Nail fungus is an unsightly, sometimes painful condition that afflicts millions of Americans. More common in the toe nails than the finger nails, this condition is notoriously difficult to treat. The following article discusses the reason why this is the case, and what physicians use most commonly to eradicate the infection.
Fungus is an organism, much like bacteria, viruses, parasites, plants, or animals. There are numerous species and forms of fungus, some large (like mushrooms), and some microscopic in size. The microscopic species of fungus are the ones that can invade the human body and use it as a scaffold to live off of. Infection of fungus can be seen in the lungs, the skin, and numerous orifices (such as the mouth and genital regions). While usually not life-threatening in reasonably healthy people, fungal infections are an annoyance and can cause numerous problems that prompt people to seek quick relief. Perhaps the most common location of fungal infection is found on the skin, which also includes the nails. Skin fungal infection goes by many common names depending on its location, including ‘ringworm’, ‘jock itch’, and ‘athlete’s foot’. Skin fungus thrives on the body where the environment is warm and moist, and that is why the feet and genital area seem to develop infections more readily. Foot fungus is transmitted, or ‘caught’, in wet areas like showers, locker rooms, and other public places where one is barefoot. Several different species of fungus can invade the feet, including molds and yeasts. However, the most common species of fungus that invades the foot is something called a dermatophyte. It is this species that causes nail infection most often.
Nails become infected when skin fungus takes advantage of a small crack or break in the nail tissue, and invades the skin surface resting underneath the nail. The fungus uses the nail above as a scaffold for living, and thrives on the material of the skin underneath. Eventually, it will cause the nail to become loosened, discolored, thickened, and misshapen as the skin and nail surface become partially destroyed by the infection. The infection creates nail debris that is seen externally as crumbly material exiting the end of the nail.
So, why is this infection difficult to treat? Athlete’s foot infection is easy to treat with topical creams, and the nail fungus is the same organism. Why would it be harder to treat when it is in the nail? The answer lies in the nature of the nail itself. Nails are hard, compressed plates of tissue composed of keratin. This material is generally impervious to water, and the penetration capabilities of medicines applied topically to the nail is generally poor without a special formulation. Even if the medicine could penetrate the nail, because the nail is more dense than skin the end concentration of medication reaching the undersurface of the micinorm unguent nail is likely to be quite low, making it much less effective. Since the fungus lives off the skin underneath the nail, the medicine must reach the skin with enough concentration to kill it off in an environment that is most favorable to it- it’s home field so to speak. Most all topical anti-fungal medicines do not have this capability, as there is either poor penetration of the medicine due to their cream or solution-based formula, or the active ingredient is not active or concentrated enough against the more entrenched nail fungus. Many homespun therapies have developed in response to this difficult-to-treat nature. These include tea tree oil, Vicks, Listerine, vinegar soaks, as well as numerous others. Unfortunately, none of these have true demonstratable antifungal properties, and have not been demonstrated scientifically to kill nail fungus. Some of these treatments can flush away debris or clear superficial discoloration, leading many to falsely believe their fungus is cured when the change is only superficial and the fungus persists. Additionally, not all nail discoloration is due to fungus, and these superficial treatments can sometimes clear the nail discoloration, leading to the anecdotal rumor that they work on ‘fungus’.