Nail fungus can be embarassing, but in a diabetic setting, it can also lead to a more serious superinfection.
Onychomycosis (on-ee-koh-my-KOH-sis) or nail fungus is not a topic most of us like to discuss, however, it is not a problem to be ignored. It starts as a benign process and progresses slowly. Most of us consider it an embarrassing nuisance that we try to hide. Women cover their toenails with polish, and men stop wearing sandals. It affects 10% of the population.
Whether we realize it or not, onychomycosis is an infection. An infection that has been impossible or nearly so to remove. Over-the-counter topical creams and ointments don’t work, although some may help slow down the growth rate. Herbal and homeopathic remedies don’t offer much help either. Prescription oral medications can be toxic and don’t deliver reliable results as well.
As young adults, we may consider this infection to be a problem we must bear. A problem to hide. As we grow older it progresses. As we grow older we may develop other medical problems. Diabetes mellitus and cardiovascular disease are common problems. Sadly so, they are very commonproblems.
In the setting of diabetes, onychomycosis is very commonly seen. Blood sugar elevations may impair defense mechanisms of the body. White blood cells don’t recognize infections as readily as they should. Nail fungus is just one of those problems that sneak up on you, unrecognized early on.
It starts as a yellowish streak or thickening of the nail. As time goes on, the nail bed definitely thickens, turns yellow and then green or brown. Eventually, the nail may lift off its bed.
Insurance companies don’t care about this problem, labelling it a cosmetic issue! Onychomycosis is an infection, a slowly developing one. In the setting of diabetes or vascular disease it can be a nidus, a portal, an opening for other infections.
Cellulitus, a bacterial infection of the skin, can begin from the nail bed. As doctors, when a patient develops cellulitis, we always search for a source. The source may be a break in the skin, a puncture wound, a bug bite, an abrasion from poorly fitting shoes. When a patient develops peripheral vascular disease, especially in the setting of diabetes, the chances of a superinfection are more common.
In my practice, I see a lot of patients with onychomycosis. Not every patient with nail fungus develops a superinfection, but nearly every patient with superinfections of the foot almost always has onychomycosis.
When treating patients, my belief and my approach has always been using an algorithm or pathway that mimicks or strives to restore normal physiology. The means are as important if not more important than the ends.
I am now offering FDA-approved laser treatments for treatment of nail fungus at all stages. I will treat my diabetic patients as well as any individual who wants to rid this problem. The standard treatment is a series of 3 sessions 30 days apart. Insurance companies do not cover treatments of this condition. The cost locally for laser therapy is in the range of $750 to $1000. I am offering the 3 sessions for $450, but discounts are available. Please do not hesitate to ask me about this exciting new opportunity we offer.
