INDULGENCES health lab by dr. joel Toe-riffic Feet June gloom lasted well into July this year, but it looks like the clouds have broken
and it’s open season for pool parties in Southern California. For some, that means frolicking in the water and walking around in flip-flops. For others, though, summer means another season of finding ways to hide red feet with peeling skin and thick, yellow toenails. Infections of the feet and toenails can make you as self-conscious around the pool
as tan lines or extra weight. If you don’t believe me, look around (and down) at the next pool party—you’ll probably see more shoes that cover the whole foot than you’d expect. Except for those new Vibram FiveFingers, it’s probably not a fashion statement. It just keeps the feet hidden. Like wearing socks in bed until the last minute. Red, warm, itchy, peeling skin is often a sign of tinea pedis, or “athlete’s foot.” It’s
caused by a fungus and can cause problems on the sole and heel, between the toes or both. Athlete’s foot is usually easy to treat, and there are a variety of safe, topical anti-fungals that you can buy over the counter. They come as creams, powders and
One of these deeper infections is onychomycosis, or fungal infection of the nail. It’s
usually—but not always—found in the toenail and it can be caused by a variety of fungi, including those causing athlete’s foot. It’s often the cause of thick, hard, yellow nails and it’s very common—affecting five to 10 percent of people. That means it will likely affect you someday, so be NICE to people affected by it. Studies have shown that fear and shame about what others might say (and what some do say) actually leads to a decrease in quality of life. Unfortunately, onychomycosis is harder to treat than athlete’s foot. Mythic home
remedies like ointments and cutting your nails really short doesn’t usually work. Neither do most of the topical therapies for athlete’s foot. For a long time, even the pills weren’t that effective, but newer antifungals like terbinafine and itraconazole have increased cure rates. You’ll need to see your doctor because these medicines require a prescrip- tion. Before you try to get them in Tijuana, realize they also typically require monitoring for liver damage—so seriously, see your doctor, who will also probably tell you to avoid
“Infections of the feet and toenails can make you as self-conscious around the pool as tan lines or extra
weight. If you don’t believe me, look around (and down) at the next pool party—you’ll probably see more shoes that cover the whole foot than you’d expect.”
sprays, and the brand names vary, so look for miconazole, terbinafine, tolnaftate, or clotrimazole somewhere on the label (there are others). Follow the instructions on the label—most suggest application twice a day for a week or two. DON’T stop if things get better in only a few days. The fungus is less likely to come back if you finish the recom- mended number of days. Stay away from anything that has steroids – it may help the rash or itching, but tends to help the fungus grow. Like mushrooms, the fungi that live on your feet thrive in warm, damp places. The
same fungi can live in your groin, so many of the creams say they treat tinea cruris or “jock itch” too. Shoes that “breathe,” changing damp socks after a work out and drying powders can make your feet a less pleasant home for fungus and they can help prevent athlete’s foot. It’s also important to keep your shower clean, and wear some sort of footwear in shared showers or bathrooms. Anyone with fungus can leave it behind for you, including those who don’t qualify as athletes or jocks. Your doctor may have more tips and ways to help, so you should definitely tell him
or her about it, especially if the topical medicines aren’t working. You might need a stronger medication, particularly if you have diabetes or HIV. Athlete’s foot can develop into deeper infections, so it’s important to get it taken care of.
alcohol while taking the medication. Okay, we say that with most medications, but it’s particularly true with medicines that are known to harm the liver. I know there are those of you thinking, “Dr. Joel, what’s the point of having prettier
feet for the next GLU pool party if I can’t have a drink?” Technology may have saved you. Some centers are reporting success with photodynamic and laser therapy. In general, these are not approved by the FDA, but they may offer an alternative for people who can’t take oral therapies. Whichever therapy you choose, be ready for two downers. First, accept that you’re getting ready for next year’s pool party, not next month’s. You need to kill the fungus, and wait for new, healthy nails to grow—so the treatments usually take three to six months to clean things up. Second, be prepared to pay. Despite the fact that untreated onychomycosis can lead to deformed nails, additional infections and pain, many insur- ance companies consider it a “cosmetic” problem and don’t cover treatment. So the summer foot summary: for athlete’s foot, you can probably try a topical treat-
ment, and it’s good to tell your doctor. For toenail disease, see your doctor to find a safe, effective therapy that you can afford. If you already have perfect feet, be nice to those who don’t. Regardless, have a safe, healthy pool season!
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RAGE monthly | AUGUST 2010
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