ASK DR. H: What is best cure for nail fungus?

Q: Could you please tell me how to get rid of toenail fungus? — T.D., Wilkes Barre, Pa.

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A: Toenail fungus is a very stubborn problem. Fungi enter the nail either through the cuticle or under the tip of the nail. They easily attack the nail, thriving off “keratin,” the nail’s protein substance.

When the tiny organisms take hold, the nail may become thickened, yellow-brown in color and foul smelling.

To get rid of toenail fungus, the best treatment is a three- to four-month course of an antifungal pill like Sporanox or Lamisil. Over-the-counter antifungal sprays and creams just don’t work. Antifungal nail paints like Penlac are not very effective but may be of additional benefit when combined with antifungal pills.

Aggressive debridement of nail fungus by a podiatrist followed by antifungal pills seems to provide additional benefit over antifungal pills alone.

The PinPointe laser system is a new option in treating nails refractory to standard treatments.

There are all sorts of home remedies, ranging from bleach to Vick’s Vaporub. I can’t recommend them because the safety and effectiveness isn’t proved. Creams, sprays and soaks don’t work on toenail fungus because they can’t reach organisms that are deep within the nailbed.

In some stubborn cases, much as it pains me to say it, the only way to get rid of toenail fungus is to remove the nail. By doing that, a topical antifungal cream along with pills can have a good shot at getting rid of the fungus.

Q: I recently read about a study that showed that most people who have had knee replacement surgery gain weight rather than losing weight afterward. Why do you think that is so? — P.O., New York, N.Y.

A: You would think that overweight people with severe osteoarthritis in their knees would, if given the opportunity to walk and exercise again, lose some of the additional weight that resulted from limited mobility. But according to a recent study conducted at the University of Delaware (Jan. 15 issue of Osteoarthritis and Cartilage), most folks after knee replacement surgery dropped weight while receiving post-op physical therapy but gained an extra 14 pounds over the next two years. What appears to be the case is that the sedentary lifestyle that folks have because of their degenerative knees is a tough habit to break — even when given a second chance — and the excess calorie consumption and poor dietary habits that caused them to become obese in the first place still remain.

An important reason gaining weight after a total knee replacement is a cause for concern is that it will greatly increase the chance that the other knee will soon need replacement.

An important conclusion from this study is that weight gain after surgery needs to be treated as a separate concern and integrated into the usual post-op care through nutritional counseling and retraining patients to encourage a more active lifestyle.

Dr. Mitchell Hecht is a physician specializing in internal medicine. Send questions to him at: “Ask Dr. H,” P.O. Box 767787, Roswell, GA 30076. Because of the large volume of mail received, personal replies are not possible.

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10 comments Add your comment

sabika

March 3rd, 2010
9:44 am

hi
i am from pakistan dr i have fungule infaction( nailfungule) sometime feel pain and it has 6 to 8 months plz
tell me any home remedy i am from pakistan
plz help me about fungule
thanx

jwc

March 3rd, 2010
10:43 am

Surely you’re joking, doc: you can’t verify the safety of putting Vicks Vaporub on toenails? Come on….

I CAN verify that its safe and effective. I can also verify that using a 50-50 solution of water and hydrogen peroxide works. But the process is slow regardless of which one you use. You’ve got to be as tenacious and consistent as the fungus itself is, so prepare for many months of treatment. But they DO work.

jwc

March 3rd, 2010
12:46 pm

In my previous note, I forgot to point out something else you neglected to mention, doc: that people who use Lamasil and Sporanox may suffer serious side effects, from liver damage to irregular heartbeats and even death. While admittedly rare, these are serious considerations — as is the cost of the drugs. One estimate I saw put the cost of using Lamasil at $700.

Katherine

March 4th, 2010
10:54 pm

Consider tea tree oil. It is a great natural medicine. Apply it to your nails. It’s also great for cleaning your house – put a few drops in water, and wash baseboards, windowframes, etc., in order to get rid of mold. Do some research on it and make your own decisions.

Dan

March 5th, 2010
5:34 pm

jwc – Thanks for the input !!
Another point… that $700… According to my Doc, that is per month, however long it takes and “most” insurance plans will not cover it, calling it an “elective” cosmetic issue as opposed to a medical one… Go Figure !!

ANON

March 10th, 2010
10:24 am

VICKS WORKS!! Doctors are pathetic. The “safety” of Vicks??? How about the mile long list of warnings on the drugs they write scripts for by the millions every single day!!??? It really is enough to make a person sick!

Len

March 15th, 2010
9:48 pm

I had two cycles of oral Lamisil both of which eliminated my toenail fungus. But each time it returned. The first time I was careless and kept my old (infected) shoes. But after the second regimen I got new shoes, changed socks daily, sometimes twice daily, and daily used fungicides on my cuticles and nail tips. But the fungus is returning a third time. Are repeated regimens of Lamisil cumulatively harmful healthwise? I am ready for a third cycle but concerned about side effects.

kiran

June 9th, 2010
5:38 am

The best for toenail fungus is Zetaclear from http://www.toenailfungusonline.com. Its really an amazing product. I am already used this one. I am really happy with this.

prasad

July 30th, 2010
7:11 am

Yes, i am also heard about zeta clear. Its really amazing product. One of my friend also used that.
http://www.herbalvigaplus.com

Eric

August 30th, 2010
12:37 pm

ou’ve got to be as tenacious and consistent as the fungus itself is, so prepare for many months of treatment

http://www.ambiengeneric.com/