A Nail Expert Weighs In: Why is Toenail Fungus So Challenging to Treat?

Dr. Dana Stern is a board-certified dermatologist who runs a Manhattan practice and teaches at the Mount Sinai Medical Center. In her professional opinion, toenail fungus is one of the most challenging nail conditions to treat for a multitude of reasons. Yet, it is important to pursue treatment because the infection can spread to other parts of the body and also infect other people. “Over time, fungal infection can cause the nails to become thickened, brittle, discolored, and even painful,” she explains. Here we’ll look at Dr. Stern’s expert opinion on why fungal infections are so difficult to cure.

toenail fungus treatment

Dr. Dana Stern dishes about toenail fungus and the importance of seeking treatment, even though it is challenging (and expensive) to cure.
Image Source: NailsMag.com

Toenail Fungus Treatment Challenge 1: Genetics

Dr. Stern explains, “Multiple factors predispose a person to fungal infections of the nail including increasing age, diabetes, suppressed immunity, excessive sweating (hyperhidrosis), poor circulation, and nail dystrophy (irregularly growing nails).” It’s a tough nut to swallow, but some of us are simply more genetically prone to picking up fungal infections than others. Over the past five years, scientists identified two gene mutations — on Dectin-1 and CARD9 — that make an individual more susceptible to developing systemic fungal infections. Genetics can also dictate why toenail fungus treatments work on some people, but not others.

Toenail Fungus Treatment Challenge 2: Side Effects

“The oral medication considered most effective (Lamisil), can on rare occasions be associated with risks such as liver damage,” Dr. Stern warns. A study of 69,830 patients treated with oral antifungal drugs found the incidence of acute liver failure to be:

– 134.1 per 100,000 persons for ketoconazole (Nizoral)

– 10.4 per 100,000 persons for itraconazole (Sporanox)

– 2.5 per 100,000 persons for terbinafine (Lamisil)

While the overall rates are nothing to be terribly alarmed about, liver side effects should be especially considered in patients with a past history of liver problems, failure, or transplant. Patients with autoimmune disorders (particularly HIV) are also more prone to suffering drug interactions and adverse symptoms related to long-term oral antifungal medication use.

liver damage

Oral antifungals are not the only drugs implicated in damaging the liver. Tylenol, another drug sometimes taken long-term, can also hurt the liver.
Image Source: Good-Legal-Advice.com

Toenail Fungus Treatment Challenge 3: Recurrence

“The longer one waits to treat nail fungus, the harder it becomes to effectively treat it,” Dr. Stern tells Nails Magazine“In addition, relapses after effective therapy are common.” She goes on to say that there must be some investigative work conducted to determine where the infection came from and who has been infected. Often, the entire household needs to go in for examination. If one person is treated, but the others are not, they can pick up the fungus all over again off the surface of the shower, a pool deck, or a bare floor.

fungus recontamination

Oh, no you didn’t! Did you just put your treated feet back into your old, contaminated, closed-toe shoes?
Image Source: VivaWoman.net

Also, many people fail to treat their shoes for the fungus. They go through antifungal treatments, but stick their feet right back into contaminated shoes again, causing a re-infection. The SteriShoe UV shoe sanitizer is a product consumers can use to sanitize the shoes of 99.9% of fungus, bacteria, yeast and viruses in just one 45-minute cycle. Nail infections may not be easy to treat, but re-infection does not have to be difficult to prevent.

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