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Treatments for Onychomycosis

Discussion in 'General Issues and Discussion Forum' started by zsuzsanna, Feb 1, 2011.

  1. zsuzsanna

    zsuzsanna Active Member

    Members do not see these Ads. Sign Up.
    I have recently found a reference reputed to cure fungal nail infection. It involves the application of Vicks chest rub on the debrided nail twice a day until the healthy nail grows out. Another suggestion was to apply Listerine mouthwash to the nail. The patient should visit his chiropodist every 2-4 weeks when any unhealthy nail is removed.I am trying these with some of my patients.
    Has anyone had any experience of the antifungal properties of (cider) vinegar?
    I was told that placing a small jam jar of this with foorwear in a closed plastic bag for 48 hours will fumigate the footwear and kill any spores of the fungus lurking in the nooks and crannies.
  2. ELM14

    ELM14 Member

    Hmmm interesting. Listerine may be used for its alcohol properties (antiseptic) but tea tree oil may be use for the same experiment as this is a natural antiseptic and may be more 'professional' than whipping out the listerine. : )
  3. Catfoot

    Catfoot Well-Known Member

    Can you provide me with the reference you refer to, as I don't recall any scientific studies on this topic ?

    RLM14, I'm not quite sure what your point is? Are you suggesting that Listerine or Tea Tree oil could be used to cure o/m or a combination of both? Again, can you point me in the direction of any studies because as far as I am aware tea tree oil has been debunked as "snake oil".


  4. DaVinci

    DaVinci Well-Known Member

    Its snake oil.

    I can't believe that anyone who is part of a profession that wants to be taken seriously would stoop to using such nonsense therapies when there is good evidence on the efficacy of other treatments.

    Tea tree oil is also just a useless and potentially dangerous.
  5. kram 0115

    kram 0115 Welcome New Poster

    Recommended Vicks Vapo rub after reading an artical some 15 years ago by an American surgeon. It is an excellent starter treatment without troubling the G.P.
    or spending alot of cash at the pharmacy on topical treatments that are very often no more effective than Vicks.Have had many satisfied patients who do not want systemic treatments,many prefering the natural ingredients of menthol, eucalyptus,camphor etc.
  6. blinda

    blinda MVP

    Can you provide any evidence for this? "Natural" aint always safe. Be careful with alternative products as they often contain known sensitizers.

    Aberer W. Contact allergy and medicinal herbs. Journal of the German Society of Dermatology (2008) 6; 15 -24
  7. starfish3211

    starfish3211 Member


    I heard about the cider viniger treatment as well. Acutally at our Podiatry school in teh UK. Tried it once but cannot say I was convinced. RUCK sells as machine that kills bacteria . It looks like a mini autoclave and 15 min does the trick. Costs around € 200- and can take a noraml shoe and trainers. Too small for boots.

  8. blinda

    blinda MVP

    Hmmm. Thanks for those, Mike.

    The second link to JD Mozena, et al states Other medications that have shown anecdotal success are tea tree oil, Vicks Vapor rub, Listerine and oral medications dissolved in different mediums including dimethyl sulfoxide (DMSO). None of these have FDA approval or are substantiated by evidence-based medicine.9-11

    Yup, what they say. Not licensed for podiatric use, nor evidence-based.

    The first link to R Derby et al, states that No published trials examining the effect of Vicks VapoRub on OM have been accomplished

    Looking closer at this case series; only 4 out of the 18 participants showed complete clinical and mycological cure. Worse yet, none of those 4 had tested positive for T rubrum (the predominant dermatophyte in OM) PRIOR to the treatment! They tested positive to other pathogens (C. parasilosis & T mentagrophytes) so were included in the `study` :confused:

    Love the conclusion; Regardless of clinical effect, participants were highly satisfied with the simple, innocuous treatment strategy....

    `Regardless` of clinical effect?? What the deuce?

  9. ELM14

    ELM14 Member

    http://jac.oxfordjournals.org/content/50/2/195.full Below is an extract from the journal.

    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. In a trial investigating tea tree oil for treating onychomycosis, patients were treated twice daily with neat oil.17 After 6 months of treatment, 18% of patients were culture negative, with a total of 60% of patients having full or partial resolution. In a second onychomycosis trial, 5% tea tree oil cream was applied three times a day and after 8 weeks of treatment the overall cure rate was 0%.18 In a tinea pedis therapeutic trial patients were treated with a 10% tea tree oil product twice daily for 4 weeks.19 This produced a mycological cure rate of 30% and clinical improvement in 65% of patients. 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.

    I've never used Tea tree oil as I work for the NHS ( it's not in the budget ; ) ). But this article does suggest there is some success when using 'neat' tea tree oil. With this still in mind I do think pharmaceutical help is best when dealing with onychomycosis though.
  10. stuartanton

    stuartanton Welcome New Poster

    I have seen good results with the application of Vicks to the affected nail/s, for a period of a few months........no hard evidence to back up or explain why it works, but it has definitely worked well for many of my patients.
  11. tonywatson12

    tonywatson12 Active Member

    Hi have used vinegar on wounds to reduce anarobic load. Think some evidence in the nursing times.
    Might try vicks not sure about evidence based practice on this!
    Have used uv wand in shoes to reduce fungal load got one of a tv shop free view 23.
    Would like to here and results you find with vicks.
    Do you drill the nail down as much as possible removing as much visable OM prior to application?
    Thanks tony
  12. Feety

    Feety Banned

    How do your patients that this has worked for apply and how often etc?
    Do you remove as much bad nail before they start treatment?
  13. stuartanton

    stuartanton Welcome New Poster

    Application is daily on and around the nail and yes the mycotic nail is reduced as much as possible
  14. hkpod

    hkpod Active Member

    It is really interesting to read these 'home' options for treatment.
    I have had a number of patients tell me that Vicks works but I can't say the nail ever appeared to look any better (nor did it get any worse though). Although it is important to note these patients had never been tested for a fungal infection.
    I have used a tea-tree solution for years as an antiseptic after treatment but in all honesty can't say it ever 'fixed' a fungal nail. Some patients reported an allergic dermatitis after using pure tea-tree oil daily for some months.
    On the note regarding vinegar, I have had quite a few patients get rid of their plantar warts......they soak a dressing in the vinegar and then cover and replace daily or twice daily. I can't say I have personally used the treatment but these patients certainly came in with no evidence of their verrucae. That being said, I have personally had plantar warts that have just 'resolved'. This is all interesting anecdotal evidence anyway....
  15. ajs604

    ajs604 Active Member

    Just out of intrest how can this be considered to be dangerous. Surely if it works then its great!
  16. ajs604

    ajs604 Active Member

    I have also heard the tooth paste is useful in ridding fungual nails!
  17. DaVinci

    DaVinci Well-Known Member

    Can you show us ONE study that actually shows it does work? We have plenty of studies that show which therapies do work. Have you ever heard of evidence based practice? Why peddle snake oil when we have good evidence on other interventions. You are doing a diservice to your patients and professions peddling stuff that is just snake oil.
  18. ajs604

    ajs604 Active Member

    I am just intrested to know what can be so bad about tea oil? Also with tooth paste thats something I ahve heard from colleagues and clients - not sure if it really works or on the research so would never suggest it - still maybe there could be something in it? Prehaps this is something I may investigate further as some of the products on the market are stupidly high for people on pensions or with little money!
  19. DaVinci

    DaVinci Well-Known Member

    Because the good evidence shows that it does not work! See the other threads we have had on it. The European Community were/are even considering banning it because its dangerous in the number of skin reactions it is causing.
  20. blinda

    blinda MVP


    Today you asked;

    Yet, on 24th Feb last year you wrote (in a thread which you started about TTO) ;

    Did you actually read the posts and cited references??

    This is the study that DaVinci refers to, which reported that TTO is no better than placebo;


    Quote from the above study;Tea tree oil cream (10% w/w) appears to reduce the symptomatology of tinea pedis as effectively as tolnaftate 1% but is no more effective than placebo in achieving a mycological cure. This may be the basis for the popular use of tea tree oil in the treatment of tinea pedis.

    With regard to the dangers associated with use of TTO (and I`m aware that I sound like a stuck record); the reported anti-fungal properties (in vitro only) of the active ingredient terpinen-4-ol is a known sensitizer for contact dermatitis (Rutherford et al, 2007), which increase with oxidation of the oil upon exposure to light, moisture, heat and air. So much so that, oxidated TTO has a sensitizing capacity multiple times stronger than a newly opened fresh bottle of TTO, after just a few days if opened daily.

    Up to you if you want to carry on recommending unsafe, inefficacious remedies.

    Ref;Rutherford T, Nixon R, Tam M and Tate B. Allergy to tea tree oil: retrospective review of 41 cases with positive patch tests over 4.5 years. Australasian Journal of Dermatology (2007) 48; 83-87
  21. blinda

    blinda MVP

  22. ajs604

    ajs604 Active Member

    I agree and did read the post. I tend to tell people to ask their doctor for advice on this matter as we cannot prescribe. The other advise I give is to contact the chemist! Until we get prescribing rights I will not give advice on what to use! Why as thats the GP and chemist job!
  23. Feety

    Feety Banned

    How are your patients doing with the vicks treatments? Did you try it?
  24. Sarah B

    Sarah B Active Member


    We cannot prescribe, but we can read the available evidence, and advise based on that. There is at least one azole nail preparation available OTC, as well as amorolfine and terbinafine.

    I don't think the fact we are unable to prescribe drugs is a reason not to understand what is available, how they work, and to look at the evidence as to their efficacy. That is part of our degree training, and is information that we should share with our patients, if only to illustrate what we as a profession are capable of.

  25. Nita Blaauw

    Nita Blaauw Welcome New Poster

    I have an 80 year old patient with Parkinsons Disease, high blood pressure and thyroid problems. As far as I can see, no oral medication will be safe, no vicks, no tto. I think best will be terbinafine creame. She has got a very bad case of onychomycosis, to the extent that the toenails grew up about 2cm. Any other suggestions?
  26. zsuzsanna

    zsuzsanna Active Member

    I do drill the nails down to remove any obvious fungal infection, removing any visible OM before sending the patient away to apply the Vicks twice daily. Also stressing the importance of washing and drying the feet!
    I have found great improvement is some patients. There are some who are not reliable i.e. do not follow instructions and there are also those who refuse to take any kind of medication. Some would be prepared to take the pills but their GP will not give it to them! So in those cases I have to have some sort of solution to the problem.
  27. cornmerchant

    cornmerchant Well-Known Member

    Nita, I have several patients with similar problems. It is unlikely that OM is the only cause of her thickened nails, not least that she has probably left it a long time before seeking help from the sound of it! Topical treatment will probably be ineffective.
    In these cases I reduce the nail to comfortable thickness by nipper and scalpel, and see at appropriate intervals to maintain comfort. IMO it is pointless to try and cure the OM, especially given that she may well find it very difficult to apply a treatment.

  28. zsuzsanna

    zsuzsanna Active Member

    Why do you think that Vicks or TT oil is unsafe? Maybe TeaTree oil is but Vicks??
    By the way what is IMO?? CM??
  29. cornmerchant

    cornmerchant Well-Known Member

    Sorry, I thought IMO was pretty universal-it means in my opinion. CM is my arena name, Cornmerchant.
    if you read the previous posts, the reasons for not using vices or tt have bben laid out. At the end of the day it is unto you whether you recommend anecdotal treatments, however it is far more professional to use evidence based practise both for your patients and for yourself should litigation ever ( god forbid) be brought against you.

  30. hamish dow

    hamish dow Active Member

    FOA Nita, sadly in my opinion the only signigficant intervention for pharma intollerant patients is PinPointe Footlaser treatment
  31. Kir2602

    Kir2602 Member

    I have been advising tea tree oil as a (cheaper) alternative to fungal nail laquer, or terbinafine. It has worked for me, but I only advise it is put on 3-4x a week at the most!! Tea tree is stronger than most people think, and you can actually become immune to it with excessive use! This coming from a holistic background aswell as a professional!

    I have never heard of the vicks one, it would be interesting to try this out on one of my patients!

    Kind Regards
  32. blinda

    blinda MVP



  33. Some ideas - [​IMG]

    or for when people mention TTO etc - [​IMG]

    Have a good one.
  34. Kir2602

    Kir2602 Member

  35. DaVinci

    DaVinci Well-Known Member

    There is NO difference of opinion. The evidence is that it does not work. Why are you still using something that the evidence says is useless?
  36. blinda

    blinda MVP

    Ultimately, it is up to you how you incorporate evidence based medicine/therapy into your practice. Is `trying something out on one of your patients` good practice, if there is no evidence to demonstrate its effectiveness? With regard to TTO, as DaVinci rightly pointed out, current evidence indicates that it does not work for OM. Furthermore, the anti-microbial properties in TTO (terpenoids) are known sensitizers for contact dermatitis, increasing in risk of adverse reaction with oxidation.

    I`m not sure what you mean by "you can actually become immune to it with excessive use! This coming from a holistic background aswell as a professional!" . Could you please expand on this?


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