Consumer Reports Insights

Getting to the bottom of toenail fungus

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Tuesday, July 13, 2010

Rarely does the lowly toenail generate much interest. But quite the opposite is true in the drug marketing field.

Millions of dollars are spent each year on ads for medications to be used in mostly futile attempts to eradicate onychomycosis, or nail fungus, a hardy, microscopic organism that infects about 35 million people in the United States.

The deformed, grayish-greenish-yellowish toenails of fungal infection are hard to miss or misdiagnose, according to Marvin Lipman, a clinical professor of medicine emeritus at New York Medical College, though occasionally the condition is confused with psoriasis. In advanced cases, the nail can be crumbly or difficult to cut.

Treatment is not often medically necessary, and then mostly to prevent secondary bacterial infections. That's especially true for diabetic patients, who seem to be more affected, and for those with compromised immune systems. Most people treat toenail fungus for cosmetic reasons.

Do it yourself?

A Google search on toenail fungus treatments produces more than a half-million hits, with plenty of ads for do-it-yourself topical liquids, salves and creams. Several of the treatments contain ingredients loosely regulated by the Food and Drug Administration and categorized as supplements, such as acetic acid, and a variety of oils, including jojoba, lavender, lemongrass and tea tree. Some are capable of killing some fungi. All clamor for your attention and dollars. Some offer money-back guarantees that expire long before you're able to see any success. Randomized, controlled trials are lacking, and evidence for cures is scant.

Two popular remedies are water-diluted vinegar foot soaks and applications of Vicks VapoRub. Details of use are up to you since neither treatment comes with instructions for treating toenail fungus. Because it is relatively cheap and nontoxic, Consumer Reports thinks that VapoRub, which contains eucalyptus, menthol, camphor and other oils, may be worth a try.

Prescription options

If you decide to treat with a prescription drug, it will cost you. Bear in mind that there is no medicine that is effective or safe for everyone. Two oral antifungal drugs, terbinafine (Lamisil and its generic cousins) and itraconazole (Sporanox and generic), have been in use for several years and have been shown to be effective for up to 50 percent of users. Monitoring is necessary, since either can be toxic to the liver. Costs for a three-month course of treatment can run up to several hundred dollars, not including doctor's visits and costs of tests.

Ciclopirox (Penlac Nail Lacquer and generic) is a less effective paint-on medication that has to be applied daily for at least four months and probably longer. Laser treatment recently arrived on the scene, and a single treatment, usually by a podiatrist, may be effective nearly 90 percent of the time, but at around $1,200 a pop.

Copyright 2010. Consumers Union of United States Inc.

For further guidance, go to ConsumerReportsHealth.org. More-detailed information -- including CR's ratings of prescription drugs, conditions, treatments, doctors, hospitals and healthy-living products -- is available to subscribers to that site.


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