Dr. Sherry Ingraham on Toenail Fungus

Host: Well, it is summertime here in Houston and the time we swap the boots for sandals, which for many women, and even some then men, mean showing off your toes. However, sometimes our toes are not looking the best during the summer. There's an increase of nail fungus. Almost one in four adults suffers from it. Here to talk about how to treat nail fungus and prevent it is board-certified dermatologist, Dr. Sherry Ingraham. Good morning to you!

Dr. Sherry Ingraham: Good morning!

Host: Kate joining us as well, who has never... has never suffered from this problem, but wants you to show us what a healthy nail should look like, right?

Kate: Right.

Host: So you want to describe what we're talking about?

Dr. Sherry Ingraham: So a healthy nail is like Kate's nail. You can see the lunula, which is that little white moon shape at the bottom. Her entire nail is one color. It's not thick. There's no dark streaks, there's no surrounding redness.

Host: All right, now, let's put your foot down a little bit so we can see the one that you took the nail polish off of. There we go. And so that's healthy, that's what you're looking for.

Dr. Sherry Ingraham: Exactly.

Host: You don't see any discoloration.

Dr. Sherry Ingraham: Right.

Host: And what is fungus is going to look like?

Dr. Sherry Ingraham: A fungus can look like many things. Usually, we see something called distal subungual onychomycosis, where the nail gets real thick. Sometimes you can't cut it, even yellow. It can get a little streaky. There's also white, superficial onychomycosis, where it looks like you have little white marks or dots you can almost scrape off on the nail. And then sometimes you can even have candida, or yeast, where the nailfold surrounding the nail gets really red and swollen and painful.

Host: What causes it in the first place?

Dr. Sherry Ingraham: Dermatophytes. So dermatophytes are fungus that affects the skin, hair, and nails. Very, very common. About 8% of the US population at any time has toenail fungus, and as you age, or if you have comorbidities like diabetes, poor peripheral circulation, we see a much higher incidents in those people.

Host: A lot of times it's really hard to treat, isn't it? Does it seem to keep coming back, or you just can't get it to go away forever?

Dr. Sherry Ingraham: Both. You know, in prior years, we didn't have as effective oral and topical medications. So now we have more effective topical medications. A newer product on the market is JUBLIA. There's another product called KERYDIN. These products are designed to penetrate into the nail bed much better. So a patient would paint this on once a day for about 48 weeks. And I'll explain why.

Host: That's a long time.

Dr. Sherry Ingraham: It's a long time. Nails grow really slowly. So an average toenail grows about one millimeter a month. A fingernail, little faster, two millimeters a month. So it needs to take about a year to grow out. And often, the fungus affects the entire nail and is in the nail bed, so you need to treat it for about a year.

Host: Okay. What can we do to prevent it? Does it have... Because you always wonder if you're going... Maybe if you're at a pool, or if you're at a nail salon, or I always think, hotel bathtubs. And when are we worried about this?

Dr. Sherry Ingraham: Really, if you are in any public place, you need to wear flip-flops. So if you're in a hotel spa, or you're at the gym -- we see many more people going to the gym -- this has contributed to the increased incidents of toenail fungus. Wear flip-flops. If you're in a hotel room, wear slippers. Don't share shoes with other people. Make sure you wash and dry your feet completely everyday, soap and water, and dry, dry, dry those toes. And then also, you want to make sure you can put an antifungal powder like Zeasorb AF in your shoes every day, and change shoes periodically because it's that warm, moist, closed-shoe environment that makes fungus.

Host: All right, Dr. Ingraham, thank you so much for good, valuable advice. Hopefully people will prevent it. And Kate, thanks for being the perfect example of what we need to look like. Hopefully everyone will get there. It's a good goal. All right, good to see you here.

Dr. Sherry Ingraham: Good to see you.

Host: Thank you.