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Posted: October 29, 2008

No Simple Solution for Toenail Infections

More Common with Age

A thick, crumbling yellow toenail is probably not high on the list of major health concerns, but your loved one will feel better and look better if it’s cared for.

Most often, the cause for a thick nail is a fungal infection. The infection can continue indefinitely if not treated. Even with treatment, nail fungus can be difficult to clear up.

Fungal organisms find their way into the skin through thin breaks or even a small separation between a nail and the nail’s bed. Fungi don’t need sunlight to survive and do very well in warm, moist environments. For example, warm toes encased in a dark shoe or always under bed covers are an ideal setup.

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The infection is more common in seniors, in part because of decreased resistance to infection due to diabetes, circulation problems or a weakened immune system. Other risk factors include wearing shoes that don’t “breathe” and socks that don’t absorb perspiration.

The first sign of fungal nail infection -- the medical term is onychomycosis -- may be a yellow or white spot under the nail’s tip. Over time, the nail may thicken, become crumbly or ragged or may start to separate from the nail bed.

If a nail isn’t painful or too bothersome, some people opt not to treat the fungal infection, instead watching for troublesome changes and carefully filing the affected nail to keep it trimmed and thinned. Treatment options include:

Self-care: Any nonprescription antifungal cream applied to the nail’s surface could improve a superficial infection. Other topical treatment options are Vicks VapoRub, tea tree oil or white vinegar; however, no rigorous studies have shown that these approaches work.

Antifungal oral medications: Two commonly prescribed medications are itraconazole (Sporanox) and terbinafine (Lamisil). Fluconazole (Diflucan) is another option. Typically, these medications are used for six to 12 weeks. Results aren’t evident until complete nail re-growth, which can take about a year. Treatment success rate is 40%-90%. For people over age 60, success rates are 60%-64%. Among those successfully treated, 15%-20% will have a recurrence.

These medications can have serious side effects. They include heart failure, liver damage, liver failure and possible adverse interaction with other drugs, including some blood thinners and cholesterol-lowering drugs.

Antifungal nail lacquer: Ciclopirox (Penlac) may help if the infection is superficial and does not affect the nail bed. Treatment involves coating the nail daily for a year. The cure rate is about 10%.

– Source: Mayo Clinic Health Letter

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