Dr. Olsen's Ringworm and Onychomycosis Treatment

As told to Jim Carter (2003-10-20)

Tinea cutis is a fungus commonly found in the skin. It manifests itself differently on different parts of the body.

Nomenclature and Recognition

Soles of the feet: Athlete's foot, which is the most common. You see moist, peeling skin between the toes; sometimes it splits painfully all the way through. On the soles, peeling and irregular surfaces can be blamed on Tinea cutis. Such infestations form a reservoir that periodically flares up and spreads to other areas. Along the edges of the soles it can form little focal lesions, like tiny pimples.
Finger and toe nails: Onychomycosis (meaning literally fungus infection of the nails). Actually the nail bed is infested, and it becomes thick and ugly and uncomfortable.
Skin of the body: Ringworm. In the crotch it is referred to as jock itch. Folded areas of the skin, which tend to be damp from sweat, are most likely to get it. It starts out as a red, itchy patch. In a bad case it works its way outward with a raised red rim and beige discoloration in the center. Local lymph nodes become swollen, giving a lumpy appearance.
The scalp: Fortunately I didn't have ringworm of the scalp.

Treatment: Ringworm

Drugs: Dr. Olsen's preferred fungicide is Lamisil cream, which is available over the counter. A less effective second choice is Lotrimin cream, which is fungistatic but does not actually kill the fungus. It is also over the counter. Jimc has had good results with Loprox (Ciclopirox), which is by prescription and is expensive, but Dr. Olsen doesn't use it. Nystatin was also effective on the ringworm but not particularly effective on athlete's foot, in jimc's experience; Dr. Olsen doesn't use nystatin either.
Steroids: Products including steroids will relieve the itching promptly, but they do so by inhibiting your immune response. Therefore, when treatment ends the fungus often flares up much worse than before. Also, steroids must not be used for over two weeks (best to use even less) because they make the skin atrophy. It is best to not use steroids at all (says jimc).
Drying Agent: As a supplement use Zeasorb AF powder with 2% miconazole. This is advertised as a drying agent, though jimc says it won't keep the area dry for very long. It contains microporous cellulose, not cornstarch.
Washing: Wash the affected area, taking off old medicine and whatever, and gently pat dry, using a separate towel, not spreading fungus over the rest of your body.
Medication: Rub the Lamisil cream into the affected area, extending onto the unaffected skin that the fungus will be attacking next. Don't just apply it, rub it in, says Dr. Olsen. Then apply the Zeasorb powder.
Schedule: Do this twice a day for at least 2 weeks. (The label says once a day for one week.) After treatment starts you should see noticeable relief within 2 to 4 days, but definite red areas may persist for as long as 10 days. For best results, overtreat: keep doing it for a total of four weeks.
Outcome: The red areas will go away completely and the lumpy lymph nodes will regress, but the affected area will have a noticeable brown color after treatment.

Treatment: Onychomycosis

Materials: Lamisil, Carmol 40 urea paste (40%), regular (not Ultra) laundry bleach, vaseline, nail file or emery boards. The Carmol 40 is by prescription and is expensive, but there are over-the-counter products with 20% urea advertised for removing corns, which should be useful. Be very careful not to drip bleach on clothes, carpet, or skin not to be treated.
Bleach: Before your shower, protect the normal skin around your affected nail with vaseline, then put one drop of bleach, undiluted, on the exposed nail bed. (Probably it would take more if the big toe is involved.) Let the bleach soak in and kill stuff for 10-15 minutes. Do this with your feet on a ceramic tile floor or in an expendable polyethylene basin; don't walk on the carpet or floor mat and get bleach (and vaseline) on it. This is a good time to read something. Wipe off the vaseline when finished. The shower will rinse off excess bleach.
Filing: After your shower, file off as much of the nail as you can reach. It will take a week or two to get it all off. Take off as much of the nail bed as you can. If the nail bed feels tender or if you file too much and it bleeds, stop and work on a different spot. You do this after a shower because the water softens the nail and skin, making them easier to remove.
Overnight: Put Lamisil on the nail and nail bed. Over it, put urea paste, which digests the skin for easier removal. It's best to do this before bedtime; arrange your feet so the sheets don't rub the stuff off.
Outcome: Do this once a day. Expect to start seeing normal nail growth in two months.

Prevention

The soles of your feet are the reservoir of fungus that causes the other problems. Attack athlete's foot with Lamisil whenever it's noticed.
Use a shoe style which keeps your feet dry. Alternate shoes, so they dry out completely before being worn again. The fungus cannot stand drying.
Thickened areas of the sole attract fungus. Spread Carmol 40 on them at bedtime. In the morning wash your feet using the rough nylon mat on the back of a dishwashing sponge, to rub off skin weakened by the urea paste.
Specifically, you can get a little spot of skin which is irritated, so it grows thicker, and the bending irritates the skin even more, until you get a big lump on your sole. This is called a corn. (A similar effect can be caused by a plantar wart, but corns are more common.) A doctor or podiatrist can get you started by cutting off the corn; don't try that yourself. With or without the professional treatment, hit it with urea paste and the nylon mat. You will be much more comfortable and your fungus will have one less home.
Corns often develop where a sharp edge inside the shoe presses on your skin. Get rid of the offending shoe. Wear sensible shoes, with enough room inside that your toes aren't packed together.
If you've put stuff all over the soles of your feet, have socks near your bed and put them on when you get up, so you smear medicine on the socks and not the carpet. But wearing socks in bed is probably not a good idea, both because they will rub off the medicine prematurely, and because they will raise the humidity of your feet.