Why Do Our Finger and Toe Nails Give Us So Much Trouble?

Published by Contra Costa Times

Posted on Wed, Sep. 21, 2005

By Dr. John Lee

WHY DO OUR finger and toe nails give us so much trouble? Humans spend millions, perhaps billions, each year to improve the appearance of their nails. Lately, we hear more and more about toenail fungus, which affects as many as 20 percent of people over than 40 years old.

Fungus (or mold) is all around us; it's also the stuff that attacks your old bread. Fungus thrives in moisture. Shoes create a warm, moist, closed place where fungus thrives.

You may have seen the commercials featuring cartoon toenail fungus on television - a fierce purple demon that wreaks havoc in an around your toe, discoloring and deforming the nail. These little devils are difficult to treat because nails grow slowly and receive very little blood supply.

The drug company has just the pill to restore harmony inside your shoe. But before you turn to medication, weigh the pros and cons. And as is the case with many things - prevention is better than treatment.

Of course, medication treatments are beneficial when the fungus invades the fingernails, since our hands are so visible in our daily lives. And if toenail thickening is painful, it can be treated with pills, though it typically takes many months.

But even then, the fungus often comes back. Sometimes quicker relief can be achieved with other treatments such as cutting or even surgically removing the nail or using chemicals to destroy the infected portion.

Diabetics need to take particular care with foot infections and should be under the care of a doctor. But non-diabetic patients rarely have complications.

So what should you do for a purely cosmetic problem? Should you take a pill that goes to every cell in your body, just to improve the appearance of your toenails?

Though the pills and prescription creams available are often safe, some patients can suffer side effects, such as allergic reactions and liver inflammation.

Creams and medicated lacquers are less expensive, but also less effective than pills because the problem extends below the surface of the nail.

One treatment touted by local podiatrists is a combination of DMSO, a penetrating solvent, mixed with one of the anti-fungal prescription medicines, ketoconazole. It must be mixed by a pharmacist but is still an inexpensive alternative.

Take preventive measures against athlete's foot, which usually precedes nail fungus problems. Reduce the wet environment that causes it by wearing sandals, using over-the-counter antifungal foot powder, cream or lacquers at least weekly.

If your feet feel itchy, appear red or scaly, have cracks between toes or have brown spots, treat them immediately with over-the-counter athlete's foot products twice daily.

Other ways to help prevent further athlete's foot infections include:

Wear hiking or running socks which allow sweat to escape.
Wear shoes that fit properly and are made of material that allow the foot to "breathe" such porous synthetics.
Go shoeless at home, but not in public places like gymnasium changing rooms and hotel rooms. Fungal particles can hide in carpets and on bathroom floors.
Keep your nails well-trimmed and filed.

If you have any concerns, contact your medical provider, especially if the nail presses into skin or becomes ingrown, since this is a setup for infection.

Dr. John Lee is a family practitioner at Contra Costa Regional Medical Center, and works regularly in the Dermatology Clinic.