Diabetic fungal infection causes yellow and thickened nails for many of us with and without type 2 diabetes. But for diabetics it can lead to a serious complication.
Onychomycosis (toenail fungus) may seem to be only an annoying cosmetic issue. But if left alone, thickened yellow toenail fungus can lead to bacterial infection.
That makes it something you cannot ignore, because infections in diabetic feet can end in limb amputation.
So here are things you need to know about toenail fungus, ways to fight it, and why you got it in the first place.
We type 2 diabetics have too much sugar in our blood. Those high glucose levels become AGEs, the destroyers of cells.
Nerve cells and tiny blood vessels in our feet are some of the first to show the damage. That means poor circulation and diabetic neuropathy.
The direct result is toes that don't let you know when they are damaged.
Shoes that are too tight cause repetitive rubbing of toes against them. Also, if you go barefoot you bang your toes many times a day without knowing it.
Since the pain signal is blunted by nerve damage, you do not realize how much trauma your toenails go through daily.
That, many podiatrists think, is the biggest reason you see diabetic fungal infection in your toenails. You do not see onychomycosis in a child's nails because it only becomes a problem as we age.
You have a damaged immune system from diabetes with its increased level of inflammation.
That means you are more likely to get the kind of infections that find cracks in your defenses. Doctors call these opportunistic infections.
So it is cracked and damaged toenails that let the fungus in. But what is a diabetic fungal infection?
Derma means skin, and phyte means eat. Its name tells its story.
The types of fungus that live on human skin (athlete's foot, ring worm, jock itch) are similar to toenail fungus but are not as hard to get rid of.
In diabetic fungal infection of the nails the dermatophytes feed on keratin, the special kind of protein in skin, hair and nails.
They penetrate to the nail bed in damaged nails and make their home there. It is what makes them so hard to kill.
If unsightly nails were the only problem we could just trim our nails short, file down the thickened parts and ignore it after that.
But even though the fungus does not bore down under the skin, it can cause small tears or breaks in your skin surface.
That wouldn't matter so much if you were not diabetic. But since you are, you need to be extra watchful for bacterial infections in your feet.
This is why a podiatrist is important. When you inspect your feet and find the evidence of diabetic fungal infection it's time to get it checked out.
First, your podiatrist will trim and thin down the thickened nails. He might take shavings for a biopsy to be sure what is causing your nails to change color and shape.
There are several causes, although fungal infection is the culprit in about 90% of cases.
The reason it matters is that there are many fungal treatments, and some work better with certain types of infections and will not touch others. It helps your podiatrist pick the right one for your diabetic fungal infection.
No treatment works in a few days or weeks like the jock itch and athlete's foot creams and powders. You'll be using your treatment for up to a year, whether it's a pill or cream.
If it is working, you will begin to see healthy nail growing from your cuticle, but it takes a long time to get rid of all the infected nail.
If the medications do not work, sometimes podiatrists will remove the whole toenail. However, no one likes to do this on diabetic feet.
The danger of nonhealing wounds is too great. It's not worth losing your foot from toenail surgery that backfired.
There is a new laser treatment some podiatrists are using. It is not FDA approved for treating nail fungus, but it has been used in some treatment trials.
The laser penetrates under the nail and basically fries the fungus without hurting the skin underneath.
In the trials it worked beautifully, but there is no proof yet that the fungus will not come right back. However, there are no harmful side effects to this treatment, so podiatrists are free to try it.
Because using laser this way is not an approved treatment, you will have to pay for it out of pocket. No insurance company will cover it yet.
Insurers call it "cosmetic surgery," and that makes it expensive. So until it is accepted therapy, you may not be able to try it.
Here are some ways to protect yourself against fungal infection.
Medium chain fatty acids like those found in coconut oil and real butter are being shown to improve nerve function. They are necessary for many of the important processes in your body.
In addition, coconut oil has ingredients that fight against candidal and fungal infections.
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There is no medical evidence that any of the remedies work. But people who have tried them and have success are posting their stories on the web.
None of these will harm you, and they won't cost you much to try. Make sure to have your nails trimmed and thinned down first.
Here are some things you could apply with a cotton swab . Vicks before bedtime (because of the strong smell you probably won't want to use it during the day) is the one I'm trying.
You can apply oregano oil at two drops to a teaspoon of olive oil right onto the nails, or concentrated lime juice. Some have used fresh onion cut into pieces and rubbed directly on the nails.
Or make a paste of turmeric powder (it's a spice) mixed with water, and slather it onto your nails. Wait for it to dry before you rinse it off and dry your feet.
For soaking you could try a foot bath of rubbing alcohol 20 minutes a day. Hydrogen peroxide mixed with an equal amount of water is another remedy.
Some people have used bleach at one capful to a gallon of warm water. A 30 minute soak every day, and then you have to wash the bleach off and dry your feet well.
Others have used Listerine mouthwash for a 20 minute soak. But the most well-known foot bath for nail fungus is vinegar at one cup to every two cups of water. A 15-20 minute soak every day is supposed to work.
No matter what remedy you choose, you'll have to continue it daily for months on end. But the same thing is true of anything used on nail fungus.
Be sure to keep your nails trimmed down so the treatment has a better chance to get to the nail bed.
Most of the creams and powders for sale in stores and online have one of these three chemicals: tolnaftate, undecylenic acid or clotrimazole.
A few are made
with tea tree oil, which is a tested natural fungicide. Just make sure you know the percentage of actual tea tree oil in the product you buy.
Tea tree oil is an antibiotic and fungicide. That means if you use it in a smaller concentration than is effective, it will only make your infection more resistant to treatment. The higher the percent level the better.
You can even buy 100% tea trea oil at health food stores. It has a pungent odor, like camphor, but it does work. In tests it was as effective as clotrimazole on nail fungus.
There are several oral medications available for treatment of onychomycosis. But all of them have a chance of causing liver and kidney problems.
For diabetics, who are probably already on medications that put a strain on those organs, adding another one seems like a bad idea.
But some have gotten good results with Lamisil or Sporanox. They have to be taken for several months, and as with all treatments, you need to be committed to them long term.
The only thing that seems to work truly fast is laser treatment by a podiatrist, but that is not an approved therapy for diabetic fungal infection yet.
The most important thing to remember is to pay attention to your feet. Give them good shoes, diabetic socks and daily care. Diabetic fungal infection comes after letting your toenails take a beating.
You might never know anything is wrong until the problem gets very serious. So watch out for your feet, and they will carry you a long way.
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