Flip Flop Season and Fungus! (Part 2)

In medical school a patient came to clinic, after a 20 year hiatus.  When asked about the reason for her visit she stated that she wanted to see if there was anything new with a 100% cure rate for fungal nails.  When told nothing was a 100% she laughed and said she’d see me in another 20 years…


The Cure! ....Patience

The goal of treatment is two-fold: curing the fungal infection and obtaining a normal nail.  Fungal nails have a slow onset therefore their treatment is slow.   Cure and noticeable improvements take 9-12 months.  Treatments prevent infection of the growing nail, not the infected portion. AKA you have to wait for a new nail to grow in and hope it doesn’t get infected along the way.


The gold standard: Tried and True

Oral medications boast an overall cure of 65% to 86%. This depends on multiple factors most prominently:

  1. Thickness
  2. Number of infected nails


Every treatment has pitfalls.  Not all fungi are created equal.

The contradiction for oral medications is liver toxicity.  Complications are rare and most accounts are from first generation drugs. Fungi are not created equal; some are round and some have tentacles!

It is important to limit use to correct drugs.  Nail culture and PCR limit over prescription of drugs and are best practice.


Topical treatments

Topical anti-fungal nail lacquers are best for toenails as penetration is prolonged.  Traditional medications have low success rates between 5-20%. Combining treatment with sterile nail debridement and softeners increases the penetration time with reported success in up to 77% of patients. 

Pedicure Tips!

  • Ensure your nail salon uses instruments sterilized in a autoclave
  • Bring your own instruments!
  • Avoid foot soaks
  • Cut nails straight across
  • Avoid aggressive treatment of cuticles

For your safety and that of other patrons avoid non-medical treatment of nails if you have diabetes, neuropathy, poor circulation and active fungal or bacterial infection


Myth versus Reality – difficult pathologies have the most home remedies!

These home remedies have increased cure rates in combination with traditional therapies

  • Vicks Vapor Rub
  • Tea tree oil
  • Snake root extract


New Kids on the block - court still in session, results are promising

  • Laser therapy
  • Keryflex


Nail Surgery

Minimally invasive complete and partial nail removal is an option for those suffering from painful nail overgrowth and pressure. It is a short in-office procedure with minimal risk.