Monday, March 14, 2011


How would you describe your toenails? Do you disguise them with polish? Or avoid wearing sandals or being seen bare foot?  Chances are that the nails you may describe as ugly are actually infected toe nails that can be treated and can even be treated without medication.

Ever since the FDA approved laser therapy for the treatment of nail fungus, there has been a heightened response from people for this therapy. It is due to the fact that the only real treatment available since this has been a potentially toxic treatment with oral therapy with success rates maxing out in the 70 percent range.

The technical term for nail fungus is onychomycosis which refers to nail infections caused by fungus, yeasts or molds. Most people with the toenail variety also have tinea pedis( athletes feet).

By most studies, the prevalence of onychomycosis is  up to 18% of the population with toenails involved and the most common being fungus. It is not only the nail but the root of the nail that is involved meaning that the nail is bad to the core. As a result, only medications or laser (no soaks or tree oil or oregano!) will kill it.

There are some situations that increase risks to getting this infection, but anyone can get it since it lives on our skin. Those risks include: diabetes, older age, swimming, athletes feet, and living with someone with fungus. Note that psoriasis of the nail is not infectious and will not respond to medication or laser.

The big toe is usually the one infected first but easily spreads to all toes. The involved nail often looks heaped up, discolored, irregular with flaky contents under the nail itself. The nail may also look white or chalky.

It is possible to biopsy the nail to figure out what the cause of the ugly nail is, however, only about half the time does the culture show the organism even though it is present. Insurance companies are increasingly requiring a positive diagnosis before paying for the medications.

So, why treat the ugly nail?

•    They look bad
•    The nail can cause discomfort/pain  since it is infected
•    You can infect others in the house
•    Adds to risks of infection especially in those who are diabetic or have swollen ankles/legs, or prior cellulitis( skin infections).

As stated, treatment can include medications, such as Lamisil. This drug is to be taken for 84 days consecutively with a success rate of about 73%. Multiple blood tests for liver function should be done during the course of treatment to guard against liver toxicity. Recurrence is common especially when dealing with toenails.

Some have tried nail removal. This however often proves fruitless as infected nail grows out since the root is infected in addition to the nail itself.
Finally, there is the laser. There are studies reporting the success of this treatment. It is called photodynamic therapy involving the application of a topical gel( photosensitizer) followed by treatment of the nail with a light energy source. Recently, the FDA has approved the use of laser for the treatment of nail fungus.

So, do you or someone you know have ugly nails? It may be a fungus! And it is an infection that should be considered to be treated.

Dr. Frank Marinkovich and his wife Rita own and operate Eastside Family Health Center in Kirkland, WA. Serving Kirkland and the Eastside, Seattle,  Bellevue, Renton and the surrounding local communities. Specializing in Primary Care, Automobile Accidents and FAA physicals. Be sure to find out more about their NEW specialized Laser Treatment. Visit them online at or call them at (425) 899-2525


  1. Laser is a great alternative to the meds that are so risky for the liver. Plus it is so quick.