Talk:Onychomycosis

Home remedies

Onchomycosis can be caused by many different fungi, and many other conditions like a psoriatic nail and paronychia can look so much like it that dermatologists still need to have a lab workup done. What was the causal agent, if any, of the wife's onychomycosis that was relieved with vinegar? How can anyone possibly give universal medical advice based on one person's kitchen experiments with the application of 19th century hygiene principles to an (I strongly suspect) undiagnosed condition?

Mercurochrome contains mercury and is banned in the US. All sorts of these common home disinfectants were tested against fungal skin and nail infections in the 1910's to 1950's and the only one that stood out as somewhat effective was Whitfield's ointment, with the active ingredient benzoic acid. But even it doesn't stand up to scientific comparison as a serious onychomycosis remedy. The common fungi causing dermatophyte onychomycosis are too deeply seated in the nail to be affected by materials applied to the surface (unless the materials are combined with chemical nail softeners under occlusion). Mercurochrome is commonly used in developing countries to treat fungal ear canal infestation (otomycosis), but there the fungus is right at the surface. Mercurochrome can't even penetrate to kill the endospores within spore-forming bacteria.

Onychomycosis isn't life-threatening but casual treatment recommendations based on anecdotes are no more helpful here than they are in any other disease. No doubt carrot juice and staying optimistic cured somebody's wife's cancer somewhere, but there's a serious ethical problem with extending this observation into a general prescription. Yes, any individual could make a novel observation -- but there's nothing novel about applying vinegar, iodine, garlic, lemon peel, oregano, etc. against fungal skin infections. It's been done. Tea tree oil is still being investigated but results are mixed (for references go to Entrez PubMed website and search on keywords: tea tree oil onychomycosis. Also: tea tree oil tinea. Also: tea tree oil dermatophyte). Keywords for the otomycosis statement above are otomycosis mercurochrome.

Summerbell 18:32, 26 September 2006 (UTC)

Remember, Wikipedia does not exist to provide medical or health advice. For medically oriented articles such as this one the focus of the article is etiology and the popular treatments, peer reviewed scientifically proven treatments as well as popular folk remedies. Even if these folk remedies are totally useless or even counter productive and dangerous. This provides those reading the article a good overview of all the available "treatments," and more importantly the place of the disease within our society as a whole. Besides anyone reading Wikipedia as their sole source of diagnoses and treatment information has greater problems. 130.71.96.19 16:19, 9 October 2007 (UTC)

Still, a personal experience is not fitting in an article like this, such anecdotes can be piled on one another in a bulletin board thread. A wiki article should provide an overview and description of the topic and that information should be somewhat objective. "there is some anecdotal evidence that suggests the ability of creme fraiche to cure nail fungus (not being funny here, there really is), however, no scientific investigation have been performed and whether the substance can be effective is unknown." is an OK entry, as it is unbiased and not misleading. "creme fraiche did it for me!" is not a good entry because a personal anecdote does not have a place in a medical article, and especially not without a specified source. — Preceding unsigned comment added by Gaffa11 (talk • contribs) 08:28, 15 June 2011 (UTC)

• Mercurochrome cured it for me. Unfortunately, this probably counts as original research. -- ProveIt 17:23, 4 January 2006 (UTC)

Anyone interested in a picture for this article?

I could get one. The question is, would anyone really want to see it?

The article lacks a good quality image, go for it. Pgr94 05:39, 21 October 2006 (UTC)

Vinegar

My wife had an infection and cured it by soaking the infected toe for 30 minutes in vinegar every day for 3 months. She would keep the nail as trimmed as possible the whole time. Don't cause your body stress with something like Lamisil. Save your money and health.

FDA Topical Antifungal Monograph

I wanted to add something on the FDA OTC Topical Antifungal Monograph, but all I could find were some very general bits of info on the FDA website (see [1] and [2]). I also haven't been able to find anything on the FDA's 1994 ruling that said that no OTC anti-fungal product was effective on nails, and required the wording "this product is not effective on scalp or nails" on all OTC anti-fungal products (even if they were still allowed to use trademarks such as Fungi-Nail!). The closest I could find was this DOC file Comparison of Labeling for All Topical Antifungals Treating Athlete’s Foot. Can anyone provide better information? ^BlankVerse 15:37, 29 August 2006 (UTC)

Ineffectiveness of Tea-tree oil - evidence?

• Tea tree oil is a known antifungal. The topical application of high levels is a verified remedy for some dermatophytic skin infections although not for onychomycosis, where the fungus is often too deeply nested in dense subsurface nail tissue to be full expunged by topically applied materials of any kind.

The article that is referenced does not say that tea-tree oil doesn't work because the fungus is too deep subsurface. This needs more evidence or is WP:OR. Pgr94 18:41, 13 June 2007 (UTC)

References

Removal of passage

The section related to tea tree oil was removed from the 'natural remedies' section via this edit by User:68.36.170.182. Was this removal in accordance with consensus? --User:Ceyockey (talk to me) 01:12, 1 July 2007 (UTC)

I think it was because of the WP:OR reference to the fungus being too deep to be treated by Tea tree oil. If you want to put it back in and either find a source for this claim or remove it feel free. Personally I tried treating my fungus militantly with Tea tree oil, with four treatments a day. During this period the fungus, which had been advancing, went into remission in all my nails, but the fungus under a few toe nails was persistent. I eventually stopped treatment and the fungus has not returned in any nails, but has grown back in the nails where it was still present. 130.71.96.19 16:25, 9 October 2007 (UTC)

Here is a summary of this topic from a 2002 article in the Journal of Antimicrobial Chemotherapy[3]:

Based on both its inhibitory and fungicidal action, tea tree oil may be a useful agent for treating dermatophyte infections. However, exactly how this in vitro activity translates into in vivo effectiveness is unclear.
[... summary of two clinical trials ...]
Given that onychomycosis rarely responds to topical therapy and is therefore usually treated systemically,20 it is perhaps not surprising that the topical application of tea tree oil was of limited effectiveness in these two clinical trials. This emphasizes the need for more clinical trial data, particularly in relation to tinea pedis, which can often be treated successfully topically.20

So it seems there is little-to-no evidence to support the claim either way. Furthermore, given topical treatments don't really work for onychomycosis, there are grounds for believing tea-tree oil won't work either. Pgr94 19:02, 9 October 2007 (UTC)

Crocodile Oil

• Crocodile Oil: There is something amazing in the crocodile’s immune system, there are strings of peptides that were only discovered very recently in the last eight or nine years and they are a powerful mechanism for fighting bacteria and fungal infections. Repcillin Crocodile Skin Balm is made in South Africa and uses the fat from CITES approved Crocodile farms in Africa.

Is this verifiable? WP:V Pgr94 22:35, 26 June 2007 (UTC)

This completely unverifiable: the only sources discussing Crocodile Oil are those selling it, usually trying to blind with pseudo-science. For more on this see the discussion for Crocodile Oil Almost-instinct (talk) 22:46, 19 April 2008 (UTC)

Wanted: images for each type of onychomycosis

There are different types of onychomycosis. It would be good to get images of each type. For example see [4] Pgr94 10:25, 18 September 2007 (UTC)

different types of onychomysosis will look mostly the same, be somewhat misleading (as for the most part, this is not a tool used to dignose the type of fungus... and may be somewhat trivial to categorize. Certainly additional photos of a general nature are always of value. —Preceding unsigned comment added by Spamwatch (talk • contribs) 18:59, 13 November 2007 (UTC)

Vinegar passage removed.

As no evidence has been found for vinegar since Feb. 2007, I have removed it.

Distilled white vinegar. Drops are applied to the cuticle twice a day. This method does not kill the fungus, but the vinegar allegedly changes the pH (acid content) of the new nail formed in that 12-hour period. (The scientific perspective, however, is that vinegar is unlikely to penetrate the dense keratinous tissue thoroughly enough to have any significant effect. Instead, it may be absorbed by the skin above the nail and work its way to where the nail is actually forming.) As the old, infected nail grows and is cut away, it is said to be replaced by an acidic nail, uninhabitable by fungi. Several months of consistent application are involved.

Pgr94 (talk) 13:14, 29 November 2007 (UTC)

I went to a podiatrist who told me to soak my foot in white vinegar for three months but I won’t see the results for one year. June 1 2009. —Preceding unsigned comment added by 75.45.16.130 (talk) 01:37, 13 May 2009 (UTC)

Fungus location

If someone with access to good sources could examine these issues and possibly amend the article it would be appreciated

• The fungus "infects" the nail. Could this be clarified as to whether fungus is growing under and around the nail, or within the material of the nail itself?

• Also the difficulty of treatment seems to be because of the difficulty of getting treating agent to the best location. Is drilling holes in the nail a workable option?

Thanks, Wanderer57 (talk) 20:33, 30 March 2008 (UTC)

It depends. The first stage is usually infection of the tip of the nail and the nail bed. As the fungus works its way back the entire nail and nail bed can be infected, and eventually it can reach the nail matrix. I have no really good link at the moment but check http://www.patient.info/doctor/Fungal-Nail-Infections.htm .

You are right about the penetration problem. Drilling holes may or may not be helpful, I have tried it with a .25 mm drill and applied various topical substances but the small holes tend to clog up quickly and probably only a little of the topical agents get through. To my knowledge no research is being done on this type of approach to drug transport into the nail. — Preceding unsigned comment added by Gaffa11 (talk • contribs) 08:45, 15 June 2011 (UTC)

Recent reviews (Aug 2008)

Short of time right now so this a note to self, or anyone who else wants to follow recents developments.

• see reviews PMID 18484426 and PMID 18569273
• check differential diagnosis of psoriatic nails

pgr94 (talk) 22:25, 20 October 2008 (UTC)

Listerine and vinegar

I've had severe toenail fungus for just over forty years. It started when I lived in the tropics.

At this writing, the fungus is completely expelled in two nails, is almost done being expelled in four others, and halfway gone in the big toes. Two were already clear.

How? I soak the toes in 50% Listerine, 50% white vinegar, for 30-45 minutes every night. I started about four months ago. I didn't make this up - a Google search for "Listerine toenail fungus" finds many testimonials, and occasional discussions of the method of operation. It seems that the fungi can't handle eucalyptol and thymol, plus the other assorted toxins that make Listerine lethal when a lot is swallowed.

Not sure if a photo of the half-clear big toes would be helpful. —Preceding unsigned comment added by MoonDJ (talk • contribs) 16:33, 31 July 2010 (UTC)

Undiluted Bleach

On recommendation from my GP, using a cotton swab, applying a single drop of undiluted bleach twice a day underneath my toenail is rapidly removing the fungus. Half of the nail bed has recovered in 6 months. Application is quick and there seems to be no tissue damage. If considered, use caution though... RudiBosbouer (talk) 08:03, 14 January 2011 (UTC)

Anecdotal evidence that should be ignored. Unless you have reliable sources, this means nothing. Please don't post your personal medical experiences. OrangeMarlin ^{Talk• Contributions} 17:20, 26 May 2011 (UTC)

It may or may not mean nothing. Any established remedy was once experimental. I, for one, intend to try it. Kostaki mou (talk) 23:12, 31 January 2014 (UTC)

Having done just that, may I add that it is important to have adequate ventilation to avoid inhaling the vapor. Kostaki mou (talk) 22:10, 3 February 2014 (UTC)

Someone posted a while ago that she used Comet to remove the fungus, however her toe got cancerous and had to be amputated. Be careful with unproven remedies. Joshmax (talk) 18:06, 1 June 2015 (UTC)

Reviews

These should be used as refs rather than as further reading

• Baran, R.; Hay, R. J.; Garduno, J. I. (2008). "Review of antifungal therapy and the severity index for assessing onychomycosis: Part I". Journal of Dermatological Treatment. 19 (2): 72–81. doi:10.1080/09546630701243418. PMID 18484426.
• Baran, R.; Hay, R. J.; Garduno, J. I. (2008). "Review of antifungal therapy, part II: Treatment rationale, including specific patient populations". Journal of Dermatological Treatment. 19 (3): 168–175. doi:10.1080/09546630701657187. PMID 18569273.

Doc James (talk · contribs · email) 17:00, 26 May 2011 (UTC)

I would accept there use if full access was available for free but there isn't. Doc James (talk · contribs · email) 00:56, 27 May 2011 (UTC)

It would be more constructive to provide alternatives than to just remove them from the article. pgr94 (talk) 09:11, 27 May 2011 (UTC)

Efficiacy of home remedies

I was diagnosed with Onychomycosis and was treated with fulvacin. The condition was eliminated within 45 days as the nail grew out. Any claim of a "challenging" treatment in this article seems to exist in order to appease believers in alternative and holistic remedies, or to appease persons apprehensive of "mainstream" treatments. Claims of a cure based on garlic/vinegar/lasers/prayer seems dubious at best. My chemical-laden, corporate/mainstream/liver-killing treatment cured my condition post haste, and I wouldn't have it any other way. Enjoy your fungus -- I'm sure your girl loves it!! — Preceding unsigned comment added by 69.60.103.173 (talk) 04:51, 1 May 2012 (UTC)

How about nail removal?

Once I had an infection in one of the foot's small fingers, it lasted for at least a year, until I removed the nail myself with a tweezer. The nail grew back and the infection was gone. Any opinions from physicians or scientific studies in this regard? — Preceding unsigned comment added by 220.238.51.163 (talk) 02:24, 3 November 2012 (UTC)

Undecylenic acid

There are products on the market claiming to cure onychomycosis with Undecylenic acid as the active ingredient. Pubmed doesn't show very strong evidence for this. E.g. [5]. Does anyone know of any other evidence for undecylenic acid? Meanwhile beware that the science doesn't appear to support the claims of "Fungi Nail"'s peddlars. (www.funginail.com) Treat nail fungus infection. Suitable for everyone (all ages) Tested clinically with 100 % efficiency after 12 weeks of use.[6] pgr94 (talk) 18:08, 20 January 2013 (UTC)

Onychomycosis vs. Paronychia

Onychomycosis is infection of the nail. Paronychia is infection around the nail. The lede of each article should make readers aware of the other, closely related article. (I have tried to cross-link the articles. My work was reverted. Now the matter is in your hands.) -71.174.175.150 (talk) 15:08, 2 January 2015 (UTC)

It is already crosslinked and listed here "Diseases of the skin and appendages by morphology" at the bottom. Does not need cross linking twice. Doc James (talk · contribs · email) 20:58, 2 January 2015 (UTC)

Completely uselessly obscure and inadequate to help the average browsing reader to be aware of this very relevant potential confusion, between two very similar conditions.-71.174.175.150 (talk) 14:46, 3 January 2015 (UTC)

We specifically do not list in see also sections topics already linked in an article. Mentioned that they are similar here [7] Doc James (talk · contribs · email) 19:33, 3 January 2015 (UTC)

Griseofulvin

I had nail fungus back in 2000 and was prescribed Griseofulvin and it knocked it out in four months. I think this drug has been generic since the birth of Christ, so I'm not shilling for big pharma/the liver killing industry. Just saying what worked for me. You can soak your toes in bleach/vinegar/witch potion all you want. Have fun with your nail fungus. 24.51.217.118 (talk) 22:06, 13 October 2015 (UTC)

More references for some limited benefit of tea tree oil

Tea tree oil has demonstrated some benefit in the treatment of onychomycosis. A 2012 review by the National Institutes of Health says that a "topical application of 100% tea tree oil solution, twice daily for six months, can cure fungal toenail infection in about 18% of people who try it."

--Timeshifter (talk) 13:48, 29 May 2016 (UTC)

References

Hum

PMID 9055360 is a primary source

This source is not suitable http://www.drweil.com/drw/u/ART03139/Nail-Fungus.html

PMID 22998411 does not discuss onychomycosis

And the NIH source does not contain the quote you mention?

Doc James (talk · contribs · email) 06:40, 30 May 2016 (UTC)

I am not sure about the NIH quote. I copied that reference from the tea tree oil article.

Concerning tea tree oil a 2012 review by the National Institutes of Health found some small studies on its use. "Some smaller-scale clinical studies have had positive results for treating athlete's foot, nail fungus, dandruff, and acne, but more large-scale, well-designed clinical studies are needed."

There are more scientific references in this article:

• http://www.sterishoe.com/foot-care-blog/toenail-fungus-treatments/is-tea-tree-oil-a-good-remedy-for-toenail-fungus -

See the "What Does Science Say?" section of the article. A quote:

A randomized, controlled trial published in the Journal of Family Practice examined the effectiveness of a twice-daily application of 100% tea tree oil, compared to a 1% topical application of clotrimazole antifungal medication. After six months, the tea tree oil was found to be as effective as the topical antifungal for the 177 study participants. After about three months, half of each group reported partial or full resolution of symptoms.

That section also discusses the tea tree oil article in the Natural Medicines Comprehensive Database. It uses a dead link though. Here is a working link:

• http://naturaldatabase.therapeuticresearch.com/nd/Search.aspx?cs=&s=ND&pt=100&id=113&fs=ND&searchid=56892143 - it requires a subscription though in order to dig into it much.

I may not have time to edit this Wikipedia article much. But I can add some references here now and then for others to use and dissect. I find it telling that Wikipedia does not have an article yet for the Natural Medicines Comprehensive Database (link is to its "about" page). Not notable? ;) --Timeshifter (talk) 14:26, 30 May 2016 (UTC)

References

I have restored the 2013 review http://www.aafp.org/afp/2013/1201/p762.html Doc James (talk · contribs · email) 09:34, 31 May 2016 (UTC)

The 2013 review you link to cites 3 articles. I quoted from one article in the box above. The article is linked here, and from the box.

The abstract for one of the other cited articles does not mention tea tree oil. The full text is not accessible for free. See here:

http://onlinelibrary.wiley.com/doi/10.1111/j.0736-8046.2004.21117.x/full

A Cochrane Library review of tea tree oil is referred to in the 2013 review you linked to. "Cochrane review found no evidence of benefit."

That paper has been withdrawn:

https://www.researchgate.net/publication/6201191_Topical_treatments_for_fungal_infections_of_the_skin_and_nails_of_the_foot_Withdrawn_Paper_2007_art_no_CD001434

So your 2013 reference when followed back to the actual supporting references does not back up what you wrote in the Wikipedia article: "As of 2013 tea tree oil has failed to demonstrate benefit in the treatment of onychomycosis." And as I previously mentioned I can not access one of the articles in order to verify anything.

I independently found another Cochrane Library article that may be part of the problem with the Cochrane Library database references:

Tea tree oil: a systematic review of randomized clinical trials. For various conditions including onychomycosis.

From that article:

"Patients with subungual onychomycosis received either 100% TTO [tea tree oil] or 1% clotrimazole twice daily for 6 months. At the end of trial, 18% of TTO-treated patients and 11% of control patients had negative cultures. Full or partial resolution of symptoms was experienced by 60 and 61% of patients, respectively. At 3-month follow-up, these figures had declined to 56 and 55%, respectively. None of these differences were statistically significant."

At the end of that article: "Authors' conclusions: There is no compelling evidence to show that TTO is efficacious in any dermatological condition."

But the results say that after 6 and 9 months tea tree oil and clotrimazole got the same results for onychomycosis.

Here is latest attempt for Wikipedia text:

Concerning tea tree oil a 2012 review by the National Institutes of Health found some small studies on its use. "Some smaller-scale clinical studies have had positive results for treating athlete's foot, nail fungus, dandruff, and acne, but more large-scale, well-designed clinical studies are needed." A double-blind 1994 study of 117 patients found that topical treatment with 100% tea tree oil got the same result as a 1% clotrimazole solution after 6 months of treatment, and also 3 months later after treatment. There was partial or full resolution by 60 and 61% of participants respectively after 6 months of treatment.

--Timeshifter (talk) 20:28, 2 June 2016 (UTC)

References

Please read WP:MEDRS

We do not follow the sources that a review uses back. We summarize and cite the reviews themselves.

We also do not replace a review article with a 1994 primary source [8]

Doc James (talk · contribs · email) 04:50, 3 June 2016 (UTC)

Not sure ResearchGate is correct. The Cochrane review does not appear withdrawn [9] Doc James (talk · contribs · email) 05:03, 3 June 2016 (UTC)

From Wikipedia:Identifying reliable sources (medicine): "Primary sources should generally not be used for medical content – as such sources often include unreliable or preliminary information, for example early in vitro results which don't hold in later clinical trials."

The 1994 study is a clinical trial.

The 2012 review by the National Institutes of Health did find some benefit. So you are cherry picking your reviews. From WP:MEDRS: "Ideal sources for biomedical information include: review articles (especially systematic reviews) published in reputable medical journals;"

It is obviously not a reputable review if it is partially based on a withdrawn article. Just because the article is still online in another medical database does not mean it hasn't been withdrawn. If it hasn't been rewritten, then it is still the old now-withdrawn article. There are multiple medical databases.

We follow everything back in Wikipedia, including reviews. Wikipedia is based on WP:NPOV which means showing all major viewpoints backed up by references. We do not cherry pick. If you are cherry-picking then you are an admin with an agenda. Such admins are some of the most serious problems on Wikipedia, as I have said periodically over my editing on Wikipedia since 2005. I sincerely hope you are not one of those admins. --Timeshifter (talk) 11:57, 6 June 2016 (UTC)

• This review from 2013 in the American Family Physician has not been withdrawn[10]
• Research gate is user contributed and is not exactly a reliable source. Someone who disagreed with the review could have marked it as such without any over site.
• There is no mention that it is withdrawn here [11]
• A 1994 clinical trial is not a review.
• What you are doing is disruptive. Doc James (talk · contribs · email) 12:09, 6 June 2016 (UTC)

agree on all points raised by DocJames--Ozzie10aaaa (talk) 12:40, 6 June 2016 (UTC)

We need to use WP:MEDRS for claims about TT oil treatment efficacy: NPOV does not mean giving all views space if they can be referenced, and "major views" on this topic will have WP:MEDRS sources available. Editors should heed WP:NPA and WP:FOC. Alexbrn (talk) 15:46, 6 June 2016 (UTC)

Thanks, Alexbrn, for adding the talk-page reference template: {{reflist-talk}}. Very useful. Did not know of it. Template:Reflist-talk. --Timeshifter (talk) 17:14, 15 June 2016 (UTC)

I see you point Timeshifter, but I do have to agree with Doc James here. Articles on Cochcrane have preference over other databases like Research gate or even Pubmed. It is also always better to use the latest review article, especially if the article is older than 5 years, and also if it is a primary article too. I personally think of primary articles as a very rough sketched articles (mistakes are often made), review articles take out a lot of these mistakes, thus making the science even better. And isn't that what we all want? :) EllenvanderVeen (talk) 00:14, 14 June 2016 (UTC)

Some review articles are fatally flawed. Just like some clinical trials. This has been in the news. The correct thing to do is to quote from all the relevant reviews, and let the reader decide. That is the WP:NPOV way.

https://nccih.nih.gov/health/tea/treeoil.htm - "Some smaller-scale clinical studies have had positive results for treating athlete's foot, nail fungus, dandruff, and acne, but more large-scale, well-designed clinical studies are needed."

http://www.aafp.org/afp/2013/1201/p762.html - 2 trials: 100% tea tree oil and 10% tea tree oil. "Tea tree oil (Melaleuca alternifolia) has been evaluated in two studies. Although one trial [100% tea tree oil] was favorable, combined data from both studies did not demonstrate significant benefit."

http://onlinelibrary.wiley.com/enhanced/doi/10.1111/j.1440-0960.1992.tb00103 - 2 trials, both using 10% tea tree oil. "Although one of the individual trials showed a statistically significant effect (Satchell 2002), the results of the second trial were less favourable, and combining data from both trials did not show a statistically significant effect."

One of the Cochrane reviews is mortally flawed as I indicated previously higher up in the discussion. See that Cochrane review:

http://www.crd.york.ac.uk/CRDWeb/ShowRecord.asp?ID=12000001396 - it looks at the 1994 clinical trial and says that tea tree oil was not a success in that trial. When in fact the 1994 trial showed that it did as well as one of the other standard treatments, clotrimazole.

--Timeshifter (talk) 17:00, 15 June 2016 (UTC)

We paraphrase the conclusions of review articles. All the three reviews say there is limited data. Doc James (talk · contribs · email) 18:48, 15 June 2016 (UTC)

(unindent). See WP:NOTPAPER and WP:OWN. Your current summary is inadequate and inaccurate:

As of 2013 tea tree oil has failed to demonstrate benefit in the treatment of onychomycosis. A 2012 review by the National Institutes of Health found some small and tentative studies on its use.

References

I put the wikipedia article quotes into boxes. Different background colors to show evolution of my suggestions versus yours. I haven't suggested another possibility yet. I want to check the review articles to see how many different 100% tea tree oil studies they are referring to. Or someone else can check. --Timeshifter (talk) 22:59, 21 June 2016 (UTC)