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Dr. John Sigle: It’s time to zap toenail fungus - Springfield, IL - The State Journal-Register
Dr. John Sigle: It’s time to zap toenail fungus

Dr. John Sigle: It’s time to zap toenail fungus

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By John Sigle
Posted Apr 04, 2013 @ 10:43 AM
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I tell my patients that “there’s a fungus among us,” because toenail fungus is everywhere in our environment. You can contract it walking barefoot at the pool, in a shower, from the floor, the carpet, in a hotel room, or when you get a pedicure. It can even be lurking in your house or sneakers. As seen in the ever popular Lamisil commercials, the little yellow fungus monsters (Dermatophytes) love to invade the nail bed and turn it into a smorgasbord. They thrive on warm, moist environments and humid conditions; and once they get under the nail, they want to stay for life.

I am sure everyone who has this condition wishes there was a fast remedy, but there is no quick fix with conventional remedies like topical creams, prescription lacquers, or oral medications. Each of these remedies is a long tedious process that works less than half the time. Buyers beware because many ads are misleading. Efficacy rates are not always accurate, risks are sometimes understated, and treatment costs can be higher than you think.

Laser technology helped millions of Americans pitch their glasses, and now it is enabling them to pitch their socks. Podiatrists are having outstanding results with it to end toenail fungus. The treatments are safe, quick and pain free. There are no drugs or side effects, results are much better than the conventional remedies and treatment costs are affordable.

Below is a brief overview of the various treatments. Talk with your healthcare provider about your options. Together, you can determine what is best for you.

Conventional treatments

• Non-prescription home remedies may be helpful for mild conditions but are generally
not potent enough to work effectively. Common remedies include daily foot baths in
apple cider vinegar and water or applying tea tree oil to the infected site.

• Topical antifungal creams may be helpful for mild infections but are not powerful
enough to penetrate the nail plate. Creams must be applied on a daily basis over a long
period of time. There are no side effects. They are about 8 percent effective but not a cure.

• Antifungal nail lacquers (Ciclopirox) are helpful for mild to moderate infections.
Treatment takes 48 weeks. It is applied on a daily basis but has to be removed and
reapplied every 7 days. Treatment is effective less than 10 percent of the time and has a low cure rate (5 precent to 10 percent).

• Oral antifungal medications (Terbinafine, Itraconazole, and Fluconazole) can eliminate
nail infections but they are associated with a number of side effects. Side effects vary
for each medication so make sure to consult with your podiatrist and review a drug
reference. Minor side effects can include headaches, upset stomach, skin rashes,
diarrhea, constipation, and bloating, unpleasant taste in your mouth, mild itching, skin
rash, joint pain or weakness, runny nose or other cold symptoms. Major side effects
can include drug interactions, allergic reactions, liver damage or failure,
and heart failure. Women who are pregnant or breast feeding should not take oral
antifungal medications. Consequently, oral medications must be used with caution.
Treatment is long-term ranging from 3 to 18 months. Weekly blood tests may be required
to monitor liver function. Terbinafine is effective 60 percent to 65 percent of the time with a cure rate of 35 percent to 40 percent. Itraconazole is less effective than Terbinafine. Fluconazole is used less often.

I tell my patients that “there’s a fungus among us,” because toenail fungus is everywhere in our environment. You can contract it walking barefoot at the pool, in a shower, from the floor, the carpet, in a hotel room, or when you get a pedicure. It can even be lurking in your house or sneakers. As seen in the ever popular Lamisil commercials, the little yellow fungus monsters (Dermatophytes) love to invade the nail bed and turn it into a smorgasbord. They thrive on warm, moist environments and humid conditions; and once they get under the nail, they want to stay for life.

I am sure everyone who has this condition wishes there was a fast remedy, but there is no quick fix with conventional remedies like topical creams, prescription lacquers, or oral medications. Each of these remedies is a long tedious process that works less than half the time. Buyers beware because many ads are misleading. Efficacy rates are not always accurate, risks are sometimes understated, and treatment costs can be higher than you think.

Laser technology helped millions of Americans pitch their glasses, and now it is enabling them to pitch their socks. Podiatrists are having outstanding results with it to end toenail fungus. The treatments are safe, quick and pain free. There are no drugs or side effects, results are much better than the conventional remedies and treatment costs are affordable.

Below is a brief overview of the various treatments. Talk with your healthcare provider about your options. Together, you can determine what is best for you.

Conventional treatments

• Non-prescription home remedies may be helpful for mild conditions but are generally
not potent enough to work effectively. Common remedies include daily foot baths in
apple cider vinegar and water or applying tea tree oil to the infected site.

• Topical antifungal creams may be helpful for mild infections but are not powerful
enough to penetrate the nail plate. Creams must be applied on a daily basis over a long
period of time. There are no side effects. They are about 8 percent effective but not a cure.

• Antifungal nail lacquers (Ciclopirox) are helpful for mild to moderate infections.
Treatment takes 48 weeks. It is applied on a daily basis but has to be removed and
reapplied every 7 days. Treatment is effective less than 10 percent of the time and has a low cure rate (5 precent to 10 percent).

• Oral antifungal medications (Terbinafine, Itraconazole, and Fluconazole) can eliminate
nail infections but they are associated with a number of side effects. Side effects vary
for each medication so make sure to consult with your podiatrist and review a drug
reference. Minor side effects can include headaches, upset stomach, skin rashes,
diarrhea, constipation, and bloating, unpleasant taste in your mouth, mild itching, skin
rash, joint pain or weakness, runny nose or other cold symptoms. Major side effects
can include drug interactions, allergic reactions, liver damage or failure,
and heart failure. Women who are pregnant or breast feeding should not take oral
antifungal medications. Consequently, oral medications must be used with caution.
Treatment is long-term ranging from 3 to 18 months. Weekly blood tests may be required
to monitor liver function. Terbinafine is effective 60 percent to 65 percent of the time with a cure rate of 35 percent to 40 percent. Itraconazole is less effective than Terbinafine. Fluconazole is used less often.

• Nail removal surgery is sometimes considered as a last resort if the nail infection
is severe or extremely painful.

Laser treatment

Laser technology is proven to be the most effective way to treat toenail fungus. Cutera,
Pinpointe, Q-Clear, and Aerolase are the leading manufacturers. The lasers all function in a similar manner. The efficacy rates range from 60 percent to 75 percent. Average treatment times range from 10 minutes to an hour. One to four treatments are required. Treatment costs range from $750 to $1,500.

Cutera’s GenesisPlus Laser is recognized as the premium laser for the treatment of toenail fungus, warts and scar reduction. Tiny pulses of laser energy are applied to the toenail and surrounding tissue. The laser provides deeper penetration to effectively reach the fungi and deep vascular skin penetration. The laser spot size enables fast treatment of affected areas and reduces the risk of overlapping or missed treatment. The laser light gradually heats the fungus to a degree that kills it instantly allowing the growth of a healthy, clear nail.

• GenesisPlus Treatments are quick (10-20 minutes). Patients are able to resume regular activities immediately. There are no anesthetics and treatments are pain free. No
medications are required and there are no side effects.

• Excellent results have been achieved by podiatrists throughout the country.
Improvement is seen in over 70 percent to 75 percent of the patients with a cure rate of 60 percent to 65 percent. A clear nail begins to emerge in 3-4 months and totally cleared in 9-12 months.

• The cost of the initial exam is usually covered by insurance. Treatment costs are paid
out of pocket. The cost for three treatments ranges from $495 for one foot and $990
for both feet. Most health savings and flexible spending accounts may be used.

To view a video about GenesisPlus laser treatment, visit www.myfootandanklecenter.com. Treatments are available at the Illinois Laser Center, 2921 Montvale Drive, Springfield, IL. Call (217) 670-2160.

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