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Fungus Nails and the
PinPointe Fungus Laser
By: Michael Zapf, DPM, MPH, FACFAS
November 2009
Thank you for visiting my page on fungus nails and the
PinPointe
Fungus Laser. When a fungus enters a nail and starts to make a home and
grow it produces a variety of effects. The nail can develop any of the following
conditions:
 | It can and usually causes the nails to become
discolored, usually yellow or brown but sometimes black |
| It can and usually causes the nails to become thicker. |
| Sometimes the nails become ingrown. |
| Sometimes the nail will lift off of the toe, this is
called onycholysis. |
| It usually causes the nails to become thicker. I can,
but won't, show you pictures of nails of some of my senior patients that are
nearly an inch thick-really. |
| The thick nails can create a painful condition with
pressure such as shoes. |
| They are almost always a cosmetic deformity in addition
to any symptoms that might cause. |
Now this last point needs some elaboration. Many insurance
companies will refer to a fungus infection of the toenails as merely a cosmetic
problem. They are wrong. I often go to the mat to achieve insurance coverage for
fungus nails, and I often lose. If this same fungus was present on your forehead
causing ringworm, it would most certainly be covered. If this same fungus was in
your groin area causing tinea inguinum (jock itch) it would, again, be covered.
If this fungus was growing between your toes causing a fissure that became
infected, it would certainly be covered. If, in fact, you had diabetes or an
immune system compromising condition or on immune system compromising
medications, your insurance would also cover fungus nail
infection. This tells me that they know that there is an actual risk
to having this infection. They just do not want to pay for your fungus
infection. It tells me that most insurance companies are much more interested in
their tall buildings and executive bonuses than they are in getting rid of a
fungus growing in your nails.
Let me be clear here: a
fungus infection in your nails is, in fact, an infection. It poses a risk to
your health, albeit small in most cases, but like any infection it deserves
treatment!
That being said, let's talk a little more about your
infection. It is caused by either one of three fungi that are so commonly found
in nails they have their own category name: dermatophytes or one of dozens of
even more difficult to treat “atypical” fungi. Years ago we had two common oral
medications to treat fungus nails: Sporanox and Lamisil. Lamisil was regarded as
the first line antifungal agents for the common dermatophytes and the Sporanox
was thought to be more effective against the atypical fungi that cause fungus
nails. For that reason I sent off hundreds of nail samples for actual
identification of the fungi that was causing the infection. I found that less
than 60% of the infections were cost by the common dermatophytes and 40% were
caused by the atypical fungi.(I still have all of the test results in my drawer
should anybody ever care to see them.) This fungal fact is of interest only
because the atypical fungi can be a pleadingly difficult to eliminate from the
infected fungal nails. A lot of you have an atypical fungi growing in your nails
which is why you frequently will fail using the common oral medication.
Dr. Zapf’s Theory of
Trauma First then Fungus
A word about my theory on fungal nails. I should tell you
that I have a BS degree in microbiology in a master’s degree in public health
(MPH) with a specialty in infectious and tropical diseases from UCLA. I believe
that some fungi, a minority in fact, are able to penetrate a healthy nail. Most
of the time, I believe, a fungus infection only gets
into a nail that was previously damaged. This damage could come from dropping an
object on the toe, kicking the furniture, injuring the
nail while running or hiking or any other assorted varieties of damage to the
toe. Sometimes the damage occurred many, many years prior, perhaps in high
school or college. The nail looses its intrinsic
integrity and becomes thicker than a normal nail and grows slower. This sets
up the nail to become infected by one of the dermatophytes or an atypical
fungus. Usually the inflection starts at the tip of the nail and works its way
towards the base, often growing under the nail plate, and sometimes it starts as
a superficial infection of the nail plate. Once the fungi grow back to the nail
root, which is under the skin, it really causes havoc by
making the nail thicker and weaker. This damage theory explains why you can have
one nail that is completely riddled with fungus while the nine siblings have
none at all.
A damaged nail can usually be cleared of its fungus
infection but the damage cannot be undone. That nail will have a great risk of
reinfection and constant attention to the nail must be given to keep it clean
and fungus free after successful treatment.
Below I give my flow sheet for the treatment of sick and
fungal nails. Of click here to see the page
à.
If you print the page out you can follow the outline as
you read the rest of my page.
There are two basic and one exotic treatment for fungus
nails: topical medication, oral medication and the
PinPointe Fungus Laser.
Usually, before treatment begins we would like to know if there is really a
fungus growing in the thick and discolored nail. Sometimes diseases like
psoriasis or nail trauma, itself, can make the nails thick and, sometimes,
discolored. For these nails we would not like to subject patients to the risk of
oral medication. Therefore we usually perform an examination on the nail,
itself, to prove there is fungus before starting oral medication. Because there
are no known risks for topical medication, other than topical sensitivity in
some patients, or to the
PinPointe
Fungus Laser, you actually can feel free to use topical medication or the
PinPointe
Fungus Laser without a positive laboratory test.
Laboratory Tests to See
If You Have Fungus:
 Laboratory
proof that you have a fungus infection is needed before using risky oral
medication or if you want to know why the topical medication or the laser did
not work. There are three kinds of tests that are commonly performed. The first
is a culture test where a sample of the nail is submitted to a laboratory where
the fungus is grown in a test tube or Petri dish and the species of fungus is
identified with a microscope. This is the most accurate test for fungus. A
second test is called the PAS, which is a name given to a method of staining
samples of the nail to see the little fungal elements under a microscope. They
shine up a bright red in an otherwise blue/purple background. If they PAS test
is positive, it is very accurate indicating that there is a fungus
present. If the PAS test is negative then either you did not have a fungus or
the fungus could be in the nail in such low numbers that it was not seen by the
microscopist. If the PAS test is negative, and you have your heart set on taking
an oral medication to kill the fungus, you might want to repeat the PAS exam. If
the laser or other treatment was not effective, and the PAS is negative, you
probably never had a fungus to begin with. The third test is called a KOH or
potassium hydroxide mount. In the KOH test portions of the nail are placed on a
microscope slide and treated with potassium hydroxide which causes the nail
material to become translucent making the elements of the fungus visible. This
is also a very accurate test when it is positive and inconclusive if it is
negative as the fungus might be present in very low numbers. There is no harm in
using either the laser or the topical medications even if you do not have a
fungus in the nails. Before using any oral medication, because of the risks, you
should have a positive culture, KOH or PAS test. Before any oral treatment:
While many drugs could conceivably treat a fungus
infection, the two most common are Lamisil and Sporanox.
Sporanox is the brand name for itraconazole. Toenails
infections are usually treated with a recommended dose is 200 mg (2 capsules)
once daily for 12 consecutive weeks. Sporanox is used much less commonly than
Lamisil for fungus nail confections because of risks of developing heart
problems. Sporanox has what is called in the pharmaceutical business as a
dreaded “black box warning” about contributing to or causing congestive heart
failure. Taking Sporanox for your fungal nails deserves a long discussion with
your medical doctor and, please, don't obtain the pills from a foreign pharmacy
without the knowledge of your primary care doctor. Generally, Lamisil is
regarded as a safer medication than Sporanox.
Lamisil is the brand name for terbinafine. The usual dose
of Lamisil is one 250 mg tablet taken once daily for 12 weeks by patients with
fungus toe nails (twice the length of time of a fingernail infection).
With either the Lamisil or Sporanox the optimal clinical
effect is seen some months after mycological cure and cessation of treatment.
This is related to the period required for outgrowth of healthy nail. Big
toenails probably take at least one year to grow out cleanly and can take as
long as 20 months for long-standing fungal infections.
Cost
Until Lamisil was available in a generic formula, patients
had to pay $600 for a course of therapy. Now that it is generic that form is
available at a much reduced cost. I have heard that some drugstore chains will
sell generic medication for as little as four dollars a month.
Liver Risks with
Sporanox and Lamisil
Both medications have been known to cause liver damage
which ranged from temporary to hepatitis and even the occasional, and rare,
liver failure. The exact percentages of liver damage and liver failure are not
really known. I once had a long discussion with the medical director of the
pharmaceutical company that makes Lamisil. I begged him to give me the relative
risk of liver damage while taking Lamisil. He obfuscated and just told me that
it was “uncommon” and “rare.” I have used oral Lamisil on about 1000 patients in
have seen mild liver enzyme elevations a few times but no cases of hepatitis. My
gut feeling, with no real data to support it, is that liver enzyme elevation
indicating something happening to the liver occurs in about one in 2000 cases.
Liver failure probably occurs extremely rarely. If you develop warning signs
such as nausea, loss of appetite, or fatigue, alert your doctor. Neither
Sporanox nor Lamisil is not recommended if you have liver disease or kidney
problems.
Other Problems with
Lamisil and Sporanox
Changes in the lens and retina of the eye have been
reported in people taking Lamisil and Sporanox. If you notice any changes in
your vision while taking the tablets, notify your doctor. If you suffer from the
autoimmune disorder lupus erythematosus, you will not be able to take Sporanox
or Lamisil. Isolated cases of decreases in white blood cell count have been
reported. In all of the reported cases to date, these have been reversible. If
you have problems with your immune system, your doctor may need to monitor your
white blood cell count carefully if you take Sporanox or Lamisil for more than 6
weeks. In some cases, Sporanox or Lamisil therapy may need to be discontinued.
Lamisil has, in rare instances, caused very severe skin reactions; more
commonly, about 2% of the time, it causes allergic hives. If you develop a
steadily worsening rash, stop taking the tablets and call your doctor
immediately. If you develop another kind of infection while taking Lamisil, tell
your doctor. Lamisil may decrease your ability to fight infection. Finally I
have had for people who have to stop taking it because of headaches and four
more who stop taking it because of stomach distress.
Liver and Blood Tests
for Oral Medication
Because of
the risk of developing liver damage or damage to your blood system the doctors
in our office will not prescribe Lamisil or Sporanox without first having the
assurance that you liver and your blood are performing normally. This requires a
pretreatment blood test that includes liver function tests and CBC. If these
tests are normal you may begin taking the medication. After taking the medicine
for 3 to 6 weeks we will repeat the lab test to make sure that there is no
adverse affect on your system from the medication. Again, I have performed
laboratory tests on all of the 1000 patients for whom I have prescribe the
medication and have found only a handful of patients that show the possibility
of damage. I asked only to patients to discontinue the medication.
Topical Medication
The list of oral medications that people have used to treat
their fungus infections in the nails is legion. There is an entire shelf of
these at any drugstore. In addition people have used unconventional topical
remedies such as tea tree oil, DMSO and Vicks VapoRub. I am sure that there are
additional ones available at your local health food store. Treatment with any of
the topical medications seems to share one common flaw: lack of dedication to
their use on the part of patients. These topical medications, if they are able
to work at all, need to be used once or twice a day for the entire length of
time it takes for the mail to grow out and replace itself. This can take as long
as 18 months. Another flaw that the topical medications seem to share is their
inability to penetrate through the nail to kill the fungus where it resides on
the bottom of the nail right touches the skin. This is why the fungus returns to
the nail the moment you stop using the topical medication: it was never really
gone, just suppressed. As soon as you stop using the topical medication, the
fungi buried deep under the nail start to grow again and repopulate itself as
fungus nails. This flaw is not shared by either the world medications or the
PinPointe Fungus Laser.
I believe that topical medications can be a valuable adjunct
to keep nails that were successfully treated free of fungus that are not very
effective in killing the fungus in the first place.
Fungal Free
Nails Topical Medicine
For those who want to try what I believe is the most
effective topical medication you can check out Fungal Free Nails. You can order
a bottle for about $44 at the website
www.FungalFreeNails.com. I have no financial interest in this company but I
do believe they make the most effective topical antifungal medication. As a
convenience we sell this medication to our patients and our office.
PinPointe Fungus Laser
Now we come to the most exotic and new method to treat
fungal nails using the PPFL. In just one 45 minute treatment will we can pass a
special wavelength of laser light over your nails and the tip of your toes that
kills fungus without harming the nail or the skin. This seems like a miracle
and, in fact, it is.
The
PinPointe Fungus Laser was developed by an engineer who had a
child with cystic fibrosis. In cystic fibrosis dense gummy material builds up in
the lungs that makes it difficult to breathe and is a source for severe
bacterial lung infections. The engineer is developing a laser light designed to
pass through the delicate lung tissues killing bacteria without harming the
lung. This research is still a long way away and is very costly. The engineer,
however, discovered that this technique is already available to kill fungus in
nails. In podiatry we benefit from this research by having a laser that works
today. The engineer is using the profits from this invention for his cystic
fibrosis research.
For more information on the pinpoint fungus laser please
see our official webpage: www.LaserMyToes.com
Options for Thick and
Fungal Nails.
THERE ARE FOUR MAIN OPTIONS
TO TREAT YOUR FUNGUS NAILS:
1. DO NOTHING
Fungus in a nail rarely goes away without treatment. The normal course is for
the nail to get fully involved with the fungus growing from the tip to the root
and then get thicker and thicker. It is not unusual to see some of out senior
patients with nails that can approach an inch thick.
2. TOPICAL MEDICINES:
Most people start
their treatment with the use of a topical medication or a home remedy. People
have tried topical Lamisil, Lotrimin, Micatin, Vicks Vapo-Rub, tea tree oil,
white vinegar, rubbing alcohol, bleach and the prescription product Penlac. All
of these need to be used twice a day for up to a year to see results. Our
current favorite is a topical Fungal Free Nails product that we sell for $38 a
bottle (available from the internet at the same price). All three doctors have
seen this remarkable product work on many (but not most) occasions. The probable
effectiveness rate is less than 20% when used twice a day for a year.
3. ORAL MEDICINE. Currently the only oral medicine is terbinafine, also called Lamisil.
This medicine is taken one tablet a day for 90 days and achieves a 75% rate of
improvement. There is a rare and slight but very real risk to the liver, kidney
and blood cells. The people who have been seriously injured probably already had
some organ damage and there is no proof that Lamisil did the damage all by
itself. To check on potential damage we require a pre-treatment
and during-treatment levels of your liver function and your blood
cells (liver function tests and complete blood count). Because of the risks of
Lamisil, we want laboratory proof that you have fungus in your
nails before we prescribe this medication. This requires a laboratory
examination of a sample of your nails. It takes us about 2 weeks to get results
back from the laboratory. Non-generic Lamisil costs more than $400 but generic
forms are available.
“The
days of hiding your feet due to nail fungus are …over… with new miracle
laser treatment” …
Good Morning American
segment,
April 9, 2009
See
www.abcnews.com key words “nail
fungus”
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 4.
PINPOINTE LASER THERAPY This is a new
treatment available for fungus nail treatment. The laser treatment is done at
one visit where a laser light is passed over and through your nails to kill the
fungus without damage to any of your skin or nails. The light literally passes
right through your skin without any damage at all. It has been used thousands of
times without any side effects. With the laser there are no injections, no
pills, no lab tests and no risks of any kind. The effectiveness is running at
88% (no fungus can be resistant to this wavelength of light). Failures are
likely due to damage to the nail plates, either through injury, severe long
standing fungus infection, poor circulation or genetics. The laser treatment
with 1 year of follow-up exams costs $950 and is not covered by any insurance
companies. You can pay for your treatment with a credit card, cash or check and
you can also use your flexible spending account or health savings account. We
have even made arrangements with an interest free health credit card for your
convenience.
Additional treatment
recommendations to avoid reinfection:
q
Use of a topical antifungal medicine daily or at least once
or twice a week. Topical Lamisil is probably your best bet. We ask that you
apply this to the tops of your toes, including the nails, between the nails and
across the bottoms of your feet in the so-called moccasin distribution. Doing
this right after your shower and before putting on your socks and shoes is a
convenient and effective time to do this. You can purchase a very helpful
topical antifungal medicine in our office or from the Footstore link on
our website.l
The Garden Analogy
I often use the following parable to illustrate the need for
frequent treatment of newly sterilized nails with an anti-fungal agent. I
call it the parable of Aunt Mable’s Garden.
Suppose you visited Aunt Mable who has been sick and bed
ridden for some time. You look out her bedroom window to the garden that
was her pride and joy and discover it is full of weeks. You do her a favor
and go out to the garden to remove the weeks. Now it looks beautiful. If
you go away for six months and return you can be sure the weeks will be
back. You might find it necessary to hire a neighbor girl to come over to
Aunt Mable’s garden once a week and pull the little tiny weed shoots. Then
the garden will be beautiful all the time.
Obviously the garden is your nails and the weeds are little
fungus spores that land on your toe nails. Every few days another spore
germinates and starts to grow into the nail plate. You can cut this little
nescient fungus in its tracks before it gets an, ahem, “toe hold” by
attacking it with topical Lamisil Cream available at most pharmacies
without prescription
Your best bet would be to apply
the topical Lamisil cream to the nails frequently, as often as daily but
at least three times a week. Also, three times a week, it would be smart
to apply the Lamisil cream to the entire feet including the toes, the area
between the toes and across the bottom of the foot in a moccasin
distribution.
It is important to use this Lamisil cream if you have used
either the PinPointe Fungal
Laser or oral Lamisil for your fungal
nails.
For your shoes I recommend that you use Lamisil spray. You
could also use Lamisil spray on your feet if you are running out of time
for foot care – but the intensity of the cream is probably more effective
than the spray on the feet.
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q
Antifungal Foot Spray. We recommend that you spray the
inside of your shoes with an antifungal foot Spray when you are finished wearing
your shoes for the day. For real shoe sterilization we recommend the use of an
ultraviolet shoes sterilizer. A good antifungal foot spray is available in our
office and many brands can be found from the Footstore link on our
website.
 q
SteriShoe. The sweat and dead skin cells from our feet accumulate on the
inside of our shoes and it becomes the perfect breeding ground for athlete’s
foot fungus, bacteria and other unpleasant critters. Spraying the inside of your
shoes with an antifungal spray does achieve some good but it is nowhere near
100% effective. Ultraviolet light, however, is 100% effective in killing all
pathogens from the inside of your shoes. We sell a set of two ultraviolet light
containing shoe trees that will kill all organisms from the inside of your shoes
in 45 minutes. They have an automatic shut off so all you have to do is place
the shoe trees in your shoes, turn it on and forget about it. If you want to be
free of fungus on your skin and nails we strongly recommend that you use the
SteriShoe. You can purchase the pair of SteriShoe shoe trees from us for $130 or
you can purchase it from the SteriShoe website:
www.SteriShoe.com.
q
If you want to get pedicures we ask that you take the proper precautions.
Make sure that the pan in which you soak your feet has a disposable liner so
that you don't soak your feet in the same water used by other clients. Make sure
that the facility sterilizes any instruments used on your feet such as clippers,
files, probes and scissors. Autoclaving (sterilizing under high pressure using
hot steam) .is the only sure way to sterilize instruments. Typically these
instruments are placed in an autoclave bag that has a colored marker that
changes color when the autoclaving is successful. In our office our autoclave
bags have a pink square that turns brown with successful autoclaving. Soaking
instruments in a disinfectant is not a guaranteed way to kill nail fungus. You
will notice that our office opens a sterile bag of instruments for every patient
every time right in front of you, the patient. Your nail salon should do the
same thing if they are interested in your foot health. Unfortunately, very few
nail salons take this level of precaution. For this reason you should purchase
your own reusable metal instruments and cleaned them yourself between visits.
You can purchase these instruments from a beauty supply house or we sometimes
have an extra supply of some instruments that you could purchase. Some
instruments are also on sale from the Footstore link on our website
www.conejofeet.com .From time to time we even have a pedicure kit for sale.
Once you have your own metal stainless steel instruments, you can run them
through your dishwasher as a reasonably effective way to keep them clean. If you
are real serious about your foot health, we will offer to place your instruments
in one of our autoclave bags and sterilize them for you. Ask about this service
next time you are in our office.
q
Fingernail and toenail polish: we have five colors
of fingernail polish available for purchase in our office. They cost $17 a
bottle and they have tea tree oil as an antifungal agent. These are not meant to
treat fungus nails but they can help you keep your new beautiful nails fungal
free. Please polishes also are free of two agents that tend to yell over the
nails after the polish has been removed. You can apply this polish your self or
you can ask your pedicurist or manicurist to use it when you receive your
pedicure or manicure. Please polishes are also available from the Footstore
link on our website
www.conejofeet.com.
q
Nonyx-Nail Gel. This product is only modestly helpful in
treating fungus nails but it has an excellent bleaching agent to lighten the
color of a discolored nail. We sell Nonyx nail gel for $25 a bottle in our
office. It is also available online at
www.drugstore.com and other sources.
q
Biotin is a vitamin pill that may help treat or prevent split and
cracking nails. Biotin stimulates epidermal cells and affects the protein
structure called keratin found in skin, nails and hair. Biotin is directly
involved in the production of keratin cells and is believed to increase the
quantity of keratin-matrix proteins in the nails. Thus, this B. vitamin is
likely to improve nails strength, and dust resistance to fungus, by influencing
keratin structure. One clinical trial of Biotin use in nails used a high tech
scanning electron microscope to carefully measure fingernail thickness and
splitting. The study used a daily dose of 2.5 mg of Biotin and found that
fingernail thickness increased by 25% and splitting decreased after biotin
supplementation. This study appeared in the respected dermatology journal,
Cutis. (Hochman LG, Scher RK, Meyerson MS.
Brittle nails: response to daily biotin supplementation. Cutis.
1993;51(4):303-305) Appearex is a
commercial product recommended and sold by many dermatologists and contains 2.5
mg of Biotin per capsule and sells for $32 for 84 tablets at
www.drugstore.com. We sell a more cost effective Biotin made by a high
quality vitamin manufacturer at $8 for 60 8 mg tablets. Probably only two or
three tablets a week are needed to improve the strength of your nails.
q
Gelatin: gelatin capsules are available at your drugstore or health food
store, Knox or other gelatin powder that you can mix in your fruit juice or even
eating Jell-O can improve the thickness and strength of your nails and make them
more resistant to attack by fungus.
q
Moisture wicking and moisture repelling
socks athletes foot fungus , like any good mushroom , prefers dark , moist
and warm environments to grow. The sweat from your feet can create a wonderfully
hospitable environment for athletes’ foot fungus. Traditional cotton socks will
absorb moisture until they are saturated and then maintain themselves as a wet
layer of cotton against your skin for the rest of the day. There are two better
alternatives for you then cotton socks. The first is exemplified by Thor-lo
brand (www.thorlo.com)
which readily transfers the sweat from your skin to the stock and allows for
more rapid evaporation than cotton. Thor-lo socks are available at all sporting
goods stores and athletic shoe stores for 31 different sports. A better
alternative is exemplified by Drymax sports socks (www.drymaxsocks.com
) which is composed of two layers of material the inner layer of which quickly
transfers moisture to the absorb an outer layer much like a disposable diaper.
In both cases the skin, and in the Drymax case, the nails, stay extremely dry.
Drymax socks were recently featured in Diabetes Educator Magazine as being very
helpful for diabetics in preventing infection. In our area Drymax socks are
Available at Road Runner Sports in Newbury Park.
q
Rotate your shoes – unless your shoes are made of all
plastic, they will, undoubtedly, absorb a lot of the moisture that your feet
produce each day. Unless you use the sterilizing shoe tree discussed above it
will take about two full days for your shoes to completely dry out and be ready
to absorb moisture again. If you wear your shoes in the rain, or get them wet
some other way, it made take a full three or four days for them to fully dry
out. Please place them in a well ventilated area so that air circulation can get
to them.
q
Avoid bare feet in public places.
qDisinfect
your shower area. Use Lysol spray,
bleach or even mildew cleaner to keep them fungus free.
q
Treat athlete’s feet of all family
members. One of the most common sources of reinfection are the athletes feet
fungus spores left on the carpet, in the shower and in the bed sheets of family
members who also have the condition. If you really want to be free of
reinfection consider having your family members treated at the same time.
q
Corynebacterium although it is not a fungus, there is a bacteria called
corynebacteria that can grow on your feet and between your toes that can cause
an athletes foot type itch, irritation and, especially, a pungent and
disagreeable odor. This bacteria produces a coral red fluorescence which can be
detected using a special wavelength of ultraviolet light. We have a special
“Wood’s Lamp” in both offices that can detect the presence of this bacteria. If
you are positive for coral red fluorescence this bacteria can easily be treated
with topical erythromycin.
q
Green nails: sometimes we will find a distinct color growth under
the nail plate. This is often confused with a fungus but it is caused by a
bacteria called Pseudomonas. Pseudomonas infections will are surprisingly common
and are usually caused by foot soaking. The bacteria can sometimes be found in
faucets used to fill a foot soak bowl. If we think you have a Pseudomonas
infection under your nail we will treat it with either Ciprofloxacin ear drops
placed under your toenail or with white vinegar. Pseudomonas is thought to be
killed by acetic acid.
Random trivia about nails
·
The longer the toe or finger, the faster the fingernail grows
·
Nails grow faster in warm climates and fastest in the summer.
·
Nails grow 20 percent faster when a body is fighting off the flu
·
Extreme
dieting slows nail growth
·
The nail on the pinkie finger and toes grows the slowest, followed
by the thumb/big toe nail.
·
Fingernails grow twice as fast as toenails.
·
Men's nails grow faster than women's
·
Nails grow fastest between the ages of 10 and 14.
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