also crumble and break. DSO is a lifelong infection that can be difficult to overcome and even harder to treat. Improper care and wearing tight shoes may worsen the condition.

White superficial onychomycosis

Candida onychomycosis

Proximal Subungual onychomycosis

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What Are The Most Effective Treatments For Toenail Fungus

The experts at Easton Dermatology Associates offer treatment customized to your exact situation, whether youve just noticed an irregularity with your toenail or youve been battling fungus for a while. Treatment options include:

  • Prescription oral antifungal medications
  • Topical nail cream
  • Special antifungal nail polish that allows your nails to breathe

No matter what treatment you adopt, patience is key. It can take several months to clear up toenail fungus because even nails that grow at an average rate dont grow rapidly. We treat your fungus until its a thing of the past, and we also advise you on how to prevent a recurrence.

Its much easier to solve the problem when youre in the early stages of infection, before it becomes too advanced.

Do at either of our locations in Easton or Salisbury, Maryland, so we can start helping you eliminate embarrassing and persistent nail fungus problems ASAP. When next summer rolls around, you can be back in those oh-so-chic sandals!

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Doctors Weigh Best Treatments

The best treatment for fungal nail infections is a prescription that your dermatologist can prescribe that you take every day for two-to-three months. The pill is not for everyone, since oral antifungals can interact with other medications and can affect the liver.

Fortunately if you dont want to or cant take a pill, there are topical solutions to treat nail fungus. Although topical medications are desirable because of the low risk of side effects and interaction with other medications, they have much longer treatment regimens. Generally, topical medications have a lower clearance rate compared to oral pills.

Newer topical antifungals including Efinaconazole and Tavaborole have better penetration of the nail plate and so they work better compared to older topical medications, says Dr. Ng. She says the topical medications work best if you only have partial nail involvement.

Lasers are approved by the FDA to temporarily increase the amount of clear nail. However, the cure rates are lower than oral medications and topical solutions.

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What About Bleach Baths

Bleach baths are an approach dermatologists may recommend for treating skin conditions such as atopic dermatitis and recurrent Staphylococcus infections on the skin. These involve mixing a very small amount of bleach in bath water typically a half cup of bleach to a full-sized bathtub of water.

While its true that bleach baths may temporarily kill bacteria, fungi, and viruses, the effects arent long-lasting and arent likely to treat an existing toenail fungal infection.

What’s New In Onychomycosis Therapy

Trimming of Super Thick Fungal Nails: FULL TREATMENT

Recent device-based therapies for onychomycosis include laser devices, photodynamic therapy, iontophoresis, and ultrasound. Laser treatment has been approved for cosmetic treatment only, but efficacy as a treatment to eradicate the fungal infection will have to be determined by additional randomized controlled trials . There have been rare reports of onychomycosis cures following the use of phototherapy, which involves the irradiation of accumulated protoporphyrin within the fungal hyphae, leading to subsequent hyphal cell damage . The ability of iontophoresis, or the use of electric current to facilitate the passage of drug through the nail plate, has been proven in studies with human cadaver nails, but relevant clinical studies remain to be conducted . Finally, though ultrasound therapy has preliminarily demonstrated fungistatic activity against nail infections , the device itself seems overly complicated, with ultrasound transducers and drug delivery compartments needed above each toenail and the requirement for a computer software interface, making it a physician-officeonly treatment and likely very expensive .

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Why Is Onychomycosis So Difficult To Treat

Fungal nail infection, as we all know, is a difficult problem to manage. Invasion from chronic fungal skin infection into the nail is a slow, insidious process but until that point it often remains invisible to the patient. As the fungus spreads under the nail, it becomes shielded by the overlying nail plate making it more difficult to treat by any means. Under the nail it is able to form a thriving mass of hyphae which have been termed by Roberts as the dermatophytoma . This is essentially a large, adherent collection of fungal mass.

Above: Biofilm of E Coli

In biological terms, such a collection should be termed a biofilm. If you visualise organisms such as bacteria and fungi, you may view them as free-floating structures but in reality, they are not. Biofilms are collections of micro-organisms encased in a tough extra-cellular polysaccharide matrix which is produced by the organisms themselves . Biofilms are known to be highly adherent to biological . Ultimately, this shield increases the organisms resistance to standard treatments acting as a both a physical and chemical barrier. Biofilms have been identified on many structures including dental appliances and catheters, for example, and can be difficult to remove both physically and chemically.

References

1. Roberts DT, Evans EGV. Sub-ungual dermatophytoma complicating dermatophyte onychomycosis. Br J Dermatol. 1998 138:189-90.

What Are The Treatments For Toenail Fungus

Toenail fungus is notoriously hard to cure. If over-the-counter fungal treatments have not worked, see your doctor. Treatment will depend on how severe the infection is and the specific type of fungi causing it.

Your doctor may start by trimming your nail, removing debris from under the nail, and scaling away the dead nail layers. Then, treatment may involve the following:

  • Topical toenail fungus medication in the form of medicated nail polish or cream you apply to the nail. Some products are for daily use and others are once weekly. Treatment can take up to 18 months and is only suitable for mild infections. Thinning the nail with a file before application may be necessary to help the medicine penetrate the nail. Always sterilize nail tools after use. Topical medicines include amorolfine , ciclopirox , efinaconazole , and tavaborole .
  • Oral antifungal drugs you take by mouth include fluconazole , griseofulvin , itraconazole , and terbinafine . These drugs have a higher cure rate and work more quickly than topical products. Treatment generally takes up to 12 weeks. However, they carry a risk of liver toxicity, side effects, and drug interactions. You will need blood tests and frequent monitoring if your doctor prescribes these medications.
  • Combination therapy can be more effective than either topical or oral drugs alone.

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