By: Michael Zapf, D.P.M., M.P.H., F.A.C.F.O.

All right my dear Acorn readers, this is a column I didn't want to write. I can write about bunions, ingrown nails and heel pain with great dignity. But how do you do justice to that age old scourge of mankind: fungus nails. Due to popular demand, here goes.

Fungus in the nails is a wide spread problem. I have seen it in all age groups but is rare in children and common in seniors. It attacks the nails and makes them thick, yellow and almost impossible to cut. I would tell you about the stuff that grows under them, but there may be children reading.

The fungus that causes the problem is found everywhere in nature. It is rare that any of us goes a week without coming in contact with the fungus. So why is it that we all don't have the fungus in the nails? This is an excellent question and we do not have good answers. What we do know is that strong, healthy, fast growing nails are relatively immune to the fungus. (This is why it is rare in children.) As we go through life our nails start to grow slower and get thicker and even start to discolor a little. Eventually the nails can grow slow enough, and be think enough as to become susceptible to invasion by fungus. damage to the nail either by an accident or through such innocuous methods as tight shoes, seems to make hem even more susceptible. Therefore it is axiomatic that if there is fungus in the nail then the nail is not healthy to begin with. This is why it is so difficult to eliminate the fungus and even more difficult to keep it away

One more bit of confusion, not every "fungus nail" has fungus. Enough damage to the nail can make the nail look for all the world like it has fungus. A nail thick and yellow due to damage is not treatable by any method. For this reason I culture every suspected fungus nail to make sure it actually has fungus. It is very discouraging for a patient to find out that a nail fungus he has been treating for years is not due to fungus.

Proven nail fungus is treated by a variety of methods. The most common treatment is with topical medicines, either by prescription or over-the-counter. Without help from a podiatrist, these almost always fail. The fungus is buried deep under the nail. Usually topical medicine cannot reach the fungus. My analogy is going through a drive through car wash. The water and soap is attacking your car but you are sitting safely inside. In the nail I imagine the fungus being mildly amused by all the effort but being relatively unaffected.

For topical medicine to be effective, the nail needs to be trimmed back. For bad nails I use a urea preparation to painlessly "melt away" the infected part of the nail. For worse nails, I sometimes remove them temporarily under local anesthesia. Using a comprehensive treatment program an improvement is seen a majority of the time.

Oral medications have also proved to be effective. There are two types depending on the type of fungus found in the nail culture. Both have very slight but definite risks, especially if there is any kidney or liver disease present. i a healthy patient decided to try the oral medication, I perform blood tests after 30 days of treatment and then every 60 days to spot potential trouble before it starts.

There I did it. Now to more pleasurable topics. In a few days my son Christopher will celebrate his first birthday and I will use the occasion to talk about children's foot problems.

ACORN NEWSPAPER ARTICLE August 1996

New Treatments for Fungal Nails

If you have fungal nails you probably noticed those four page inserts in your favorite magazines touting a new oral antifungal medication. You presumably wondered, can these medications really be that good? Well I have good news and bad news for you. They are that good. They are also very costly.

It is not exactly clear why a nail becomes eligible for a fungus infection. Clearly a damaged nail, either from nutrition, trauma or disease, is at greeter risk for a fungus infection. But apparently healthy looking nails can also get the disease. It is caused by a microscopic plant-like creature that takes up residence in the nail plate.

Topical creams and lotions, even when applied twice a day, are rarely effective. Only if you temporarily remove infected nails and apply the medicines, can you boost the success rate to 20% or more. Luckily there is now a method to remove infected nails that uses a cream and not needles, injections and pain. Choosing a course of a topical cream is a reasonable choice if a patient cannot take an oral medication.

The older oral medications, griseofulvin (also called Fulvicin) and ketoconazole have been all but abandoned. One was very ineffective and the other hazardous.

The first of the new medications is called Sporanox, A full course of two tablets a day for three months costs well over $1000. The European "pulsed" method uses four tablets a day for a week repeated each month for four months. These 112 tablets coast about $800. Sporanox is useful against both the common and uncommon forms of the fungus. Its only drawback, except for the cost, is that in interferes with some drugs that pass through the liver. Many patients on these medications cannot take Sporanox.

The second new medication is Lamisil. A full course of one tablet a day for 90 days costs almost $600. Lamisil does not interfere with medications and is very effective against the common fungus types. Since there is a question about its efficacy against the uncommon fungus forms, a culture should be taken to identify the fungus before taking Lamisil.

Dr. Michael Zapf is a board certified podiatrist with offices in Agoura and Thousand Oaks. He has been using the oral antifungal medications for three years. For more information you can call his office at (818) 707-3668.

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Finally here is an article from February 2, 1994 on Fungus nails including the use of urea and topical Mycocide. Just double click the article and it will pop up.