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Alternatives for Toenail Fungus

June 13, 2012 Written by JP       [Font too small?]

Nothing says ‘summer’ quite like lounging around the pool in a swimsuit and flip flops. But, if you’re one of the millions of people with toenail fungus, wearing sandals may be something you dread. Fungal infections of the toenail (onychomycosis) affect an estimated 6 to 8% of the adult population. And, although they rarely present a serious health risk, it’s still an unsightly reminder that an infection has taken hold. Worse still, conventional treatments for this largely cosmetic condition often carry the risk of serious side effects including liver damage. Thankfully, both allopathic and alternative healers have some non-pharamacological options worth considering.

If you search for home remedies for toenail fungus online, you’re likely to come across numerous sites that suggest soaking your feet in variety of natural solutions containing everything from Epsom salts to vinegar. These alternative options are certainly economical, require no prescription and are widely regarded as safe. Whether or not they’re effective is another matter. To the best of my knowledge, these traditional remedies haven’t yet been studied in a controlled, scientific manner. That’s not to say that they’re disreputable. Rather, they’re only supported by anecdotal evidence i.e. testimonials. In essence, you’re taking the word of the people who claim to have found success with these natural approaches.

There are a few holistic solutions that have been subjected to scientific scrutiny. Mentholated ointments, such as Vicks VapoRub, have demonstrated efficacy in cases of toenail fungus both in vitro and in vivo. A pilot study, published in the February 2011 issue of the Journal of the American Board of Family Medicine, reported that 83% of those tested found a “positive treatment effect” after using Vicks VapoRub for 48 weeks. Of those, 27.8% was deemed cured and 55.6% was described as presenting “partial clearance”. Tea tree oil has likewise shown positive results in managing onychomycosis. In fact, one trial determined that tea tree oil was comparable to an over the counter antifungal medication (clotrimazole). Another intervention found that combining tea tree oil with conventional treatment (butenafine hydrochloride) resulted in an 80% cure rate without signs of relapse in follow up assessment.

Two other natural remedies are noteworthy in relation to fungal infections: grapefruit seed extract (GFSE) and propolis. Some experiments report that GSE possesses activity against dermatophytes, fungi and molds – the underlying causes of toenail fungus. However, several investigations have uncovered a consistent trend of adulteration in tested batches of GFSE. The findings indicate that, “A significant amount, and possibly a majority of ingredients, dietary supplements and/or cosmetics labeled as or containing grapefruit seed extract (GFSE) is adulterated, and any observed antimicrobial activity is due to synthetic additives, not the grapefruit seed extract itself.” Propolis, an ingredient derived from beehives, does not present the same controversy as GFSE. Having said that, the only peer-reviewed data with regard to propolis and toenail fungus is based on test tube studies. The preliminary data is positive, but needs to be verified in human studies.

A recently introduced, conventional treatment is also worthy of consideration: laser therapy. Unlike other allopathic options, the use of lasers is not linked to systemic side effects. The small number of studies currently available for review indicate that laser treatment inhibits “fungal colony growth” and lead to clearance or improvement in most cases of onychomycosis. The downside to this treatment modality is the cost – between $750 to $1,500. Furthermore, insurance companies typically don’t cover any of the expense and some degree of topical treatment is often recommended after the procedure is complete.

Regardless of the treatment option employed, both allopathic and complementary practitioners generally support the idea that improving circulation to the feet, increasing exposure to free air and sunlight and managing high blood sugar and immunity system deficiencies helps the cause. There isn’t much evidence that diet or antifungal supplements directly impact onychomycosis. Nevertheless, any strategy that positively affects the above noted issues may be helpful, albeit from a theoretical standpoint. In practical terms, this might mean: exercising more, exposing your feet to non-peak sunlight, cutting back on high glycemic carbohydrates and supporting immune function by eating probiotic-rich foods and getting adequate sleep. This is by no means a comprehensive “to do” list, but certainly a decent place to start.

To learn more about the studies referenced in today’s column, please click on the following links:

Study 1 - Novel Treatment of Onychomycosis Using Over-the-Counter (link)

Study 2 - In Vitro Antagonistic Activity of Monoterpenes and Their Mixtures (link)

Study 3 - Comparison of Two Topical Preparations for the Treatment of (link)

Study 4 - Treatment of Toenail Onychomycosis with 2% Butenafine and 5% (link)

Study 5 - Effects of 33% Grapefruit Extract on the Growth of the Yeast (link)

Study 6 - Antimicrobial Activity of Grapefruit Seed and Pulp Ethanolic Extract (link)

Study 7 - The Adulteration of Commercial “Grapefruit Seed Extract” with(link)

Study 8 – Antifungal Activity of Propolis Extract Against Yeasts Isolated from … (link)

Study 9 – New Concepts in Median Nail Dystrophy, Onychomycosis (link)

Study 10 - Mayo Clinic: Nail Fungus – August 25, 2011 Update (link)

Clinical Improvement in Toenail Fungus Using Vicks VapoRub

Source: J Am Board Fam Med. 2011 Jan-Feb;24(1):69-74. (link)

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4 Comments & Updates to “Alternatives for Toenail Fungus”

  1. JP Says:

    Updated 04/20/15:

    http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0074-02762006000500002&lng=en&nrm=iso&tlng=en

    Mem Inst Oswaldo Cruz. 2006 Aug;101(5):493-7.

    Antifungal activity of propolis extract against yeasts isolated from onychomycosis lesions.

    The aim of this study was to determine the in vitro activity of propolis extract against 67 yeasts isolated from onychomycosis in patients attending at the Teaching and Research Laboratory of Clinical Analysis of the State University of Maringá. The method used was an adaptation made from the protocol approved by the National Committee for Clinical Laboratory Standards. The yeasts tested were: Candida parapsilosis 35%, C. tropicalis 23%, C. albicans 13%, and other species 29%. The propolis extract showed excellent performance regarding its antifungal activity: the concentration capable of inhibiting the all of the yeasts was 5 x 10(-2) mg/ml of flavonoids and 2 x 10(-2) mg/ml of flavonoids stimulated their cellular death. Trichosporon sp. were the most sensitive species, showing MIC50 and MIC90 of 1.25 x 10(-2) mg/ml of flavonoids, and C. tropicalis was the most resistant, with CFM50 of 5 x 10(-2) mg/ml of flavonoids and MFC90 of 10 x 10(-2) mg/ml. In view of the fact that propolis is a natural, low cost, nontoxic product with proven antifungal activity, it should be considered as another option in the onychomycosis treatment.

    Be well!

    JP

  2. JP Says:

    Update 04/20/15:

    Note: Eugenia cariophyllata is commonly known as clove.

    http://www.sciencedirect.com/science/article/pii/S0367326X04002746

    Fitoterapia. 2005 Mar;76(2):247-9.

    Sensitivity of fungi isolated from onychomycosis to Eugenia cariophyllata essential oil and eugenol.

    The antifungal activity of Eugenia cariophyllata essential oil and eugenol, its major constituent, on fungal strains isolated from onychomycosis was evaluated. The natural products presented prominent antifungal action with MIC of 1% and 4%, respectively.

    Be well!

    JP

  3. JP Says:

    Updated 08/17/17:

    http://onlinelibrary.wiley.com/doi/10.1111/jocd.12393/abstract

    J Cosmet Dermatol. 2017 Aug 8.

    Oral supplementation with specific bioactive collagen peptides improves nail growth and reduces symptoms of brittle nails.

    BACKGROUND: Brittle nail syndrome is a common problem among women and refers to nails that exhibit surface roughness, raggedness, and peeling.

    AIM: The goal of this study was to investigate whether daily oral supplementation with collagen peptides alleviates the symptoms of brittle nails and improves nail growth rate.

    METHODS: In this open-label, single-center trial, 25 participants took 2.5 g of specific bioactive collagen peptides (BCP, VERISOL® ) once daily for 24 weeks followed by a 4-week off-therapy period. Nail growth rate and the frequency of cracked and/or chipped nails as well as an evaluation of symptoms and global clinical improvement score of brittle nails were assessed by a physician during treatment and 4 weeks after discontinuation.

    RESULTS: Bioactive collagen peptides treatment promoted an increase of 12% nail growth rate and a decrease of 42% in the frequency of broken nails. Additionally, 64% of participants achieved a global clinical improvement in brittle nails, and 88% of participants experienced an improvement 4 weeks post-treatment. The majority of participants (80%) agreed that the use of BCP improved their nails’ appearance, and were completely satisfied with the performance of the treatment.

    CONCLUSIONS: This study demonstrated that the daily ingestion of BCP increased nail growth and improved brittle nails in conjunction with a notable decrease in the frequency of broken nails.

    Be well!

    JP

  4. JP Says:

    Updated 10/07/17:

    https://bmccomplementalternmed.biomedcentral.com/articles/10.1186/s12906-017-1970-2

    BMC Complement Altern Med. 2017 Sep 18;17(1):464.

    A pilot single centre, double blind, placebo controlled, randomized, parallel study of Calmagen® dermaceutical cream and lotion for the topical treatment of tinea and onychomycosis.

    BACKGROUND: Most of the current anti-fungal treatments are chemical-based, fungistatic, have low efficacy in the treatment of tinea and toxicity concerns, while onychomycosis remains recalcitrant to most antifungal therapies. The study aimed to establish the fungicidal, efficacy and safety profile of Calmagen® dermaceutical cream and lotion containing AMYCOT® as a topical treatment in patients with severe to very severe presentations of fungal skin (tinea) and nail infections (onychomycosis).

    METHODS: A randomized, placebo-controlled, double blind, parallel, single centre study was conducted on 28 subjects with severe to very severe tinea or onychomycosis. All patients were randomized in a ratio of 1:1 for treatment or placebo group. Subjects in the treatment arm received Calmagen® cream or lotion, while subjects in the placebo arm received a similar inert topical preparation. Tinea subjects were treated with cream for four weeks, while onychomycosis subjects were treated with lotion for 12 weeks. Mycological cure, the primary endpoint, was assessed by three parameters: KOH (potassium hydroxide) smear, fungal culture and live spore count. Clinical cure was defined as Investigator Global Assessment (IGA) response of ‘cleared’ or ‘excellent’.

    RESULTS: All three parameters constituting mycological cure were confirmed in 92.8% (13/14) of subjects in the treatment arm, while all 14 subjects in the placebo arm remained positive for KOH smear. Calmagen® cream and lotion treatment showed a significant improvement in all three parameters: KOH smear, (95% CI (Calmagen): 79.4, 100.0; 95% CI (placebo): 0.0, 0.0; p < 0.0001); fungal culture (95% CI (Calmagen); 100.0, 100.0; 95% CI (Placebo): 17.0, 100.0; p < 0.0019); and live spore count (95% CI (Calmagen): 100.0, 100.0; 95% CI (Placebo): 17.0, 100.0; p < 0.0019). Clinical cure was achieved in all subjects in the treatment arm while none in the placebo arm were clinically cured. No treatment-related adverse effects were observed in either group.

    CONCLUSIONS: The Calmagen® cream and lotion containing AMYCOT® represent a potentially safe and efficacious natural alternative in the treatment of Tinea and onychomycosis.

    Be well!

    JP

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