Nail fungus or onychomycosis is an infection of the nails occurring both on the hands and feet but certainly more prevalent on the feet due to the environment that feet find themselves in. Nail fungus generally thrive in dark, moist environments, so when you consider wearing shoes and socks all day along with perspiration that occurs, it ends up being a perfect growth media for nail fungus.

The true, tough to get rid of nail fungus, actually grows underneath the nail. As it grows, it forces the nail up off the nail bed and the nail becomes thick, crumbly and discolored ranging in color from yellow to brown. There may also be an odor. It is not uncommon for these infected nails to then spread to the remaining healthy nails on the foot. It is also not uncommon for nails to fall off and unfortunately, in most cases grow back the same way if not properly treated.

Aside from the unsightly appearance of the nail fungus, other problems can arise. Having nail fungus makes most people more prone to developing athlete's foot of the skin. (The opposite also holds true). Additionally, thick fungal nails can be uncomfortable in closed shoes as they feel like rocks underneath the top of the shoe. These infections can make people more susceptible to secondary bacterial infections as they exacerbate the formation of ingrown nails, plus the sheer distortion of the nails tends to irritate the healthy skin of the adjacent toes causing abrasions that can become infected. This is especially dangerous in people who suffer from diabetes or have poor circulation.

Treatment can be difficult because of the fact that fungus thrives in "dark moist environments". Eliminating those factors can go a long way to reducing recurrence.

Many patients ask me if the infected nail has to be removed. The only time I remove them is if they are already partially loose. If the onychomycotic nail is adhered to the nail bed I no longer advocate removal of the nail because the simple truth is, just removing a nail all the way back to its growth plate will cause the nail to grow out with a degree of thickness even if there is no fungus present.

There are both oral and topical medication treatments. The gold standard for treating onychomycosis in an otherwise healthy individual is the oral therapy. The most widely prescribed medication today is Lamisil tablets (Novartis), although there are certainly other oral antifungals that can be used. The newer generation of oral antifungals is very safe medications if properly used. Your doctor may prescribe one or two blood tests during the course of therapy to make sure there are no adverse effects. Additionally, your doctor should take a sampling of the nail and have it tested to confirm that it is true nail fungus. Visual inspection is not the proper way to make a diagnosis.

Although topical treatments are available, they tend to be less effective. The main problem, as stated earlier, is that fungus grows underneath the nail; so applying medication to the top of the nail becomes an effort in futility. Trying to force the medication underneath the nail rarely works.

The best way to use topical medication is to see a foot specialist who will grind down and cut away as much of the diseased nail as possible (a painless procedure), so that the topical medication will penetrate to the live fungus more readily. This can become a tedious process as the medication generally has to be applied twice a day by the patient, (being lazy about it defeats the whole purpose) and then the nail has to be ground down on a regular basis. The other problem is that depending on the degree of fungus this process can take upwards of a year. The other problem is that the greater the number of nails that are infected, the less the likelihood is of clearing them all up with the topical medication. Having said that, I have seen some very gratifying results with topical medication.