[Dr. Smith]

Got another call from my friend who lost her insurance. Seems she's got something under a toenail that's becoming painful. Has anyone tried any of the OTC remedies for this kind of thing or is that a lost cause and she needs to bite the bullet and see a podiatrist? We know it's going to take several weeks either way. TIA.

Doc

[mrsD]

Toenail fungus does not usually hurt. It could, but this could also be an infection. If the toe is red, hot, and throbs, I'd go to a podiatrist.

[Dr. Smith]

Thanks - I'll pass that along. Was hoping maybe someone had tried these OTC remedies - even by PM....

Doc

[mrsD]

The topical fungicides do not penetrate well.

Some people file down the nail, to make it thinner. Apply whatever topical, and cover with a bandaid to enhance penetration.
Remedies include, Vicks vapro rub, liquid clotrimazole, Lamisil lotion, even a new thing called Dr. Paul's Piggy Paste (at Walgreen's).
If you Google the latter and put "review" into the search you'll find many people who have tried the various approaches in the comments. There are many many approaches, but it appears they only work for some people.

Toenail fungus is typically ugly, but mostly benign.
But ingrown nails, or nails that curl up on themselves and penetrate the nail bed, can be very painful, and if the infection is not treated, cause serious problems. Some people get mrsa and that could be even fatal. Putting triple antibiotic on the
cuticles if that is what is inflamed may help, but may not cure anything. Cover with a bandaid.

It is important to get the correct diagnosis before attempting your own treatments. Because circulation to the feet is poor, and difficult, infections are difficult to get rid of there.

[Dr. Smith]

Originally Posted by mrsD

cover with a bandaid to enhance penetration.

This is, according to portions of the directions read to me over the phone, one thing advised against, and it makes sense. Fungi thrive on dark, moist, airless environments. Her directions (and pharmacist) told her to go shoeless whenever possible, change socks at least twice a day, and she's cut the toe out of an old slipper to allow better ventilation.

I've encouraged her to see a podiatrist, but as she's on a limited income w/ no insurance, I can understand her desire to try this first.

Doc

[mrsD]

You cover with the band-aid only when medicating.

Not for every day use.

When you apply ANYTHING to the skin, and cover, it penetrates better. Saran wrap is used in some derm treatments for this reason.

To get penetration of an agent into the toenail, covering it enhances this.

You apply the agent, to a clean dry toenail, and if you cover it the medication will go into the area it needs to go. Some products have a "new skin" additive in them to cover the medication. This is a clear chemical that dries like nail polish.

But doing Vicks, one would have to cover, since there is no additive in that.

There is a distinct difference in HEALING, and prevention.
For example, it used to be in the old days, that you left a cut or sore open to "air out"... Not any more! Turns out that certain healing factors prefer moist situations.
http://hyamin.blogspot.com/2008/05/w...er-or-not.html

We see today many new treatments including some Band-Aids in drugstores today, designed to keep on wounds for 3 days or more. There are some used in nursing homes that stay on a week. They are made from a special material, and don't need changing so often. Regular bandaids would need changing at least once a day or more.

Dr. Paul's remedy needs covering to force the thymol into the growth plate of the nail, so new cells will be resistant to the fungus. That is how it works. (not by primarily killing the present fungus that is there, but driving it out.). Some drugs like griseofulvin work this way too...they take several weeks to work therefore. (and many of them are quite toxic long term).

The bottom line is to see a podiatrist to find out what is really going on and how best to deal with it.

[Marlene]

You can also try good old vinegar. You apply it 2x/day and let it air dry. I guess you could soak the toe also.

[clarkstar]

we tried otc anti fungals for my moms black toenail with zero effectiveness. her podiatrist said there really isnt anything that can be done without removing the nail, which we declined, since it doesnt hurt her or anything, just looks bad...

[mrsD]

Black toenails imply bleeding under the nail.

This can come from a bone spur that grows on top of the tip of the toe bone. The spur then pushes against the nail and the
nail bed bleeds. These show up in x-rays. Typically the podiatrist will suggest removing the nail. Avoid tight shoes, too, and that may help. Constant hitting of the big toe at the top of the show is what aggravates toe spurs.
The medical term for spurs under the toenail is:
Subungal exostosis