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  • Rocky Mount Telegram

    Ask the Doctors: Toenail fungus treatments limited but evolving

    6 days ago

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    Q I have been dealing with toenail fungus on just a single toe for more than a year. There is a mountain of misinformation about it on the internet, and I keep seeing ads for all sorts of drugstore products that claim they can cure it. Any suggestions for how to deal with this?

    A You are asking about a topic that, each time we have written about it in the past, brings a flood of mail. Toenail fungus is a common — and very stubborn — infection. Also known as onychomycosis, it is estimated to affect between 6 million to 7 million people in the United States. Although the effects are visible on the exposed part of the nail, the fungi that cause the infection are housed within the nail bed. And because our nails are so well-engineered to shield the tips of our toes from potential threats such as moisture and trauma, the fungi that take up residence beneath them are largely protected.

    When it comes to treatment, the options are somewhat limited. The topical nonprescription ointments and liquids you have been seeing can make the nail look better. However, the protein that makes up the nail plate, which is known as keratin, is not porous. That means topical medications can’t reach the entire site of the infection.

    A more effective approach has been an oral antifungal medication, which requires a prescription. The medication enters your blood stream and is delivered to the blood vessels that serve the nail bed. As with many medications, antifungals have potential side effects. These include headache and stomach upset. These meds can also affect the liver, which makes liver function tests necessary. The treatment, which lasts several months, is up to 80% effective.

    More recently, the use of lasers to treat toenail fungus has grown in popularity. This requires multiple treatments and, because data is somewhat limited, the efficacy is not yet clear. An even newer approach, known as cold atmospheric pressure plasma, is now being explored. Also referred to as CAPP, it involves the use of a device that delivers shock waves, which researchers say are effective at killing the fungus. This treatment is still being studied and is not yet in use.

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