One morning you wake up and notice that one or many of your nails is undoubtedly discolored. Over the past few months you have watched as your nail has become a yellow color, which started at the end of the nail and is now approaching the middle portion. You notice that your nail is becoming progressively thicker and is getting impossible to cut with a regular nail nipper. This is when you realize that you may have a fungal nail infection, most commonly referred to in medicine as Onychomycosis.
 
Onychomycosis affects up to 6-8% of the adult population. Organisms such as: dermatophytes, candida, or mold cause this disorder. Dermatophytes were made common knowledge to the public with a TV advertisement by the Lamisil drug company who introduced digger the dermatophyte to the world. Digger is an organism called Trichophyton rubrum, and is the cause for 90% of the total cases of onychomycosis.
 
Onychomycosis can be divided into 5 subtypes:
-Distal Subungual Onychomycosis
-White superficial Oncyhomycosis
-Proximal subungual onychomycosis
-Candidal onychomycosis.
-Total Dystrophic onychomycosis.
 
Distal subungual onychomycosis is the subtype that most patients will experience at some point in their lives. Fungus, yeasts, and molds are all common inhabitants of one’s shoes. Unlike the commercials, these organisms cannot just lift up the nail and sneakily climb under. Rarely do they cause a problem unless there is a type of trauma that allows the nail to separate from the skin This can include tight shoe gear which causes chronic damage to the nail plate, an event that caused some sort of nail destruction, and dirty instrumentation found at nail salons. Patients with athletes foot, a fungal infection of the skin of the foot, have a high risk of developing these infections seeing as the organism can easily spread from the skin to the nail.
Kicking digger the dermatophyte out is harder then it appears on TV. The cure rate for treating nail fungal infections is less then 50%, and 10-20% of people will contract onychomycosis again in their lifetime. A human nail grows between 1-2mm per month, and it takes 12-18 months to grow out a toenail completely. The decision to treat this condition takes dedication, commitment, and lot of personal time. 
 
There are three types of treatment for nail infections: topical solutions, oral pills, and surgery. Surgical treatment consists of removing the entire nail and treating the nail bed with a topical antifungal. This type of procedure can be painful, invasive, and very traumatic. Most patient choose to begin treatment with topical drugs such as:
-Ciclopirox (Penlac)
-Rinnovi (Quinnostik)
-Fungisil
-Fungoid Tincture
-Vick’s vapor rub
-Topical Lamisil
-PGULA solution
 
When using the topical solutions one should keep the nail filed down on the top to help the topical solution absorb.
 
Oral Medications Include:
-Lamisil
-Itraonazole (Sporanox)
-Fluconazole (Diflucan)-Off label use.
-Griseofulvin (GRIS-peg)
When using the oral medication it is important to consider the interactions with other drugs and the many side affects. The main side affect of Lamisil is that it can have a damaging effect on the liver. Most Podiatrists will have lab work drawn to check the liver enzymes before this medication is prescribed. The treatment of Onychomycosis is a challenging task, but can be done with the guidance of your Podiatrist.

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