A quick search on Google will uncover many stories about people treating themselves with bleach and miraculously getting rid of fungus within a week. A typical Toenail Rot Cure recipe would include dipping toes into undiluted bleach for 5 minutes 2-3 times a day for a week or so. Done and over with and no recurrence. Ever!

I’m happy for those who have been cured. Most likely these people (if the story is true to start with) did not suffer from nail fungus (onychomycosis). Bleach just whitened the nail, which could have been discolored for a hundred reasons – other than toenail fungus.

Any nail treatment that actually kills fungus relies on a new nail growing in and replacing the old, infected nail. Provided that the fungal spores and all dermatophyte activity has been eradicated and risks of reinfection from the patient’s immediate environment has been removed the new nail will completely grow our in 10-14 months.

On the other hand, I’ve had quite a few people come into my office with open sores caused by chemical burns on the skin from using undiluted beach that take weeks to months to heal when applied for nail fungus. The risk of all kinds of infections is very high for the people with these sores. I am strongly against the use of any chemicals on the skin, but bleach is arguably the most dangerous one.

Mark Leitner, DPM
Advanced Podiatry Associates
Brandon, FL

The fact that shoes harbor microorganisms has been well established; the journal article cites three previously published studies to this effect. For this study, Dr. Mahmoud Ghannoum designed a repeatable way to culture shoes and then successfully tested the ability of the SteriShoe ultraviolet shoe sanitizer to decontaminate the shoe.

The study, which involved scraping material from the shoe, showed that the SteriShoe sanitizer destroyed, on average, over 80% of the microorganisms in the shoes. Dr. Ghannoum states “these finding have implications regarding breaking the foot infection cycle.”

Dr. Ghannoum is the Director of the Center for Medical Mycology and Mycology Reference Laboratory, University Hospitals of Cleveland and Case Western Reserve University. Dr. Ghannoum has spent a career working with onychomycosis and is the President of the Medical Mycology Society of the Americas; a Fellow of the Infectious Disease Society of America; he has been a reviewer and editorial board member for over 40 journals and publications; conducted clinical studies for the top prescription oral antifungal medicine; and he has authored over seven articles regarding Onychomycosis, four of which have been published in the Journal of the American Academy of Dermatology.

I have to give these guys a credit for publishing (quite seriously) the most ridiculous treatment method to get rid of a fungal infection.

The article starts out with the standard paragraph about ugly nails and then goes on to an intriguing solution kick-off: “So if you don’t wish to take a prescription medication as recommended by a doctor, what do you do? Fortunately there is another option for folks who prefer the homeopathic approach to medicine.”

The author claims that combining a stout beer (Guiness is the best, of course) with white vinegar and acidophilus you can create a magical medicinal soak right in the comfort of your home!

Among other pseudo-scientific allegations there is one I like the most: this potent nail fungus soak allows “the acidic environment to permeate (enter) the nail in order to do its job”. First of all, you do not need to “permeate the nail” because dermatophytes that cause the nail damage reside in the nail bed and the root of the nail – unreachable even for the darkest and the most full body beer in the world! Secondly, Some of the best minds in R&D departments of very well funded pharmaceutical giants have been trying to figure out an effective way to get under the nail and deliver medication to the nailbed to do its lethal job on dermatophytes – but sadly have failed so far. Do you seriously think scientists don’t drink beer? Or don’t know what’s in it? You cannot be serious!

According to the author, “Once you have made this mixture, the same batch can be used repeatedly for up to 48 hours. Don’t throw it out right away.” Considering that you have to soak your feet twice a day (each time for 30 minutes) for about 6 months, you’ll need a lot of beer and vinegar! So save a lot on reusing the mixture for two straight days! Beware though: don’t use on a third day! Life goes on in that mixture, and you can’t even imagine what you can find in the soak a few days after preparation. Baby alligators infested with fungus may start popping out in a couple of weeks!

Contrary to the author’s prescription quoted above, “This treatment should start to show efficacy within one week to one month, depending on the individual and the severity of the fungal infection. The treatment is most effective if strictly adhered to instead of missing regular treatments.”

Good luck! I just have one modest recommendation: after six months of the program and wasting over 330 bottles (I calculated at least 55 6-packs) go see a podiatrist or a dermatologist that offers a laser assisted treatment plan in your area. Cost? The beer soak will cost you about $800. Three or four medical treatments will cost about the same, but save you 360 hours or more. Get serious! Life is short – don’t waste beer and your time.

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Image: Filamentous Fungi (Dermatophytes) / MicrobeLibrary.org

Dermatophytoses are prevalent, prompting well over four million physician visits annually in the US.¹ In the general population of the US, data suggest that onychomycosis is most common (23.2 percent of all dermatophytoses), followed by tinea corporis (20.4 percent), tinea pedis (18.8 percent), tinea capitis (15 percent), and tinea cruris (8.4 percent).¹

Reliable recent data for disease prevalence among athletes are not available, though it seems from clinical experience that superficial cutaneous infections—tinea pedis, tinea cruris or “jock itch,” tinea corporis, tinea faciale, and tinea manus—are more common complaints among athletes than is onychomycosis.

Consider that the term “tinea gladiatorum” has been applied specifically to tinea corporis caused by the dermatophyte Trichophyton tonsurans in competitive wrestlers.² And in one recent survey, 69 percent of professional soccer players, 69 percent of male college soccer players, and 43 percent of female college soccer players were found to have tinea pedis, compared to just 20 percent of male non-athletes and none of the female non-athletes.³

Several factors contribute to the increased incidence of dermatophytoses in athletes. Dermatophytes thrive in the moist environments that perspiration creates in skin folds and interdigital skin spaces or athletic equipment. Furthermore, there may be enhanced opportunity for the spread of infection between sport enthusiasts: Athletic shower rooms are a confirmed source of dermatophyte infections.⁴ Additionally, dermatophytes may colonize footwear or other athletic equipment that may be shared by individuals. Improperly laundered towels, socks, or other items may harbor dermatophytes and facilitate infection spread.⁵ Rarely does the diagnosis of tinea pose challenges for the clinical dermatologist. Treatment, however, can be a different matter. Most cases of dermatphytosis can be managed with topical antifungals (Table 1). Oral antifungals typically are reserved for extensive or chronic involvement or when application of a topical agent is physically challenging for the patient.⁶ Treatment must be selected that is expected to address the causative organism and in a vehicle formulation that the patient can easily apply to the treatment site. A broad-spectrum antifungal is preferred and is especially important in the case of inflammatory, malodorous presentations of tinea pedis, because the conversion from a scaling, erythematous presentation to a more macerated, malodorous, symptomatic process indicates that bacteria have proliferated.⁷

Allergic contact dermatitis of the feet or hands may mimic tinea pedis or manuum, respectively, and must be considered in the differential diagnosis. Of note, a dermatitis that develops on both hands and both feet is more likely to have a systemic cause rather than to be an allergic contact dermatitis.⁸ Conversely, involvement of two feet and one hand suggests a primary fungal infection of the foot that has been transferred to one hand only.⁹ Why the other hand is not involved is still a puzzlement.

Strategies to prevent recurrence or subsequent infection are as important as medically treating the dermatophytosis, though some proposed strategies may be unrealistic for patients. (See sidebar.) Simple preventive strategies have been shown effective. Wearing clean socks (but not stockings) was shown to prevent passage of dermatophytes from colonized shoes to the feet.¹⁰ In addition to wearing shower shoes, individuals with healthy feet who use public showers should wash the feet with soap and carefully wipe and dry the feet to remove any adherent dermatophytes. Laundering at temperatures of 140 degrees F or higher can remove or kill T. rubrum and C. albicans.¹¹ This is a standard temperature for home water heaters, so residential washing machines can achieve this temperature. Permitting shoes to dry thoroughly before wearing them again may also be effective for reducing dermatophyte transmission.

Prophylactic topical antifungal therapy applied at intervals may be indicated for those at high risk for or with a history of recurrence of dermatophytosis.

Tinea pedis or manuum may provide a reservoir of dermatophytes leading to onychomycosis, though in some cases nail involvement is a primary presentation. Development of topical therapies for onychomycosis has proven challenging, due to the difficulty of penetrating the nail plate to deliver drugs to the nail bed, the site of infection. Therefore, systemic antifungal therapy has been the mainstay of treatment. Although systemic terbinafine and itraconazole are shown to be effective and generally safe for the management of onychomycosis,¹² there are potential risks associated with therapy.¹³ Given this albeit very low risk, some patients prefer to avoid or postpone systemic therapy.

For distal subungual onychomycosis, a topically applied, low-viscosity, alcohol-based antifungal solution (sulconazole nitrate 1%, Exelderm, Ranbaxy Laboratories) may offer benefit when properly applied. Therapeutic success requires that the patient deliver the solution directly into the nail bed by placing the toe or fingernail in an upright position then instilling one to two drops subungually between the nail plate and nail bed. The patient should hold the toe or finger in an upright position for 30 seconds, to allow gravity to pull the active agent into the nail bed. Treatment should be applied twice daily. Coexistent tinea pedis or manuum must be managed to minimize the risk of re-infection of the nail.

Superficial cutaneous yeast infections may be predominantly caused by Candida. Among immunocompetent individuals, candidiasis may be especially common in the inframammary folds or genital crease region (more so for women than men). Culture can be used to distinguish Candidiasis from dermatophytosis. Topical antimycotics are standard treatment for candidiasis, particularly clotrimazole or ketoconazole. Oral fluconazole is the primary systemic agent with anti-Candida activity.

Another yeast infection that may affect athletes is Malassezia folliculitus (previously called pityrosporum follicultius). Papulopustules are found in a follicular pattern on the back, chest, upper arms, and, occasionally the neck, and face into the scalp. Monomorrphous erythematoid papulpustules measure 1-2mm in diameter and are frequently misdiagnosed as acne vulgaris. The yeast is ubiquitous on the skin and its growth is encouraged by heat. Moisture, friction, occlusion, sweating and increased oil production appear to contribute to exacerbation.

1. Panackal AA, Halpern EF, Watson AJ. Cutaneous fungal infections in the United States: Analysis of the National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS), 1995-2004. Int J Dermatol. 2009 Jul;48(7):704-12.
2. Kohl TD, Lisney M. Tinea gladiatorum: wrestling’s emerging foe. Sports Med. 2000 Jun;29(6):439-47.
3. Pickup TL, Adams BB. Prevalence of tinea pedis in professional and college soccer players versus non-athletes. Clin J Sport Med. 2007 Jan;17(1):52-4.
4. Watanabe K, Taniguchi H, Katoh T. Adhesion of dermatophytes to healthy feet and its simple treatment. Mycoses. 2000;43(1-2):45-50.
5. Hammer TR, Mucha H, Hoefer D. Infection risk by dermatophytes during storage and after domestic laundry and their temperature-dependent inactivation. Mycopathologia. 2011 Jan;171(1):43-9.
6. Gupta AK, Cooper EA. Update in antifungal therapy of dermatophytosis. Mycopathologia. 2008 Nov-Dec;166(5-6):353-67.
7. Aly R. Tinea Pedis: Epidemiology, Clinical Manifestations, PAthophysiology, and Therapy. in Cutaneous Infection and Therapy. Aly R, Beutner KR, Maibach H, eds. 1997. Marcel Decker, Inc. New York, NY.
8. Nedorost S. Clinical patterns of hand and foot dermatitis: emphasis on rubber and chromate allergens. Dermatol Clin. 2009 Jul;27(3):281-7,
9. Daniel CR 3rd, Gupta AK, Daniel MP, Daniel CM. Two feet-one hand syndrome: a retrospective multicenter survey. Int J Dermatol. 1997 Sep;36(9):658-60.
10. Tanaka K, Katoh T, Irimajiri J, Taniguchi H, Yokozeki H. Preventive effects of various types of footwear and cleaning methods on dermatophyte adhesion. J Dermatol. 2006 Aug;33(8):528-36.
11. Gupta AK, Konnikov N, Lynde CW. Single-blind, randomized, prospective study on terbinafine and itraconazole for treatment of dermatophyte toenail onychomycosis in the elderly. J Am Acad Dermatol. 2001 Mar;44(3):479-84.
12. Ajit C, Suvannasankha A, Zaeri N, Munoz SJ. Terbinafine-associated hepatotoxicity. Am J Med Sci. 2003 May;325(5):292-5.
13. http://emedicine.medscape.com/article/1091037-overview

I recently stumbled upon an online article on Fox News where Chris Kilham, the Medicine Hunter and Fox News contributor, talks about plant-based cures available to treat health problems, including toenail fungus.

To treat toenail fungus, Kilham absolutely “swears by tamanu oil, or Calophyllum inophyllum, a tropical nut oil from the Pacific Islands. The anti-fungal properties of the oil have been well-documented in previous studies.”

“Toenail fungus responds rather brilliantly to tamanu oil,” Kilham said. “If you put the oil on the nail, it will get rid of the fungus.”

I wonder how many people actually ran to their local natural foods stores our their computers to learn more about the healing powers of this mysterious plant.

A quick research of the more reputable sources revealed that all parts of the plant ( bark, leaves, seeds) have been used medically as antiseptics, astringents, expectorants, diuretics, and purgatives. The oil possesses some antimicrobial and antiviral activity. Apparently cosmetic industry in Europe likes to add some of this oil into skin care products, such as creams and moisturizers.

Long story short: don’t get any illusions. Tamanu oil may help moisturize the skin on Athlete’s foot, but it’s unlike to cure even a mild case of toenail fungus – the fungal infection residing in the nail bed, the skin UNDER the nail plate. Onychomycosis is a disease that requires medical treatment.

Now, prevention is a different story. Tamanu oil may certainly be added to your preventive regimen – if you have the time and patience to use it daily.

Ick! This is the normal reaction to the fungal toenail picture. Most people don’t want their toenails to look like this. The truth is: this is a picture of a moderately severe case. Discoloration, thickness, flaking, peeling… but not too bad!

A dermatophyte is a type of fungus which affects skin, hair and nails. You may be familiar with Digger the Dermatophyte from the horrifying commercial where Digger climbs under a toenail and makes a home with his buddies. But, Digger and the dermatophytes are not the only ones making homes, non-dermatophytes and yeast also can infect the toenails. The fungus causes the nails to first become slightly yellow or white and splotchy.

Later nails will thicken, and become very brittle. The shape begins to change and the discoloring can darken to deep brown. As the fungus worsens, the nails become thicker, more yellow or brown, more brittle (or sometimes much harder) and abnormally shaped.

About 30 million Americans are affected by toenail fungus. That is a lot of fungus! Men are twice as likely to develop fungus than women, athletes, seniors and the elderly are more at risk, those who have poor circulation or sweaty feet are more at risk, those with a compromised immune system are more at risk and those with poor hygiene and chronic foot fungus (athlete’s foot) are more likely to develop toenail fungus.

In the 1800s, fungal toenails were very rare. The increased prevalence is linked to the increased exposure to fungus through the use of hot tubs, saunas, showering facilities in gyms and public pool areas. There is an increase in use of nail salons, which help spread the pandemic, prevalent use of occlusive footwear, increase in obesity, diabetes and the age of the U.S. population.

Nail’n'Toe treatment is safe, pain-free and highly effective.
Call 1-877-927-3864 or click here to find out if a provider is available in your area.

There is no easy way to treat toenail fungus. Once it works it’s way into the nails, it becomes extremely difficult to get out. At Nail’n'Toe we do not recommend the use of any home remedies, heavily advertised on the Internet. Over the counter treatments cannot be effective as prescription topicals, and require daily use for 6-12 months with mixed results. Oral anti-fungal medications are effective, but they have side effects.

Results: At the end of the study 63% of the patients achieved clinical improvement, 86% of patients had mycologic improvement and 54% attained a mycologic cure. No serious adverse advents were observed during the trial period.

Summary: This study concludes that Penlac® is a safe and effective treatment for diabetics with mild to moderate toenail fungus.

Brenner MA, Harkless LB, Mendicino RW, Page JC. Ciclopirox 8% nail lacquer topical solution for the treatment of onychomycosis in patients with diabetes: a multicenter, open-label study. J Am Podiatr Med Assoc. 2007 May-Jun;97(3):195-202.

Notes:

• Distal subungual onychomycosis, as seen in the picture above, is the most common type of toenail fungus and is generally a mild to moderate type of toenail fungus.
• Ciclopirox 8% laquer is the generic name for the prescription medication Penlac®. Ciclopirox is applied like a nail polish.
• Toenail fungus in a diabetic is a risk factor for ingrown toenails, ulcerations and bacterial infections. Having an effective topical medication for use in treatment is significant.
• It is important to note that the patients in this study were treated for 48 weeks.
• Mycologic cure means that there was a negative culture or negative microscopy. These tests are not entirely accurate, therefore not definitive, which is why they are used in conjunction with clinical cure.
• Clinical cure means that there is no evidence of the fungal disease, whereas clinical improvement is variable and subjective. In this study, they evaluated the nail surface, color and thickness to help define clinical improvement.
• This study does not tell us about the effectiveness of ciclopirox in the general population (previous studies of ciclopirox in the general population have not shown the same effectiveness).
• This study also does not tell us the effectiveness of ciclopirox in severe cases of onychomycosis with associated dystrophic changes, as seen in the picture here.

Women with toenail fungus have always tried to cover their unsightly nail. One of the more recent trends – acrylic nails. Any pedicure salon can offer the service these days. Looks nice, but…

You actually help fungi grow by enforcing the protective shield, which your natural nail already is. Fungus thrives in moist, dark and poorly ventilated spaces. This is exactly what artificial nails offer!

It’s understandable that the artificial nails is a very tempting option. In the long run, however, it is also one of the worst ones. Consider Nail’n'Toe to get rid of fungus under nails on toes and/or fingers, and when your nail are healthy and fully grown again – get your fancy acrylics on.

Nail fungus can go undetected for months before signs and symptoms become visible. Look out for these five.

1. Yellowish nails
We all know what healthy toenails look like. If any of your toenails start turning yellow, brown or black, this usually spells trouble and you need to have it diagnosed.

2. A nail is thick, flaky, pitted, crooked and falling apart
If the nail breaks easy and often, or worse, begins lifting at the tip – rest assured, you got it!  Fungi are in the nail bed causing the nail to crumble.

3. There are smelly residue under nail
You’ve waited too long! Byproducts of the thriving fungus have a horrid odor.

4. The nail is slowly but surely turning black
That’s black fungus! Looks bad, but might be easier to treat with laser than a white onychomycosis.

5. Thickened, distorted and lifting nails
It might be too late for the rescue. If the matrix (the root of the nail) is destroyed, even Nail’n'Toe might be helpless. We can try but no guarantees of success.

Here is something that may help as part of the anti-fungal therapy – colloidal silver. Known for many useful properties silver has been used as a home remedy for centuries. It’s not a cheap solution but it may add to the standard Nail’n'Toe treatment protocol, i.e. in between the treatment sessions in doctor’s offices. We have not found any decent studies on it but stumbled upon some anecdotal evidence.