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Are you embarrassed to wear sandals or do you hide your feet so no one sees your toes? You may be suffering from a fungus that have invaded your toe nail beds. 



What causes toenail fungus? 


Tiny organisms, including fungi, yeast, mold and bacteria, work together to cause toenail fungus.  Most often caused by fungi called dermatophytes, these infections feed off the keratin found in the toenails and the skin around the toes. Because fungus is so prevalent, anyone can develop fungal toenail infections. 



How does it happen? 


The prevalence of fungal nail infections is on the rise. Several reasons unique to modern life have resulted in an increase in fungal toenails. It begins with some sort of trauma to the nail whether it be from direct trauma from stubbing the toe, or repetitive jamming into a tennis shoe while running, or toes being crowded into a fashionably tight high-heeled shoe.  The trauma exposes the nail plate (the part under the nail) to the world allowing the fungus that lives naturally on the body to get in.    Fungi thrive in damp spaces such as the shower, locker rooms and gymnasiums, and nail salons. They love moist, dark environments such as wet shoes. Shoes are the reason why toenail fungus is much more common than fingernail fungus, which can also occur.    




What are the symptoms? 


Toenail fungus causes nails to become thick, yellow and brittle in a way that looks pretty ugly and can be painful.  




There are different classifications of nail fungus — depending on type of fungus and manifestation — which may have somewhat different signs and symptoms. In general, however, you may have a nail fungal infection — also called onychomycosis 

(on-i-ko-mi-KO-sis) — if one or more of your nails are: 


  • Thickened 

  • Brittle, crumbly or ragged 

  • Distorted in shape 

  • Dull, with no luster or shine 

  • A dark color, caused by debris building up under your nail 


Infected nails also may separate from the nail bed, a condition called onycholysis. You may feel pain in your toes or fingertips and detect a slightly foul odor. 




When to see a podiatrist? 


Once a nail fungal infection begins, it can persist indefinitely if not treated. See your doctor at the first sign of nail fungus, which is often a tiny white or yellow spot under the tip of your nail. 




Ways to treat fungal nails: 


Nail fungus can be difficult to treat, and can come back. Over-the-counter antifungal nail creams and ointments are available, but they aren't very effective. If you have athlete's foot as well as nail fungus, you should treat the athlete's foot with topical medication and keep your feet clean and dry. 




1.) Topical Medication: 


Anti-fungal solutions, lacquer, creams, lotions.....have about 20% cure rate.  These medications must be applied every day, twice a day for up to a year.  Most people don’t have the time or the attention span to achieve normal, healthy nails with topicals. Over-the-counter antifungal nail creams and ointments rarely work because they can’t penetrate the nail root. 




Your doctor can prescribe an antifungal lacquer . If you have a mild to moderate infection of nail fungus, your doctor may prefer to prescribe an antifungal nail polish called ciclopirox (Penlac). You paint it on your infected nails and surrounding skin once a day. After seven days, you wipe the piled-on layers clean with alcohol and begin fresh applications. Daily use of Penlac for about one year has been shown to help clear up some nail fungal infections. 




Prescription topical medications may be prescribed by your podiatrist along with an over-the-counter lotion containing urea to help speed up absorption. Topical medications usually don't cure nail fungus, but they may be used with oral medications or if you can athletes foot as well.  Your doctor may file the surface of your nail (debridement) to lessen the amount of infected nail to treat and possibly make the topical medication more effective. 




2.) Oral Medication:  


The most commonly prescribed oral antifungals are terbinafine (Lamisil) and itraconazole (Sporanox). This pill you must take once a day, everyday for 3 months. Monthly blood tests must be done because it has been associated with rare cases of serious liver problems.  According to Lamisil’s FDA-approved prescribing information this medication is about 66% effective. Other potential side effects include diarrhea, headache, rashes and changes in taste. These medications help a new nail grow free of infection, slowly replacing the infected portion of your nail. You typically take these medications for six to 12 weeks, but you won't see the end result of treatment until the nail grows back completely. It may take four months or longer to eliminate an infection. Recurrent infections are possible, especially if you continue to expose your nails to warm, moist conditions. 




3.) Surgery: 


If your nail infection is severe or extremely painful, your doctor may suggest removing your nail. A new nail will usually grow in its place, though it will come in slowly and may take as long as a year to grow back completely. Sometimes surgery is used in combination with topical medication to treat the nail bed. 




4.)  Laser treatment: 


The treatment, in which the podiatrist aims a laser beam at the patient’s toenails to kill the organisms that cause the fungus. The laser penetrates the toenail and vaporizes fungus embedded in the nail bed and nail plate where toenail fungus exists. The nails aren’t immediately clear after the 20 minute treatment, the patient must wait for the fungus-free nails to grow out which usually takes a total of 8 months. 


Benefits to Laser Fungal Nail Treatment: 



1. No Pain: 


The focused, targeted laser light beam will have no effect on healthy tissue, and will only target the infected areas. 

2. Quick and Easy: 

Although specific treatment schedules will be determined by a physician. Many doctors report that it takes approximately 10 minutes to treat infected big toenail. If you have more than one toe infected with toenail fungus, it may take longer. Laser toenail fungus treatment patients generally require up to three sessions.

3. Clinically Proven: 

Clinical studies to date reveal that over 80% of treated patients show significant improvement.  In most cases the nail fungus pathogen is completely eliminated. Please consult with your physician to request the specific clinical results on your particular laser used to treat toenail fungus as different locations may use different lasers. 



4. 3 Months till new, healthy nail is visible: 

On average, any toenail will replace itself every 6 to 9 months through natural growth. Healthy new growth will be visible within the first 3 months as the new nail replaces the old. However, follow up treatment with an anti-fungal cream with L-arginine has shown an increase of up to 100% in the speed of healthy nail replacement. Your podiatrist can make recommendations for a post laser treatment toenail cream. 

5. SAFE: 

The clinical studies on a variety of lasers there have been no adverse reactions, injuries, disabilities or known side effects from use of lasers to treat toenail fungus infection vs the oral nail fungus medication may cause possible systemic involvement (commonly the liver and kidney). This laser toenail treatment does not.  The laser toenail fungus treatment will not harm you in any way. Toenails are dead cells, the laser targets living fungus inside the nail. During the procedure a technician will ask you to indicate any discomfort, and if it is felt will adjust the laser treatment accordingly. Please note that each physician will determine the specific course of action depending on their diagnosis and the equipment involved. 





No drugs or topical ointments are required. Some doctors may prescribe topical or oral medication in conjunction with treatment depending on your situation and their diagnosis, again only a physician can make a diagnosis and determine the treatment for your toenail fungus infection. 




Disadvantage of Laser Treatment: 


The only disadvantage to laser treatment vs other treatments is the cost.  The cost of the treatment vary by factors such as the severity of the infection, thickness of nails and location of the center. 


Currently the laser toenail fungus procedure is not  included as a health insurance benefit in any plan, however, they will cover the costs for the initial consultation and monthly nail debridement.  Insurance plans will consider the laser toenail fungus treatment a cosmetic/aesthetic procedure and therefore does not provide coverage. 

If you have a Health Savings Account (HSA), Medical Individual Retirement Account (Medical IRA) or other Flexible Medical Spending Accounts (Medical FSA), you can pay for the laser fungus treatment with these funds. Otherwise, payment can be made with cash, credit or debit card. 

You need to do your research on the different lasers that are FDA approved for fungal nails. 


Regardless of the type of treatment you choose, good hygiene and consistent follow up treatments are necessary for patients to experience good, long-term results with the elimination of the toe nail fungus. To help prevent nail fungus and reduce recurrent infections, follow these tips: 

1. Keep your nails short, dry and clean. File nails straight across, not rounded, and file down thickened areas. Make sure your feet are DRY after bathing. Don’t cut or pick the skin around the nails.  This can be an open invitation to fungi and bacteria to invade your nail. 

2. Wear socks.  Change them often, especially if you have sweaty feet. Take your shoes off occasionally during the day and after exercise. Alternate open-toe shoes with closed toe. 

3. Use an anti-fungal spray or powder. Spray or sprinkle inside your shoes and your feet. 

4. Wear shoes in public places such as public pools, showers and locker rooms. 

5. Choose a reputable manicure and pedicure salon. Bring your own instruments or make sure the salon sterilizes its instruments. 


6. Don’t hide under nail polish or artificial nails. Although tempting, this can trap unwanted moisture and worsen the infection. 

7. Wash your hands after touching an infected nail. Nail fungus can spread from nail to nail. 


Remember, only you and your podiatrist can decide the treatment options that are best for you. 



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