Toenail fungus

In My Humble Opinion
1

I posted a thread a few years back, kinda (mostly) tongue in cheek about cutting my fungus infected toenail off.

I had tried everything: bleach, frequent washings, over the counter medications, etc. None of it worked. I finally started using a petroleum based “first aid” cream that I would apply after showering and drying off. It did nothing to reduce the fungus, but it did keep the area soft so I could better clean and descale (ick) the area once a week or so. Doing that at least kept the nail bed looking better.

Strangely, last summer, the fungus went away on its own. I used to have about 90% coverage on my big toenail. It was reduced to maybe less than 5% by last August.

At the time, I was on medication for psoriasis. I first started with methotrexate for 6 months, then switched to Enbrel for 3 months. For various reasons, I have been off all medications since September.

And now, within the past month or so, the fungus has returned. :smack:

At first, I assumed that the methotrexate or Enbrel was the cause for the fungus going away. That seemed a logical conclusion, given the timeline of events. But now I’m not so sure. This is because, aside from the medication, I also started walking everyday. This began last summer (June). I made it a point to get 6,000 steps a day. This usually meant a walk in the evening to get my steps in.

The reason I’m thinking this is that I switched jobs in September, and since then have been getting home so late that I don’t walk. I also sit much more at my job than previously (my steps are down to maybe 1,200 a day, maximum).

I wonder if the steps I was doing did indeed help? Perhaps the increased blood flow from all the walking helped? Or not? I’m wondering if anyone can offer insight on this hypothesis.

Oh, forgot to mention that it was diagnosed as fungus, and not a result of psoriasis. Though maybe the doctor was wrong on that, not sure.

2

Not sure why you would conjecture it wasn’t the meds but walking that killed a fungus.

That kind of makes no sense to me.

But if I recall your original thread you were doing all knds of bleach and borderline home surgical stuff, which while not actually working, you seemed determine to stick with, mostly ignoring any advice offered. (apologies if I’ve misremembered it all!)

Go to a doctor and get some meds specific to your issue. Listen to him instead of devising your own theories. Then follow his instructions. This is how fungus is cleared.

Good Luck!

3

My reading shows the medications I was on actually increases chances of fungal infection (or I’m reading it wrong).

And my previous thread was always tongue in cheek. I thought I made that clear.

Anyway, I just wonder if in the end, all that walking was helping in ways I hadn’t expected. It would be neat if that were the case.

4

Occam’s Razor would suggest that you have psoriatic nail disease, not your run of the mill toenail fungus infection. Note that the two diagnoses are not mutually exclusive - you can have psoriatic nail disease AND a fungal infection. IF you have *just *a toenail fungus, we have to explain why lots and lots of things didn’t go as expected. If you were incompletely diagnosed, we just have one simple explanation (the doctor didn’t tell you the whole story), and nothing else needs to be explained away.

In short, no, neither those medications nor walking are likely to kill a toenail fungus. In fact, those medications both carry the risk of making one *more *prone to fungal infections, not less. And more walking generally promotes the damp dank environment in your socks that fungus love. More walking with more frequent sock changes might not hurt, but I’ve never seen it help.

5

The only sure way to diagnose toenail fungus is to take a toenail clipping and see if you can grow the fungus out of it, or identify it with stains and a microscope.

If one does have a nail fungus, about the only effective treatment is an oral antifungal, which may need to be taken for 6 months or more, may irritate the liver, and may clear up the fungus in maybe half the cases. Topicals have not been shown to be effective, save in some small studies which didn’t prove out on further evaluation.

I’d agree with WhyNot that psoriatic nail changes are at the root of your problem. But it’s also possible you had a secondary fungal infection in the nail that your body was able to handle on its own once your psoriasis improved. And I’d bet that your current nail changes (off the MTX and Enbrel) are psoriatic.

Just my 2 cents,

6

The topical worked for me.

I’d try it for a long time before I’d mess with oral.

7

Here is what worked for me, although it took 6 months for the nail to grow out and everything to be clear.

A few drops of ordinary white vinegar on the nail, twice a day. Make sure it goes to the edges of the nail and a little of the skin around it. This will eat away at the fungus from the outside in - and so this only works if the fungus is extensive enough to reach the outside of the nail bed.

My fungus was so bad that only about 10% of the nail was held on by flesh instead of by fungus. After about 3 months the nail was very loose so I cut it back as far as possible so that it wouldn’t catch and tear off. Eventually it all grew out and was fungus free after that.

Having said that, I never had the nail tested for fungus, so it might have been something else. I went for vinegar because I read that fungus can’t live in an alkaline environment. It seemed to work, with the provisos noted.

8

Vinegar is acidic, so that doesn’t make a lot of sense.

9

oooops -

It was the topical Lamisil that worked. I didn’t even know that it was available as oral.

10

Sorry, I meant acidic not alkaline. Not the first time I have made that misteak…

11

Scholl Fungal Nail Treatment worked for me in about a month. No idea why I can’t find it anywhere in the states, but it worked great.

12

Campho Phenique twice a day all over nails & underneath, clean socks 2-3 times a day and clean feet at least once a day.

Sleep with socks on ( I hate that ) to keep the CP from rubbing off too quick.

What my GP told me and it works for me.

13

To all the SDMBers reading the anecdotal recommendations regarding topical treatment, be aware that the medical/scientific consensus is that topicals have not been shown to be effective.

From Uptodate.com

14

The newest/best thing is laser treatment, very expensive but shows an 80-90% success rate.

15

When I had this issue a couple of years ago, I determined that the potential side effects of the prescription medications were too risky for such a minor ailment and I ended up trying several different topical treatments. None of them led to any improvement whatsoever.

Then I noticed that the toenail was partially detached from the nail bed, so I used a flathead screwdriver to pry the nail up while simultaneously clipping off the infected portions. I had to excavate about 2/3rds the way down with clippers and needle nose pliers until only healthy tissue remained, but my toenail grew back normally in about 6-8 weeks and I’ve had absolutely no issues since.

16

cringe