What do garlic, Listerine, tea tree oil and apple cider vinegar have in common? They are popular—but ineffective—treatments for nail fungus, the scourge of 14% of American adults.
The hot, humid days of summer encourage the spread of onychomycosis, an infection of the nails caused by the fungus T. rubrum, whose spores flourish in moist human habitats like sweaty socks and shower stalls. They enter tiny cracks in nails then germinate and feed on keratin, the protein that makes nails hard. T. rubrum thrives in damp, slow-growing toenails, which account for 75% of onychomycosis cases in the United States. (The rest involve fingernails.)
Affected toenails gradually become whitish-yellow, thick and crumbly. They can change shape and even look horn-like. The nails will often start to pull away from the toes, causing pain, and your shoes may not fit as well. (Contact your medical provider if you have bleeding, skin reddening or swelling, or trouble walking.)
The American Academy of Dermatology warns that untreated athlete’s foot (also caused by T. rubrum) is likely to infect your toenails. Toenail fungus occurs more frequently in those with poor circulation (caused by hardening of the arteries or diabetes) or a weakened immune system (such as autoimmune disease or chemotherapy treatment). Half of the U.S. population over the age of 70 is afflicted.
There are no serious consequences from toenail fungus, but it is highly contagious, and you may spread it to household members. Most sufferers are upset by the ugly appearance of fungal nails, and the damage can be permanent. If you’re unsure whether you have onychomycosis, schedule an exam with your medical provider. Skin conditions like psoriasis can mimic toenail fungus, so a culture may be necessary.
The bad news for those infected: There are no surefire cures. Antifungal toenail “polish” (Penlac) can slow a mild infection, but has only an 8% success rate. Jublia, a topical cream, brings that up to 20%. With either treatment, the sufferer must be dedicated: The products must be applied daily for a year or longer.
For moderate to severe infections, prescriptive pills, such as Lamisil, are the most effective. Taken for up to three months, the cure rate is 40%. Oral antifungals can stress your liver, however, and interact with other prescription medications, like cholesterol-lowering agents and antidepressants.
Laser treatment is all the rage, but it can be expensive and often isn’t covered by insurance. Plus, the cure rate is no better than topicals. Permanent surgical removal of the infected toenail is extremely effective but rarely used because it’s considered aggressive, and recuperation can be painful.
To prevent onychomycosis wear clean, dry socks, and change them regularly if your feet perspire, especially after exercise. Then wash the socks in hot soapy water to kill the fungus. Wear flip-flops around swimming pools or locker rooms. Avoid tight-fitting footwear and attend to damaged toenails. Keep your feet clean and dry, with the nails cut short and straight across the toe. Disinfect your nail clippers with rubbing alcohol each time before use. Put over-the-counter antifungal powder (like Desenex or Lotrimin) in your shoes every morning. If you get pedicures, make sure your salon has a New York State Cosmetology license; this ensures that instruments are sterilized. If a family member is infected, don’t share towels or toenail clippers and wipe out the shower or tub between uses.
Two non-prescriptive treatments are worth considering: Vick’s Vaporub or spruce tree resin. File across the top of the toenail to reduce the fungal biomass, then apply either twice daily for at least six months to suppress fungal spread. Each has a 10% chance of cure.
Mary Jenkins recently retired after nearly 40 years as a family practice physician in New York state.