Let's get to the bottom of nail fungus treatment and various controversies!

Hello. I am Dr. Lee Sang-ju, a dermatologist. According to statistics from the Health Insurance Review & Assessment Service, 1.2 million patients visit hospitals annually for nail fungus. In fact, it is a common disease, with one out of two Koreans experiencing nail fungus. This means that many people are silently struggling with it. Today, I will clearly answer your questions related to nail fungus.

Nail fungus typically shows three main symptoms:

• Nail discoloration: Nails may change from white to yellow, brown, or black.
• Nail thickening: Nails gradually become thicker.
• Brittle nails: Nails tend to crumble easily.

Sometimes patients say their nails itch due to nail fungus, but in fact, nail fungus itself causes almost no itching. However, if you have nail fungus, it is often accompanied by athlete's foot or hand fungus, which can cause itching. Therefore, if your nails change color, thicken, or become brittle, it's a good idea to suspect nail fungus.

My pinky toenail has thickened after wearing shoes, is it fungus?

Many people who stand and work all day wearing shoes experience their pinky toenail thickening and turning yellow. If continuous irritation is applied to the toenail due to wearing shoes, the nail can thicken and become more susceptible to fungal infections. In such cases, it is advisable to visit a dermatology clinic and get a fungal test.

I'm worried my child might get infected with fungus

Parents of elementary school children often worry that toenail fungus might spread to their children. Theoretically, it can be transmitted, but the probability of transmission to children is much lower compared to transmission between adults.

My toenails are thick, how should I manage them?

If toenails become thick due to nail fungus, it is often difficult to cut them with regular nail clippers. In such cases, you can use a specialized tool like a nipper or file down the toenail. Filing may feel a bit inconvenient, but it can be managed without major problems, and after consistently filing to adjust the thickness, using nail clippers becomes much easier.

Can nail art cause nail fungus?

Nail art does not necessarily cause nail fungus. However, when a plastic plate or similar is attached to the nail during nail art, an environment where moisture can easily accumulate under the nail is created. Increased moisture creates a favorable environment for fungi to grow, which can cause discoloration. Therefore, in such cases, it is advisable to temporarily stop nail art, thoroughly treat the nail fungus, and resume nail art after the nails have recovered to a healthy state.

A black line on my nail, could it be melanoma?

Sometimes, a black line appears on the nail due to pigmentation. This must be distinguished from a dangerous skin cancer called melanoma. Melanoma generally has a very dark color and tends to worsen over time. On the other hand, melanonychia is a case where increased pigmentation, similar to a mole or freckle, occurs at the root of the nail, causing pigment to appear on the nail. If the black line darkens or changes, it is crucial to visit a hospital for an accurate diagnosis. If there is no change, it is usually melanonychia.

Treatments for nail fungus can be broadly divided into oral medication, topical medication, and laser treatment.

• Oral medication: The effect is good, but nail fungus requires long-term treatment, from 6 months to as long as 2 years. The disadvantage is that long-term use of medication can cause side effects.
• Topical medication: It is known to be somewhat less effective than oral medication.
• Laser treatment: The biggest advantage is that you don't need to take medication. It is preferred when oral medication is difficult due to poor liver function or other medications. However, laser treatment can be costly.

Oral medication vs. topical medication, which should I choose?

If you have fungus on multiple toenails, oral medication may be considered, and if you have fungus on only one or two toenails, topical medication may be suitable.

There are three main types of oral medications:

• Daily medication: Typically, medications containing terbinafine are used. They are effective but have the disadvantage of requiring long-term use for more than 6 months.
• Pulse therapy medication: Taken for one week and then rested for three weeks, medications containing itraconazole are mainly used. The overall treatment period is not shortened.
• Once-a-week medication: Medications containing fluconazole are available. They are easy to take and have a low risk of liver toxicity, but their treatment effect is somewhat lower than the previous two medications, and the overall treatment period can be 2-3 times longer.

Among topical medications, the efinaconazole-containing medication, released about 4-5 years ago, is known to be the most effective. It is known by the brand name Jublia and requires a prescription. It is more effective than other topical medications, and some even say it shows effects comparable to oral medication. However, it has the disadvantages of needing to be applied once a day every day, requiring a prescription, and being relatively expensive.

Can topical medication 'Jublia' alone completely cure it?

Jublia is considered the most effective topical medication. Some scholars even say it shows similar effects to oral medication. It may be difficult to treat very severe fungus with it alone, but for moderate or mild cases, sufficient effects can be expected. However, medical professionals do not use expressions like '100% complete cure'.

I'm planning a pregnancy, is it okay to use nail fungus medication?

Since Jublia is a topical medication applied to the nails, systemic toxicity is not a major concern. However, caution is needed during pregnancy. Research on specific medications for pregnant women is limited, so it is difficult to conclude that it is 100% safe. It is best not to use it during pregnancy, but it seems to be fine when preparing for pregnancy.

Is long-term use of nail fungus medication safe?

All medications are metabolized through the liver, so during long-term use, it is important to periodically check your health status through liver function tests. Treatment should proceed by balancing the condition of the toenail fungus, the patient's health, and the medication.

What types of nail fungus laser treatments are there?

Currently, there are broadly two or three types of nail fungus lasers:

• PinPointe Laser: Uses thermal energy to destroy fungal cells. Treatment is typically once a month.
• Low-output laser (OnychoLaser): Works by inhibiting the activity of fungal cells to induce their death. It does not use heat, so there is no pain during the procedure, but it has the disadvantage of requiring weekly treatments.

What are the intervals and frequency of laser treatment?

The number of treatments varies by device. PinPointe Laser is treated once a month, and OnychoLaser is treated once a week for about 12-15 sessions, after which the progress is checked and additional treatment is performed if necessary.

The laser treatment time is short, will it be effective?

In the case of PinPointe Laser, if you watch the developer perform the procedure, it's so short that the laser light passes over one nail area about twice. In Korea, it is usually irradiated about 4 times, and in some cases, the energy is increased until the nail feels hot. However, sufficient therapeutic effects can be achieved by maintaining an appropriate temperature, so you can think of it as depending on the medical professional's skill rather than the time.

If laser treatment is not effective, are there other options?

Nail fungus treatment varies from person to person; some respond well to medication, while others find laser more effective. If laser treatment is minimally effective, combination therapy with other treatments or switching to medication therapy can be considered. If the nails are too thick, they can be filed down beforehand to allow the laser to penetrate better before treatment.

Can old nail fungus also be treated with a laser?

Of course. Even old nail fungus can be treated with a laser because the fungus is still present. In particular, nail fungus laser treatment is often effective not only for younger people but also for older individuals.

The causative agent of nail fungus is a fungus, and this fungus does not thrive in dry environments. Therefore, the following management is important to prevent recurrence:

• Keep feet dry: It is most important to keep your feet as dry as possible.
• Prophylactic medication use: If your skin is susceptible to fungus, applying an antifungal preventive ointment once a week can be helpful.
• Shoe care: It is better to alternate between several pairs of shoes rather than wearing only one pair continuously. Shoe sterilizers are also available overseas and can be utilized.

Vinegar contains glacial acetic acid, a type of acid, and using it to peel off the skin can temporarily weaken the fungus. However, the problem is that it is difficult to accurately control the concentration of vinegar. Misusing glacial acetic acid can cause chemical burns, leading to severe damage to the feet, like 'burning down the house to catch a flea'. Therefore, it should never be attempted.

Private health insurance covers the patient's co-payment and non-covered portions for diseases covered by national health insurance. Since fungus is a disease covered by national health insurance, parts of fungus treatment that are incidentally recognized may be covered by private health insurance. However, the limits and standards for coverage may vary by company, so it is most accurate to inquire with your private health insurance provider.