A Guide To Treatments For Onychomycosis

By John Mozena, DPM

Onychomycosis is the number one diagnosed and treated disease by podiatrists today. While the disease was first recognized in the United States in 1928, it has only recently been brought under control with drugs that have been introduced in the last 10 years. With the advent of safer oral and topical medications, there has been a renewed focus on increasing efficacy rates. The current research seems to be centered on synergistic activity of oral and topical medications as well as different vehicles to add additional penetration of the medication.
Onychomycosis is present in 2 to 3 percent of the population with the most common source of contamination coming from the patient’s own skin. Currently, 70 percent of the population has fungus recovered from the feet. Fifteen to 20 percent of people between the ages of 40 and 60 have onychomycosis, 32 percent of 60- to 70-year-olds have nail fungus and approximately 50 percent of those over 70 are afflicted.

A 1965 U.S. study stated fungus can also be contagious throughout the patient’s own body and can also spread among individuals. In a study of 963 children cultured for onychomycosis, 263 (30.74 percent) were positive. The number of cases rose quickly with the age of the child, with only 25 percent of the patients being below the age of six.
The question of treatment is always present due to the fact that onychomycosis has been considered a cosmetic problem in the past. This has led many physicians to falsely believe that this infection should be monitored and not treated. However, recent evidence shows this is not the case. Seventy-five percent of the people who have this infection exhibit psychosocial concerns. These people face the dilemma of not being able to go to the swimming pool, public shower areas or even wear open-toed sandals. More important is the fact that 48 percent of the people with onychomycosis have pain. The pain is intense enough to have these patients miss 1.8 days of work on average over a six-month period.1,2,3

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