Ask Your Pharmacist

August 14, 2019
Q:

I saw a commercial about toenail fungus, and now I’m worried that I have it and I’ll spread it to my family. What advice do you have about this?

A:

Does the commercial you mentioned show kids telling their parents that their toes are gross and doctors telling patients about contagious nail fungus that shouldn’t be ignored? I know I checked my toenails after I saw that ad for the first time, and based on the increase in the number of cases I have helped treat this summer, I’d say this commercial has prompted a lot of folks to check their own nails. I think raising awareness about this condition is positive, but if the commercial has left you feeling ashamed, nervous or guilty about potentially spreading this to loved ones, that is not good. By understanding how foot fungus occurs and how to prevent and treat this condition, we can help take away some of your worry. Keep in mind that not all infected nails will require treatment.

Nail fungus (Onychomycosis) is caused by opportunistic fungus, usually the same that causes athlete’s foot, growing into the toenail. It can occur on the fingernails as well but is less likely.  Fungus grows well in warm, moist, places like a sweaty pair of shoes, hence the name athlete’s foot. The fungus usually appears as a white layer under the end of the nail that can become discolored thick and crumbly. Left over time, it can cause discomfort and irritation and can spread to other toes. So, if you think you have nail fungus, it is a good idea to see a healthcare provider to see if treatment is required, especially if you are over 60 or have diabetes, as you may be more prone.

I wish I could say that with a quick treatment your toenails will be back to normal. Unfortunately, that’s not the case. I tell patients to expect to wait about a year before their toenails are back to normal as the entire nail will have to regrow. Treatment comes in two forms: oral tablets and topical treatment applied to the nails. Topical treatments like prescription Jublia, Penlac, and over-the-counter Emtrix are good options if the infection is not too far along (less than 60 per cent of the nail is affected) but they require daily application for a long period of time which can be pricey. In my practice, I tend to lean towards the prescription topicals for efficacy and cost of treatment (prescription product cost may be covered). Topicals should be applied nightly over the nail and around the nail bed. These are typically prescribed for 11 months. If your infection is severe, six weeks or longer of oral antifungals may be needed for treatment. That sounds easier than nightly application of a treatment, but the oral drugs require monitoring to make sure there is no harm to the liver and to watch for side effects. Oral antifungals also tend to interact with some medications.

Treatment failures occur in one out of three treatments, so it’s not uncommon to have to try multiple products. Also, reinfection can occur which is frustrating. That being said, to help prevent infection, reinfection, and spread of the fungus: keep your toenails short, wear 100 per cent cotton socks and change your socks if they become wet. Powder in shoes can also help reduce moisture in your footwear, but looser-fitting, breathable shoes are more ideal. Infections are common from showers and pools, so dry your feet off well after a shower, or after the pool. Wearing shower shoes in public showers and pools or in a house where someone has a nail infection can also help protect your toes. If you have a fungus on your feet or toes, tell your family member these tips to help prevent them from getting the fungus too. Consult your healthcare professional to see if you need treatment.

Jared Mactavish (BSc., Pharm) is a pharmacist at Guardian Pharmacy in Hampton and St. Stephen. His opinions expressed in this newspaper are published for educational and informational purposes only, and are not intended as a diagnosis, treatment or as a substitute for professional medical advice, diagnosis or treatment. Send your questions to AskYourNBPharmacist@gmail.com.