Nail Fungus, what to do?

December 13, 2004 11:58 PM

FungusFilter:

I have nail fungus on one foot. It hasn't been a problem until now. However, I've started taking ballet classes, and after class, the big toe (with the fungus) hurts like a mofo under the nail. (It's not due to ill-fitting ballet slippers, I checked that with the teacher, and we're not doing pointework, so it's not that either.) This is annoying, and I'd like to get rid of it. (I also don't want to drop the ballet classes.)

Is there any homeopathic/OTC stuff that'll work on nail fungus, or is this a situation that's best handled by a doctor? Anyone have experience with this? I occasionally get Athlete's foot on that same foot, but I've been diligent about making sure it's kept at bay with foot cream. Many thanks!
posted by spinifex23 to health & fitness (36 comments total)

You shouldn't be periodically be getting fungal infections on one foot. I would see a doctor about it.
posted by grouse at 12:34 AM on December 14, 2004

I'd see a doctor if I were you: toenail fungus is often extremely resiliant and can turn into a chronic condition, and the more thoroughly it spreads through your nail, the harder it will be to eliminate. Sometimes topical creams will clear it up right away, but not always, especially since they can't penetrate all the way into the nail. Antifungal pills are the next line of defense (although they're pricey and can wreak havoc on your liver). The last resort is getting your toenail surgically removed - I don't know anything about how that works, but it doesn't sound pleasant...

I know all this because my dad has had a case of it for decades and has been unable to get rid of it with any medication. He just uses OTC antifungal cream and frequent heavy-duty nail trimmings to keep it in check as best he can. I think keeping the nail really short helps ease the discomfort (which is often caused by nails swelling and pressing against shoes more than they should), so you might want to give that a shot.

Here are some suggested natural remedies. I haven't been able to find a page endorsing them that isn't selling something, though.
posted by introcosm at 2:45 AM on December 14, 2004

Vick's Vapor Rub, applied to the toe. This is what my DOCTOR recommended. It will take awhile but from my experience it got better pretty quickly. It needs to be applied daily.
posted by konolia at 3:25 AM on December 14, 2004

I had a severe fungal infection on one big toenail for about 15 years. It varied from awful and totally disgusting to merely very ugly without medical treatment. I finally got sick of it and about 4 years ago, I decided to seek treatment. A dermatologist prescribed either terbinafine (Lamisil) or itraconazole (Sporanox) (we discussed both and I can't remember which it was for sure, although I think it was Sporanox). Rather than take the regular dose for 3 months straight, the dermatologist said I'd get better results by taking a month's worth in a week, then going 3 weeks without medicine, and repeating for two more months. Four years later and my big toenail is still fungus-free and looks almost completely like the one that was never infected.
posted by dmo at 3:52 AM on December 14, 2004

First line treatment for foul and fulminating foot and/or toenail fungus used in Emergency Rooms everywhere is a 15 minute soak in sodium hyphochrorite (common liquid household bleach) diluted to 10% strength. Wash the bleach off, afterwards, and airdry.

Recommendation is to repeat every 3 days for 12 days, then again after 30 days. See your doctor if no improvement is noted within a week. I remind people to do a patch-test on the skin of the top of their foot at least 10 minutes before doing the soak, just to be sure about skin sensitivity.

It is a good treatment for any acute outbreak of fungus (ie athlete's foot).

The usual cautions when working with bleach apply.

The fungal invasion has to be exceptionally severe for oral antifungals to be supplied. As already noted; the nail itself isn't really on the circulation system's path; just the bed.
posted by reflecked at 4:37 AM on December 14, 2004

For the rest of the day i am going to deeply dislike semicolons.
posted by reflecked at 4:40 AM on December 14, 2004

Some people find that the OTC options never clear it out and have to go with the oral prescription meds. As introcosm said, the oral meds are pricey if you don't have insurance and require monitoring your liver function while on the drugs.
If you have insurance, it is not uncommon for the carrier to only cover the medicine if the fungus is in your hand and not if it is only in your foot.
posted by kreinsch at 6:38 AM on December 14, 2004

Dr. Peter Gott always recommends twice-daily Vicks Vaporub as well, after trimming the nail back as far as you possibly can.

If it were me, I'd try that first for a few months. It can't make it any worse and those antifungal drugs are pretty nasty. And chlorine bleach? For me those usual cautions include "don't apply to skin."
posted by naomi at 6:45 AM on December 14, 2004

a side benefit of the oral antifungals: the nail fingus may not go away (mine has recurred, dammit - should have taken one more round of pills i guess, but i thought i was safe) but that athelete's foot? gone! and that's a relief, no more itching feet. the fungus i don't like but have been keeping in check with some trimming.
posted by caution live frogs at 6:58 AM on December 14, 2004

OK - I have a plan to work with, at least.

I'm going to try the Vick's route first. I have to see my doc for other issues, so I can mention this to him when I see him. I'm hesitant to take meds for this because I have a history of getting really bizarre side effects, and I really don't want to possibly tank my liver if I don't have to.

I do know there's a prescription nail fungus drug that you just paint on the nail - I could ask the doc about that as well.
posted by spinifex23 at 7:42 AM on December 14, 2004

Also, you can try soaking it in hydrogen peroxide. That's what my grandma recommends.
posted by dame at 7:46 AM on December 14, 2004

.
posted by geekyguy at 8:04 AM on December 14, 2004

I just wanted to add that many doctors are reluctant to prescribe oral medications for toenail fungus. This is why:

Lamisil side effects are very dangerous and deadly. The FDA found the Lamisil side effects to be so dangerous that a public health advisory warning was issued...

See your doctor and determine what the best course of action is.
posted by sequential at 9:08 AM on December 14, 2004

Is there any homeopathic stuff that'll work on nail fungus?

No. There is no evidence that any homeopathic remedies work for anything, and indeed there is a wealth of data indicating that they are totally worthless.

Introcosm's link is chock full of things that will do nothing but lighten your wallet, and in the case of colloidal silver taken orally, will literally turn your fucking skin gray.

See a dermatologist.
posted by Optimus Chyme at 9:39 AM on December 14, 2004

Never heard of the Vaporub but I tried the bleach (at more like 30%) and it seemed to suppress, not get rid of, the problem. Some recommend also using Tea Tree Oil topically along with the bleach treatment. I tried the Lamasil (5 months) and Sporonox (4 months) - typical course is 3 months for either (I took longer because I got initial scripts filled locally and then a 90-day supply though our carrier's mail-order pharmacy at much reduced cost).

The Lamasil helped greatly but didn't seem to get rid of it. The Sporonox you take for one week and off for three. It seems (possibly in conjuntion with the earlier Lamasil) to have largely done the trick. However, depending on your insurance you may have to get prior authorization from your insurance company for them to cover it (they wanted to talk to the doctor even though he already wrote the prescription!). Otherwise a 1-month supply of either could set you back up to $300. And they are hard on your liver function - requiring repeat visits to the doctor for blood work to monitor your liver enzymes. If you have liver problems or taking other meds that are liver stressors (e.g., Lithium) either may be contraindicated.
posted by Pressed Rat at 10:06 AM on December 14, 2004

I had something like this once and the podiatrist I saw prescribed a clean, nail-polish like thing called Penlac. Not only did it provide the nail some extra strength, it totally cleared it up. However, it did take time. Basically, healthy new nail started to grow, and eventually I'd clipped all of the gnar-gnar away. Can't recommend it enough. I think it's somewhat new, you might want to ask for it. It requires a prescription.
posted by scarabic at 10:07 AM on December 14, 2004

that's "clear nail-polish-like"
posted by scarabic at 10:07 AM on December 14, 2004

Oh and FWIW I only went to the podiatrist after trying every single non-prescription foot-fungus killer I could find. I even peed on my foot in the shower based on someone's home-remedy advice. There: that's a double dose of TMI.
posted by scarabic at 10:08 AM on December 14, 2004

Lamisil side effects are very dangerous and deadly. The FDA found the Lamisil side effects to be so dangerous that a public health advisory warning was issued...

Interesting. I was going to remark about that page not mentioning Sporanox, but then I found the FDA Advisory. Looks like they now recommend that a nail specimen be sent to a lab for better diagnosis before prescribing the medicine.
posted by kreinsch at 10:13 AM on December 14, 2004

In my experience, the oral fungicides did nothing except make me worry about liver damage. I used a generic over-the-counter paint on fungicide, and now my toe is normal. However, it takes a loooong time for it to work: the nail has to grow out completely before the danger of re-infection is gone, and that usually takes at least six months.

P.S. Optimus Chyme, you need to do a little more research on homeopathy. Have you ever tried it for anything yourself? Actually talked to a naturopathic doctor about how they work? Or are you just having a knee jerk reaction because it sounds so unlike your experience with medicine?
posted by Specklet at 10:32 AM on December 14, 2004

Specklet: If Optimus Chyme had tried homeopathy and declared that it hadn't worked, would you then decide that it was completely useless? If not, then whether he has tried it is irrelevant.

There is an extensive article on Wikipedia about homeopathy:

The homeopathic concept of disease differs from that of conventional medicine—the root cause of disease is believed to be spiritual rather than physical, and a disease is thought to manifest itself first in emotional symptoms (e.g. cravings, aversions) and if left untreated gradually progress to mental, modal and finally physical symptoms. As the disease process is thought to begin long before any physical manifestations appear, it logically follows that homeopathy regards bacteria and viruses as effects, not causes, of disease.

If you believe that spiritual causes rather than physical causes are the reason for disease, praying is a lot cheaper than homeopathic "remedies."
posted by grouse at 10:56 AM on December 14, 2004

Grouse, although there is a derth of information in the article, Wikipedia's root definition of homeopathy is not entirely accurate. No naturopath I've consulted has ever referred to the cause of illness to be spiritual in nature. Homeopathy is not a philosophy. Try here, here, or here for more accurate definitions of what it is and how it works.

I didn't mean to jump on Optimus Chyme about whether he had tried homeopathy or not. Sorry. It's only that, in my experience, when someone discounts an entire field of medicine, they are rejecting the possibility that there might be something they don't know about the field... Sure, you can find articles on why homeopathy doesn't work, but you can find just as many articles on why aspects of any health care system doesn't work.
posted by Specklet at 11:25 AM on December 14, 2004

Homeopathic preparations treat symptoms with substances that are known to cause the same symptoms which have been diluted beyond any hope of effectiveness on the theory that the "spiritual essence" of the substance will be transferred to the diluting agent by a series of good hard whacks. The more you dilute the substance, the more potent it supposedly becomes, thanks to all the essence getting knocked around (apparently, the more you whack a molecule, the more essence comes out). The most diluted preparations are said to work directly on the spiritual plane, which is tantamount to admitting that they work via the placebo effect.

If you know how homeopathic medicines are prepared, and yet still believe homeopathy works, well, pull the other one, because the only way you could possibly believe homeopathy would work is if you don't know how the preparations are made or else are completely ignorant of science.

Now there are some things that claim to be homeopathic (i.e. Cold-Eez zinc tablets have, or at least had, a big "HOMEOPATHIC!" label on the box) but do in fact contain effective amounts of actual ingredients. That's just marketing. Cold-Eez are made in a factory using a clinically-tested amount of zinc gluconate glycine. No whacking of spiritual essence is involved.

I am unaware of any homeopathic preparation that has been proven in a double-blind clinical trial.
posted by kindall at 11:29 AM on December 14, 2004

I don't buy into the spiritual wack thing. What I mean to say is, the remedies I take may be diluted and agitated, but whether or not they're "spiritualized" I have no idea. All I know is: it works. For me, it works.
posted by Specklet at 12:12 PM on December 14, 2004

On Belmont street in Portland there's this house with a huge homemade plywood sign in it's front yard

"Fungus under the nails?
Try Malaleuca Tea Tree Oil!"

I have no idea if it works or not but, after years of seeing that sign, damned if it's message hasn't bored it's way into my brain... and forced me to pass on it's wisdom.

(Also, Men Below, Please Don't Throw)
posted by blueberry at 12:16 PM on December 14, 2004

Specklet, what's the name of the OTC 'paint on your nails' substance?

I had tried tee tree oil in the past, but gave it up after a few days. Made my feet and shoes stink to high heaven.
posted by spinifex23 at 12:21 PM on December 14, 2004

Spinifex, I think it's called "Funginail." (How's that for a moniker?) I feel pretty sure that any OTC paint on stuff will have the same primary active ingredient... Just be paitient and diligent in your application.

And Blueberry, I've seen that sign!
posted by Specklet at 12:36 PM on December 14, 2004

Specklet: you're welcome to believe what you want works for yourself and spend your own money on it. It is irresponsible to recommend something unproven to others with medical problems when they should be seeing a physician. As others have said, screwing around with this stuff could result in the loss of your toenail.

If you insist on doing something that has no proven medical value, I would suggest prayer healing instead. It's the most popular form of alternative medicine. It's cheaper than homeopathy, and I'd imagine more people say "it works" for them. If individual testimonials on what "works" is a rational way to decide on a course of treatment, then clearly you should go with what is most popular.

If you think that is whack, then you should get to a real doctor.
posted by grouse at 1:05 PM on December 14, 2004

Grouse: First of all, I did not recommend that Spinifex take any homeopathy. In fact, I mentioned that I had used an OTC paint-on medication. Second of all, although there are indeed numerous articles debunking homeopathy, there are just as many articles stating that the remedies are effective and why. Mostly, though, I'm relying on my own experience here, which (thankfully) has been very positive. Thirdly, get off the prayer healing kick. Believing in that there is a medical use for homeopathy does not equate a belief in faith healing.
posted by Specklet at 1:18 PM on December 14, 2004

First of all, I did not recommend that Spinifex take any homeopathy. In fact, I mentioned that I had used an OTC paint-on medication.

You are totally right. I'm sorry I implied anything else.

I should note, however, that the FDA has officially prohibited the manufacturers of Fungi-Nail from claiming it is an effective treatment for nail fungus. I'm glad it worked for you, though.

Believing in that there is a medical use for homeopathy does not equate a belief in faith healing.

No, and from your responses I wouldn't guess that you believe in the effectiveness of prayer healing. But the logical process you use to arrive at that belief works just as well (in fact, better) for prayer healing. You should either switch to a prayer healing regimen or acknowledge that choosing medical practice based on anecdotes and testimonials is absurd.
posted by grouse at 1:56 PM on December 14, 2004

It's all good. In fact, I'm loving this discussion - thanks.

I'm not against homeopathic treatments for non-serious ailments. In fact, I prefer them sometimes, like when I have a cold or a stomach ache/nausea. Asthma? I'm seeing a doc and taking hardcore meds. Bum toenail? I'm willing to try the Vicks Vap-O-Rub route before seeing a doctor (Who I'll be seeing in a month or two anyway).

I'm hesitant about the prescription meds because, while I'm sure they work, I don't know if insurance will pay for them, and I don't want the punishment on my liver. But I'm not against the pills as a last resort.
posted by spinifex23 at 2:34 PM on December 14, 2004

A note on Fungi-Nail (that name still cracks me up): I don't care if the FDA prohibits a claim on its efficacy. (If I believed everything the FDA told me about drugs, I might have believed Vioxx was a safe and effective drug.) Even if you take the statistics in this article with a grain of salt, one must admit that the fact that the FDA is even partially funded by drug companies is suspect.

But that's a debate for another day.

Grouse: I'm not sure where you got the idea that I decided to use homeopathy based on others' testimonial, and this seems to be your main contention. Rrrr. I never stated that I choose to use homeopathy in this manner. I use it and condone it because it has worked for me, in treating everything from earaches to anxiety. I was initially introduced to it by a medical doctor, ironically enough.

This thing you're stuck on about prayer healing: despite the website you linked to, prayer is not commonly accepted by practitioners of allopathic medicine, as compared to the acceptance of the validity of diet as medicine, acupuncture, chiropractic treatment, Aurvedic and Chinese herbal medicine, and homeopathy. I visit a naturopathic doctor (and yes, she is an MD), and while she may recommend one or more of the above, she would never recommend prayer. I wouldn't trust anyone who would.

I'd be willing to wager that you, Grouse, don't believe that any so-called alternative health practices have any "proven medical merit". Of course there is a time and place for allopathic medicine! (I wouldn't call my herbalist if I got hit by a car.) But I am frustrated by this traditional Western medicine fundamentalist attitude. "Well, it's nice you think it worked for you, dear, but if you can't measure the effects with a thermometer or a CATscan, it just don't jive for anyone." There's more out there than can be explained by traditional medicine, folks. Anyone who is sure they know all the ways in which all alternative medicines are proven ineffective is just plain arrogant. To believe that all the people who have been treated with non-allopathic medicine for the past few thousand years (and have improved) are all experiencing some sort of placebo effect is absurd.

Incidentally, Spinifex, asthma is one of those ailments that's considered to be systemic by naturopathic doctors, and can respond quite positively to holistic treatment.
posted by Specklet at 3:32 PM on December 14, 2004

Using a combination of low-concentrated vinegar as a wash on the toenail and vapor rub worked here. I also bought tea tree oil spray for regular use and haven't had a reoccurrence since.
posted by nuala at 4:57 PM on December 14, 2004

I honestly have no idea why you started with homeopathy. I do know that the main justification you have provided for others to use it is that "it works" for you. And presumably others, but not in a way that can be measured in a blind clinical trial.

Homeopathy is not commonly accepted by medical doctors, so please don't conflate it with things like acupuncture or herbal medicine. Things that have proven merit have and will be accepted into conventional medicine. In particular these include certain dietary and herbal supplements. Science and legitimate medicine are self-correcting.

Certainly we do not understand everything about how the human body works. A detailed explanation of the mechanisms involved in a treatment is persuasive, but not necessary. What is important is that the treatment actually works, although this must be proven through controlled experiments and not mere anecdotal observations.

Again, mainstream medicine is self-correcting. But is alternative medicine? It is conceivable that you could show medical doctors that homeopathy is effective, and what you would need is outlined above. Could you prove to homeopathic practicioners that it is no more effective than a placebo? What would be necessary for them to believe that? If that can't be done, or they refuse to examine the question, then it is obvious which side stubbornly relies on faith rather than evidence.

As a sidenote, the use of the word allopathy to refer to mainstream medicine is incorrect, and was originally used exclusively by advocates of unconventional medicine. There are plenty of labels that, while useful for rhetorical purposes, I have refrained from calling homeopathic practicioners during this discussion and you should really do the same.
posted by grouse at 5:19 PM on December 14, 2004

Ah, but there have been double blind clinical trials that have proven its efficacy. But not many. And here’s why.

You're not going to like this, but the reason that there are not many trials that prove the efficacy of homeopathy is because the trials are not taking into account that homeopathy is not a one-size-fits-all medicine! You can't test remedies in the same manner in which traditional medicine’s drugs are tested, because they aren't prescribed in the same manner. As this guy says:

In homeopathy, there is no such thing as giving a remedy for a specific ailment or disease.

In other words, you can't take a hundred people with bronchitis and give them all the same particular homeopathic remedy. Each individual would need to be prescribed a remedy tailored for them specifically, taking into account their “totality of symptoms.” Also complicating the issue is the fact that homeopathic remedies tend to exacerbate the symptoms briefly when initially taken. For a naturopathic doctor, this is a good sign that the appropriate remedy has been chosen, while for a traditional medical doctor, this is a bad indicator that the penicillin, let’s say, is working.

To believe that homeopathy needs to be tailored to each individual doesn't take a leap of faith, it only takes an understanding of how the remedies function. Unlike traditional medicine, alternative medicines treat the patient holistically. (Or, sorry, I won't say all alternative medicines, I'll just keep it to homeopathy.) Homeopathy prescribes remedies on a constitutional basis, treating the entire individual, their symptoms and modalities. To find the correct remedy (or combination of remedies, as is often the case), the patient’s symptoms are noted, but also noted is their overall constitution, lifestyle, and mental state. A brief example can be found in this article:

For example, a homeopath would treat a patient with a cold whose primary symptoms are lacrimation, stinging and irritation of the eyes, and thin, clear nasal discharge with a potency prepared from onion extracts (Allium cepa) because these symptoms mimic those produced by onions.

However, another patient with a cold might have thick, yellow nasal discharge, have lost all thirst, and want cool, fresh air. That person would be treated with a potency of the purple cone flower (Pulsatilla) because these symptoms are more characteristic of those produced by this plant. Both patients have the same diagnosis (upper respiratory tract infection), but each is treated with a different homeopathic drug based on their characteristic symptoms.

This is radically different from the approach of traditional medicine, and I can see how people might have a hard time wrapping their brain around it.

What needs to happen here is that a method of testing be developed that will satisfy the scientists’ needs for a traditional clinical trial, while at the same time, taking into account that homeopathic treatments must be tailored for each particular test subject. The few tests that have been conducted in this way have shown homeopathy to be significantly more successful than a placebo.

This article sums it up nicely:

Despite skepticism about the plausibility of homeopathy, some randomized, placebo-controlled trials and laboratory research report unexpected effects of homeopathic medicines. However, the evidence on the effectiveness of homeopathy for specific clinical conditions is scant, is of uneven quality, and is generally poorer quality than research done in allopathic medicine (61). More and better research is needed, unobstructed by belief or disbelief in the system (62). Until homeopathy is better understood, it is important that physicians be open-minded about homeopathy’s possible value and maintain communication with patients who use it. As in all of medicine, physicians must know how to prevent patients from abandoning effective therapy for serious diseases and when to permit safe therapies even if only for their nonspecific value.

As time goes by and more and more people use homeopathy, the testing methods will get better. In the meantime, I will continue to use the remedies. If you still want to chalk it up to a placebo effect, well, just wish me good health. However, I'll say what I said before: if you think that all the positive results from alternative medicines are all due to the placebo effect, you're in denial.

Oh, and I do apologize for the incorrect use of the term “allopathy.” I honestly meant nothing derogatory towards traditional medicine; and was unaware that it carried negative connotations. (You needn't be so preachy about, though. I really am enjoying the debate, despite our butting heads.) Apparently, I'm not the only one to misuse it, the medical doctor I quoted above used the term in his article to mean traditional medicine. Heh.
posted by Specklet at 11:46 AM on December 15, 2004

One more thing. Spinifex, I was glad that you said you were enjoying the discussion; I didn't mean for your question to turn into a debate about homeopathy...
posted by Specklet at 11:48 AM on December 15, 2004