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How to Treat Toenail Fungus

Toenail disorders are rarely disabling or even painful. But they are a nuisance. One of the most common problems is toenail fungus (medical name onychomysosis)about 15% of people have it, including nearly half of those over 70. The toenail, particularly on the big toe, thickens and discolors; the end may separate from the nail bed. You notice debris when you cut the nail, which is often so thick you can't cut it. In severe cases, the nail may detach and fall off. Diabetes increases your risk for toenail fungus (and other foot disorders); so does smoking and being over 60. Thickened, discolored toenails, whether they hurt or not, are an unwelcome development, especially in an age where sandals are popular and people want to look young.

There's plenty of hearsay about remedies. Some popular measures, such as dipping the toes in bleach, can be harmful. Others, such as a daily application of Vicks VapoRub, are merely ineffective or unproven. Some people swear by Campho-Phenique, tea tree oil, toothpaste applied with a toothbrush, or soaking the toe in rum or sea water. Drugstores and health-food stores sell salves and potions. Such remedies may seem to work, since toe-nail fungus eventually gets better (and worse) on its own. None of them can actually penetrate to where the fungus is.

If you try to treat your toenail yourself, avoid anything abrasive, flammable, or highly toxic, or any substance likely to irritate the skin. Damaging your skin will only help the fungus to flourish. Applications of vitamin E are useless and can cause rashes.

Medication options
There's a choice of prescription pills to treat toenail fungus: fluconazole (Diflucan), itraconazole (Sporanox), terbinafine (Lamisil), and others. They do have drawbacks: you need to take them over several months, and a full course of treatment can cost up to $1,500. Sporanox costs more than $100 a week. Side effects may include liver and kidney problems, nausea, and headache. You'll need blood tests to monitor liver function. The drugs can interact with many medications, notably cholesterol-lowering drugs. They don't work for everybody, and even if they do work, the fungus may come back. There's also a toenail lacquer, ciclopirox (Penlac), requiring up to 48 weeks of treatment. It helps, but may not cure. It's somewhat less expensive than the pills.

When to see a doctor
If you have diabetes or circulation problems and are therefore more vulnerable to foot infections, or if your toenail is really painful, get medical advice. A doctor can accurately diagnose the condition. It may look like a fungus, but could actually be eczema or something else. You may decide to take a prescription drug. In extreme cases, surgical removal of the nail may be necessary.

The best steps
Avoid getting athlete's foot, since the fungus may spread to the toenail: wear rubber shoes in public showers, and practice good foot hygiene. The truth is, though, that anybody can get toenail fungus, with or without athlete's foot.

Here's how to care for your feet:
Wash them daily and dry thoroughly between the toes.
Wear well-ventilated shoes. Make sure they fit. Avoid pointy styles and other toe-crushers.
Wear socks made of synthetics that draw moisture away from your skin. Cotton is not as good.
If your feet sweat a lot, try an antiperspirant on them.
Cut toenails short and straight across. It's okay to apply nail polish to cover up the discolored nail.
If you do have toenail fungus, gently remove debris from under the nail with an orange stick (used for manicures) once a week.
Go barefoot and/or wear sandals when you can. Fungi thrive in dark wet places.
If you share pedicure tools with your family, wash and disinfect the tools (dip them in alcohol) after use. If you go to a nail salon, make sure the tools are disinfected, or bring your own.

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