What Is the Main Idea?

Onychomycosis is a relatively common infection of the fingernails and toenails. The currently available oral antifungals are not without risk. In the review article “Complementary and Alternative Therapies for Onychomycosis: A Systematic Review of the Clinical Evidence”, published in the journal Skin Appendage Disorders, alternative treatments were considered.

What Else Can You Learn?

Learn about the causes of onychomycosis and some of the ways you can approach your nail health to prevent it.

What Is Onychomycosis?

Onychomycosis is a fungal infection of the fingernails and toenails. It’s a common infection, occurring in around 10% of the population overall. It’s more common in older people, with around 50% of those over 70 years of age experiencing it. It’s also more common in people with immune disorders, including HIV; auto-immune disorders, including psoriasis; and diabetes. It’s more likely to occur in toenails than fingernails because the damp and dark are more conducive to fungal growth.

There are three main classes of fungus that cause onychomycosis:

  • Dermatophytes are by far the most common. These are fungi that grow on keratin, the protein found in hair, nails, and skin.
  • Non-dermatophyte molds are the least common cause in the general population, but the dominant cause in patients with HIV. They can only infect keratinized tissues if the keratin is damaged by some other infection or physical trauma.
  • Yeasts of the genus Candida are a slightly more common cause than non-dermatophyte molds. Candida is more common in fingernail onychomycosis than in toenail onychomycosis.

How Can Nails Be Protected?

Hand and foot hygiene should go beyond washing the skin and using a nail brush to clean under the nails. It’s also important to consider what environment and condition the nails are in. Continually wearing shoes and socks is not good for the toenails, as it keeps them in the dark and prevents them from drying properly. Wearing nail polish and nail varnish continually means the tissues of the nail bed don’t “breathe” properly. Damaging the nails during gardening exposes them to bacteria and fungus. Leaving dermatophyte infections untreated can allow non-dermatophyte infections to take hold. It’s important to treat your nails as well as you treat your skin, considering them not just as “dead keratin”, but as part of your hands that need good conditions to stay healthy.

How Is Onychomycosis Treated?

As explained in the review article “Complementary and Alternative Therapies for Onychomycosis: A Systematic Review of the Clinical Evidence”, onychomycosis is very difficult to treat. The nails are made of keratin and are not permeable to many topical agents. What’s more, while oral antifungals can be effective against onychomycosis, this type of drug cannot be used in every patient population due to the risk of system-wide effects.

Are Alternative Treatment Strategies Effective?

The authors of the review looked at every paper that mentioned complementary or alternative therapies for the treatment of onychomycosis. They found 17 articles with alternatives, including:

  • Tea tree oil, which seems successful against Candida infections and has shown some potential against dermatophytes.
  • An extract from Ageratina pichinchensis, a plant used in traditional Mexican medicine, which exhibited some therapeutic effectiveness against onychomycosis in pilot clinical trials.
  • An extract from Arthrospira maxima, also called spirulina, which also showed promise in a pilot clinical trial.
  • Vicks VapoRub®, a commercially available topical ointment used to ease breathing, which showed promising results with cure or partial clearance of the fungus in the majority of patients in a non-clinical trial.

Does This Mean These Treatments Can Be Used?

As pointed out in the review article “Complementary and Alternative Therapies for Onychomycosis: A Systematic Review of the Clinical Evidence”, all the results with alternative or complementary therapies for onychomycosis are preliminary. There have not been any large-scale, randomized, placebo-controlled trials. Therefore, while these treatments are promising, they could not be endorsed as official therapies.

However, you could certainly discuss this paper and these treatments with your physician if you had onychomycosis and wanted to try something other than antifungals to deal with it.

Note: This post is based on an article that is not open access, i.e., only the abstract is freely available.

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