San Antonio residents can wear sandals nine months out of the year without getting a second look, so their toes had better be presentable. unfortunately, the city’s weather also makes for ideal breeding grounds for icky-looking toenail fungus.
Otherwise known as onychomycosis, toenail fungus can turn healthy nails into hard, yellow, thick and painful embarrassments.Toenail fungus is one of the most common foot conditions seen in local podiatric offices. Dr. Morris Stribling of Foot Care-Central San Antonio says 70 percent of his patients have some sort of fungus.
Stribling suggests a few ways to prevent contracting the fungus: Keep feet dry and clean; wear protective shoes in public showers or pools; let shoes air daily; wear cotton socks and breathable shoes.
Unfortunately, once the fungus gets a toehold, it is very difficult to cure. Here are several treatment options, from simplest to most severe:
No studies have shown a direct effectiveness against toenail fungus but, due to vinegar’s ability to stop the growth of certain bacteria, the Mayo Clinic suggests soaking infected toes in a solution of one part vinegar, two parts water. other at-home treatments include slathering Vicks VapoRub on the nails.
Success rate: Depends on the severity of the infection, and it may take several months to see results.
Over-the- counter creams
Antifungal creams like Dr. Scholl’s Fungal Nail Revitalizer or Lamisil anti-fungal cream are available at local drug stores, but success rates tend to be low.
“Users have to apply the cream twice a day, and most people won’t do that,” Stribling said. “They just don’t have the time, especially since an infection can take months to clear up.”
Success rate: Typically 10 percent to 15 percent, depending on consistency of use and degree of infection.
Over-the- counter topical nail lacquer
Lacquers made with antifungal ingredients are designed to penetrate into the nail bed and the root of the infection. Stribling’s office offers colored antifungal lacquers.
“We usually don’t like for patients to use nail polish because it’s [air- and water-tight] and doesn’t let the nails air out,” Stribling said.
Cost: About $40 a bottle. Most treatment requires daily use, and two or more bottles may be required to clear up an infection. Colored lacquer is available in 25 shades (although the medication is less potent) for about $17 a bottle.
Success rate: 50 percent to 60 percent over a period of 6 to 7 months.
The only oral FDA-approved treatment for toenail fungus is terbinafine (brand name Lamisil) and its generic counterparts. Treatment consists of one pill daily for three months, while also keeping nails clean and dry. Patients should have no history of liver problems, as the drug can increase liver enzyme levels and conflicts with high cholesterol medications.
Cost: around $130 for complete treatment; generic prescriptions are available for around $40.
Success rate: Higher than 60 percent in most cases.
The latest treatment stops toenail fungus at the source with laser light.
During the initial consultation, Dr. Liza Chabokrow, one of the handful of podiatrists offering laser treatment in the San Antonio area, stresses the importance of keeping feet clean.
“We spend a lot of time discussing the need for prevention against recurrent fungus,” Chabokrow said. she has done the procedure on children as young as 7 and adults as old as 98.
During the half-hour procedure, patients feel warmth, which can be controlled, as well as a static electricity-like tingle. There are no post-treatment limitations for patients. Healthy nails are visible from six to nine months after treatment. Patients are called in for four- and eight-month evaluations, during which the physician may decide a second treatment is necessary.
Cost: $1,000; treatment is not covered by most insurance plans.
Success rate: at 88 percent, lasers are the closest thing to a cure on the market.
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