ACORN January 1994
Something New
for Fungus Nails
By: Michael Zapf, DPM, MPH, FACFO
While fungus infecting a nail makes the nail yellow, brown or white, it
makes people who have it see red. The fungus causing the problem is a little
microscopic plant that normally lives in the soil. Under the right conditions it
gets into the nails and sets up housekeeping. It is extremely hard to evict.
Fortunately more and more doctors are reporting success using an old treatment
in a new way. The result is more people experiencing the pleasure of normal
looking nails.
Why a fungus infects a nail has been a mystery for hundreds of years. In
some cases it occurs after a traumatic episode to the toe. This may be as great
as dropping a heavy object on the toe or it could be as little as years of
wearing tight or ill-fitting shoes. In other cases some type of sickness or
disease predisposes the body to fungal involvement. In still more cases the
cause will never be known. An otherwise healthy person suddenly notices a
discoloration creeping up the nail. Sometimes only one nail is affected and
other times all ten are involved. It rarely occurs on the hands and even more
rarely on the hands or feet of children.
Up to now the most successful treatment for fungal nails is one of a
variety of oral medications. These drugs will work about 60-80% of the time if
they are taken religiously for 10 to 20 months. The drawback is the potential
for rare but significant and severe problems with the liver or kidneys. While
the chance for problems is quite rare it would be foolish to take any oral
anti-fungal medication without periodic blood checks to assess the liver and
kidneys. Should the tests show any abnormalities the drug is immediately
withdrawn and the abnormal laboratory values almost always revert to normal.
These medications are widely prescribed but the potential side effects make many
doctors a bit wary of using them.
The easiest form of treatment is also the least effective: topical
medicines. Using even the most sophisticated topical medication on the fungus
nail is usually not very effective. Mycocide, a new topical medication, has
recently been introduced and early reports indicate that it might be much more
effective than other topical medications. Still, I would consider it a success
if half of the fungus nail patients had their nails clear up using Mycocide
twice a day. The problem is that
many of the fungus spores (or “seeds”
of fungus) are located deep under the thick nail. Without doing something to get
rid of the thick and infected nail, the fungus spores just sit underneath
waiting to sprout. For this reason many doctors recommended trimming or removing
some of the nail plate to allow the medicine to get where it can do some good.
Removing the nail plate and treating the nail bed with topical
medications until the new nail grows back seems to be as effective as the oral
medication without the side effects. Certainly the drawback is the pain of the
procedure and the discomfort of the newly nail-less toe for a week or two. A
final insult is not having a nail on the toe for the time it takes for a new
nail to grow.
In an ideal world there would be a medicine you could put on the nail
that would melt away the infected part of the nail and let the normal nail
alone. Such a medicine would not harm normal skin or nail, would not hurt to use
and would not cause any disability. Fortunately such a medicine exists and it is
called 40% urea paste.
Applying this benign cream to a fungus nail will soften and remove only
the infected nail so that topical medicine, like Mycocide, can work effectively.
In some cases one or two treatments with the urea paste will remove all the
infected nail. In other cases it will take a series of applications to fully
clean the nail. The good news is that there is no pain, blood, disability or
time away from work or school. The medicine is removed 3 to 7 days after it is
applied. Most insurance carriers will cover the cost of this procedure,
especially if the nails are thick enough to be painful.
If you have fungal nails and choose to take oral medication, the chances
of any problems are very small. Should you wish to avoid the risk altogether,
now you have an alternative that is easy, safe and probably equally effective.
Dr. Michael Zapf is a board certified podiatrist in
practice in Agoura Hills and Thousand Oaks. For more information please call his
office at (181) 707-3668
