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FUNGUS
IN THE SKIN
Fungus is found everywhere in nature: on the ground, in our shoes, and in the house. We are exposed to fungus every day. Athlete’s foot is a fungal disease of the skin. It can result in three clinical scenarios:
- Peeling, itching, and whitening of the skin between the toes, especially the 4th and 5th toes
- A dry, red, scaling reaction to the bottom and side of the feet that sometimes does not itch
- An itchy blistering reaction
Fungus loves moist, warm, dark places like the insides of shoes. Athlete’s foot is contagious though some people have a better immune system for fighting it off. People who are susceptible to fungus can develop a skin infection which can be passed on to others. Fungus in the skin can also spread to the toenails, which is discussed below. Other skin diseases such as eczema, psoriasis, and contact dermatitis (an allergic skin reaction to shoe material/adhesives, topical medications, or soaps) can mimic athlete’s foot and also cause dry cracked skin.
Treatment
- Topical antifungal medication, either prescription or over-the-counter (Lamisil and Lotrimin), are usually effective at resolving most skin infections.
- Oral antifungal medication is sometimes required in difficult cases.
- Keep your feet dry by drying well after showering, use foot powder, use an antiperspirant, alternate your shoes, and wear cotton/acrylic socks.
- Avoid walking barefoot and use sandals around public places such as the locker room and pool.
IN THE NAILS
Nail fungus is called onychomycosis and causes the nail(s) to become thickened, discolored, loose, smelly, brittle, and hard to cut. It can be caused by injury to the nail or repeated bouts of athlete’s foot. However, nail thickening and discoloration can also be caused by: injury to the nail growth cells such as crush injuries to the toe, psoriasis, or other microbial infections from bacteria, molds, or yeast. Fungal nails can be confined to only a part of one nail, can spread throughout the nail, or spread to other nails over time. There can be psychological trauma brought on by fungal disease of the toenails that impairs the patient’s quality of life. People are more motivated to treat the problem if they are embarrassed about the appearance of their nails and avoid going barefoot in public.
Treatment
- Topical antifungal therapy is used in mild cases and is about 10% effective.
- Oral antifungal therapy is 60-70% effective. The medication is safe, but like any oral medication, can have side effects most commonly headache, diarrhea, stomach upset, liver damage, itching, taste disturbance, and hives. The medication is taken for 3 months and it stays in your system and keeps working for 9 more months after you stop taking it. There is a 15-20% chance of recurrence with the oral therapy and the medication (which is covered by most insurances) costs $600-$700, depending on the pharmacy.
- If there are only 1 or 2 nails involved, removing the nails and using a topical antifungal medication daily until the nail grows out completely can be done in the office. If the nail(s) are very bad, they can be removed and a chemical put on the nail growth cells so the nail(s) do not grow back.
- Benign neglect is also an option, i.e. no antifungal treatment. These patients periodically come into the office to have their nails cut that cannot do it themselves. Thinning the nails is necessary in patients with impaired circulation or sensation, i.e. diabetes, since onychomycosis can also be a source of secondary fungal and bacterial skin infections as well as secondary ulcerations under the nail.
To make an appointment, call (253) 631-4960 |
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