With increasing daylight now that we’re past the winter solstice, we can literally see light at the end of winter. Daylight savings time starts this year on Sunday, March 10th, giving us a quick jump with an additional hour of daylight. With all this sunshine, you may be quickly digging out the sandals in preparation for warmer weather, trips to the beach, or just to show off that new pedicure. “Uh-oh, what’s that? My toenails haven’t always looked like that!” If you’re over a certain age, you may notice your toenails starting to change. It usually starts as a mild change in color or clarity. They may start to take on a yellowish or greenish cast, and they usually start to thicken as well. As the problem progresses, the nails often begin to “cup” and take on a convex shape that can pinch the tissues beneath the nail causing pain. The nails may start to crumble and look like they are falling apart. As the nails thicken, wearing normal closed-toe shoes can be painful. Sandals may bring relief, but oh, there are those unsightly nails now on display!
These changes in the toenails (and sometimes fingernails) are usually caused by a group of fungi called dermatophytes. These organisms love warm, moist, dark places like the inside of a sock, inside of a shoe. They often hang out in public showers and swimming pools, but can be found almost anywhere with the right conditions. The fungi enter the body through small, often invisible cracks in the skin or through a small space between the nail and the nail bed.
What can be done? Although there are many treatments offered out there, most are local applications of various remedies that are usually not effective. One of the best medical options is terbinifine (Lamisil), a medication that is available by prescription from your primary care provider (PCP) or podiatrist. Although previously expensive, terbinifine is now available generically and on the “$4 list” at many pharmacies. Terbinifine is a 250 mg tablet taken once a day for 12 weeks for toenail fungus (6 weeks for fingernails). Like all medications, your PCP will want to follow some safety precautions, including a simple blood test before, and half-way through, your treatment period to ensure that your liver is happy with the medication. The medication is usually quoted to be about 85 percent effective, meaning that you have about an 85 percent chance of killing all of the fungus. Note that the existing nails do not “clear up.” Rather, as the nails grow out after the fungus has died, you will start to see new, normal nail coming in at the base. As the nail grows, you can progressively cut off the bad nail until the old nail is finally replaced by a whole new nail that is normal. The treatment is 6-12 weeks, and it will take several more months for the bad nail to finally grow completely out of the picture. (So better start soon if you are planning to show off your feet this summer!)
What can be done to prevent toenail fungus? This gets challenging as we age, but there are a few recommendations that can help prevent the disease. Of course, wash your feet well with soap and water, followed by thorough drying every day. Experts actually recommend a change of socks and shoes at least once during the day, although most of us don’t find that practical. Wool and cotton socks tend to hold moisture more that synthetics, which tend to wick away moisture. Disinfect any clippers or other instruments that you may use to trim and clean your nails. Cut toenails straight across and do not let the nail extend past the tip of the toe. Do not paint nails that might be infected. See your PCP or podiatrist for any redness of the toes as this could be due to many problems, some very serious.
As you look forward to fun in the sun this year, stop into your PCP to discuss the health of your nails. You’re probably overdue to discuss a few other things, right?
Dr. Fleming is the Medical Director of The Jane Pauley Community Health Center (part of Community Health Network). Ideas for this column can be e-mailed to Dr. Fleming at AskDrFleming@gmail.com