Update

So, I have been going along more or less faithfully with the treatment as I described it for the last couple months. Every week I file the nail, apply the Curanail, give it two or three of days to soak in, then apply tea tree oil every morning for the rest of the week. I was originally worried that the tea tree oil would irritate my skin but it doesn't at all. I doesn't seem like it's making my toenail "flake off" like my doctor suggested. Of course I'm filing it every week so that might be kind of hard to see.



About 3 weeks ago, though. I started to notice a patch growing on the toenail with the characteristic, yellow, fungal look to it. It is nice that the Curanail package comes with it's little book of toenail files, but frankly I don't think they work very well at removing the old nail. As I tried to remove this little infected patch I scraped up the skin surrounding the nail and didn't even do a very good job. I decided to use my dremel, which may sound crazy. But, I got a set of precision rotary files and I use it on low speed...and it works great. I mean it's really great at removing old toenail carefully, thoroughly, and precisely. You don't want to press down too hard or hold it in one place too long or it will build up heat. But if you go slowly and gently, it works really well.


Below the toenail has been pretty much filed down all the way down and was very cleanly removed. I didn't have any bleeding or pain, but I used the dremel on a medium-low speed (speed 4 on the dremel xpr400) and I was very slow and cautious. Also, remember, my nail was so far gone that I had no feeling or bleeding in it before if I just took clippers and chomped off the whole nail. You may have to be more careful with a nail that's not surrounded with so much dead tissue from being infected for years.


And you can see below that after the toenail is completely filed down and the lacquer is applied, it looks pretty normal. I wear flip flops and don't even think about it, whereas the nasty yellow nail that was there before was a little unsightly. So even if all this nonsense doesn't cure the fungus, during treatment the toe is at least cosmetically pretty normal-looking.

Deciding to do something about the toenail fungus

I have had a fungal infection on my pinky toenail for about three years now. At this point I am sick of worrying about the ugly mutant toenail on my foot and have decided that, one way or another, I'm going to do something about it.

About two years ago I went to the dermatologist and he recommended oral Lamisil (terbinafine). At that time treatment cost about USD $300/month to follow the recommended dosage schedule. That cost of treatment was out of the question for me, so he was very nice and gave me several boxes of oral Lamisil samples from his drawer and recommended a pulsed dosage schedule. I think the schedule he gave me was to go on treatment for 1 week, off for 3 weeks. I followed that for 6 months or so until the samples ran out. At that time I had two infected toenails. The pulsed treatment cured one of them, but my pinky nail was still infected. I have basically ignored it ever since. But, it is getting uglier and less healthy looking every month and I think something needs to be done.

I am sure that the pictures posted here will be kind of grody to the general reader. But I hope that they might be helpful to someone dealing with the same problem.







You can see how the nail has come right off of the nailbed--it's not even really attached anymore.





I did a little research on the pulsed Lamisil treatment and it looks like it is a little less effective than the continuous treatment. But what is also striking is how ineffective even the continuous treatment is. The percentage of patients that had a complete cure of their toenail (meaning the nail looks normal AND no fungus shows up in laboratory test of the new nail) according to this study was 26% for continuous treatment and 20% for pulsed treatment. According to another study the percentages were 41% for continuous and 28% for pulsed. I'm sure there are more studies out there and a lot more research you could do. But this seems like a very iffy treatment to spend a lot of money on. Especially when you consider that you have to have lab tests done on your liver to take oral Lamisil--extra time, expense, hassle, and risk. And what is depressing is that I believe oral Lamisil is reported by the medical community to be pretty much the most effective treatment that is available for fungal nail infections.

But, I was fed up with this nail and I decided to go back to the dermatologist and at least talk to him about it. For insurance reasons I needed to go to another doctor to get a referral to go back to the dermatologist. This other doctor wanted me to try Australian tea tree oil before he would give me the referral. He said to paint it on the nail every day and it would cause my nail to flake off and after several months might lead to a cure. At this point I thought I was kind of perturbed and thought my doctor was a total quack being paid by my insurance company to turn me on to weird natural remedies instead of receiving treatment from an actual dermatologist that would bill the insurance. This may or may not be true but nevertheless I did at least look up tea tree oil and do a little research on it. I found this study that says that it is probably not that effective, but maybe warrants further investigation. I also found this study that combined tea tree oil when combined with another antifungal (butenafine HCl). This mix together in a cream softened the nail up until it was completely removed (debrided) with clippers. This was reported to be 80% effective in curing onychomycosis (toenail fungus). But, after reading the paper it wasn't clear exactly what they defined as a "cure." I don't think it was necessarily the same measure as the "complete cure" discribed above.

Anyway, since the oral treatment is such a hassle and so expensive, I'm going to give it my best go at topical treatment for the next 9 months or so. I'm guessing that, even though the tea tree oil is reported to have some antifungal properties, if it is effective at all, it is probably mostly in the context of helping to soften and remove the infected nail to be able to get at the fungus underneath. Ive decided to try to combine a topical antifungal treatment with a regular trimming and filing down of the nail and also try this tea tree oil stuff.

In looking for the best topical antifungal I came up with these guidelines published by the British government that suggest that amorolfine might be among the most effective topical treatments. It is available over the counter in Great Britain under the trade name Curanail as a nail lacquer that only needs to be applied once a week, which seems convenient. You apply the lacquer and the drug soaks into the nail over the next week until your next treatment.





I ordered some along with some Australian tea tree oil. The first step that I took in starting treatment was to remove most of the infected nail. It was basically coming off anyway, so this was just a matter of trimming it off with nail clippers .





Next, the Curanail comes with a book of disposable files, kind of like a book of matches. I filed the nail down as far as I could. It's strange, I didn't feel any pain in removing the nail or filing down the nub. This nail is really far gone.







I then cleaned it up with a wipe, also provided. Then, I applied the lacquer over the nail. Well, really just over the skin where the nail should be and over the nub sticking out of the nailbed.







My plan is to apply the Curanail on Saturdays, let it soak in for 4 days, then apply the tea tree oil Wednesday, Thursday, and Friday before soaking it, filing it, and reapplying the lacquer the next Saturday. I'll repeat this every week and post pics of the progress as time goes on.