By Total Foot and Ankle of Tampa Bay
November 11, 2015
Category: Uncategorized
Tags: Untagged

Question:

Is there any health risk to allowing a toenail fungus to exist untreated over the long term?
I have avoided using oral drugs for chronic toenail fungus because I don't want to risk liver damage. Which raises the question: Is there any health risk to allowing a toenail fungus to exist untreated over the long term? Thanks!

 

Answer:

Fungal infections of the nail can be difficult to treat. As a previous Ask Well column noted, plenty of remedies exist, but none are certain. And the one considered most effective, the drug Lamisil, is associated with rare cases of liver damage.

So it is no surprise that some people would consider covering up their feet and turning a blind eye to the problem. Most healthy young adults who ignore it will probably not notice any immediate issues. But over time, as the fungus progresses from the tip of the nail toward the cuticle, it can make the nail thick, discolored and brittle, and pain and inflammation become more likely.

In about one out of two dozen cases, the fungus migrates to other parts of the body, like the hands, back and legs, said Dr. Boni E. Elewski, a professor of dermatology at the University of Alabama at Birmingham who specializes in nail disorders. Older people or those taking medications that weaken the immune system, like chemotherapy drugs and corticosteroids, are particularly susceptible.

“If you don’t treat it, you have an organism living in your nail that could spread,” she said. “In most people, it probably won’t go beyond the foot. But there are some people who are at risk of getting it in the fingernails and other places.”

The other problem with ignoring nail fungus is that the fungus creates cracks and openings in the skin where bacteria can sneak in and cause infections. For people who have nerve damage and poor circulation -- someone with diabetic neuropathy, for example -- this can have serious consequences.

“Podiatrists frequently cite this as a cause of diabetic amputations,” Dr. Elewski said. “The fungus paves the way for bacteria, and it can definitely be a problem.”

If the side effects of Lamisil are your concern, Dr. Elewski said, then alternatives are on the horizon. Two promising new topical treatments -- Efinaconazole and Tavaborole -- are expected to be released next year. Nail lacquers can also be effective but require regular application. And it is better to begin treatment early.

“The longer you wait,” Dr. Elewski said, “the harder it is to treat.”

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