By Brian Irwin
Chances are that you or someone you know has sustained an unsightly infection of their finger or toenails known as onchomycosis. This common condition is fairly pervasive, with a prevalence approaching 2 to 13 percent of the U.S. population. While harmless to your overall health, it can be a serious hassle, especially when one weighs the fact that the infection is contagious and can spread from toe to toe and from person to person.
Onchomycosis is a infection caused by fungal organisms. There are many types of fungus that are responsible for this condition, and these carry varying degrees of sensitivity to medications. Some forms of the fungus are more likely to respond to curative treatment than others. And treatment, while quite elective, is often desired by patients.
Onchomycosis is, by definition, infection of the nail, the nail matrix or the nail bed. These are all components of the toenail anatomy; some reside in plain view (like the nail), others, like the nail plate, reside under the cuticle. For this reason, because the infection may be tucked away under the skin, the condition can be quite stubborn to treat.
Because the nails can be uncomfortable or unsightly, many patients opt to treat this condition rather than live with it. In untreated onchomycosis, the nail may become so thick (and discolored) that it may make tight-fitting footwear uncomfortable or even impossible. Given the popularity of skiing in our region, the tight application of a ski boot is one common genre of footwear that I've heard patients cite is unrealistic to don with a severe case of the disease.
Treatment is a challenge. Most options are only marginally helpful and require long application periods. But they can work, albeit each option has its own downside. Topical lacquers are among the most preferred option by patients, due to a multitude of reasons. There are over-the-counter options for this, perhaps the most effective being a product known as Tineacide, which is readily available online. Bear in mind that this option must be applied for a period of around one year to be considered maximally effective.
Prescription options do exist. A newer product known as Jublia has been shown to be effective and can cure the condition in as few as 48 weeks. Bear in mind that most insurance companies decline paying for this product and it can be cost prohibitive. Even then, the typical response to therapy is akin to some of the OTC versions, with only modest efficacy of around 50 percent.
Because the topical medications are inefficient at penetrating deep to the cuticle, many providers opt for oral therapy in cases where a patient seeks a cure. Oral antifungal medication is more effective at stomping out onchomycosis than topical therapy. Also, in addition to higher cure rates (which still may only be around 60 percent depending on the agent chosen), these medications can work more swiftly, sometimes in as few as four months.
One must understand that oral antifungals carry risk. These medications universally metabolize through the liver, and the risk of liver inflammation or even failure does exist. For this reason, many patients and providers shy away from these options. If they are employed, they should be done so under strict lab test surveillance to maintain safety.
Perhaps the most safe and effective option is laser treatment. The data on cure rates is variable, but this modality seems as least as effective as oral therapy. But it's expensive (around $900), and this is its primary downside.
Onchomycosis is a hassle, and, although it's stubborn, it is curable in most cases. Talk with your primary care physician today if you suffer from this common condition and see what your options are.
Dr. Brian Irwin is a family physician at Tamworth Family Medicine, a division of Huggins Hospital.