Managing Toenail Fungus and Skin Issues: Expert Dermatologist Advice

Consultation with a physician regarding multiple issues?

Hello, Doctor: I currently don't understand why my liver enzyme levels have dropped from 41 to 30, so I can take the antifungal medication, which I've been on for over two weeks.
I only missed one dose because I overslept, and I take one tablet every day.
However, the area on my left big toe with the black toenail seems to never change to a healthy color.
I know toenails grow slowly.
Additionally, I work in cleaning and wear rubber boots every day at work, only taking them off during breaks to let my feet air out.
I tend to sweat a lot, especially in the summer! My work clothes often get damp, and sometimes the moisture seeps into my rubber boots, making my socks wet and uncomfortable!
I thought of a method: besides taking the antifungal medication prescribed by my dermatologist, when I have free time or feel good (sometimes work is tiring), I plan to buy antifungal ointment for athlete's foot and toenail fungus from the pharmacy to use in conjunction.
I wonder if this is effective or just redundant? How should I maintain hygiene for athlete's foot and toenail fungus? Typically, after work, I don't shower and go straight to bed, washing in the morning like some foreigners do.
I feel refreshed and energized after washing in the morning.
I also prefer quick showers.
However, because I sweat a lot, my damp pants sometimes rub against my thighs, causing redness and pain.
I'm very concerned about developing cellulitis and wonder if I can relieve my body itch with ice packs? I found that my body itch is due to humidity and excessive sweating, but I don't know if it's contagious.
The itching and the pain from scratching are unbearable, driving me almost to madness! My dermatologist prescribed me a topical medication, but without it, I can't seem to get better! Why do I have this itch? What other methods can prevent athlete's foot and toenail fungus from recurring? I know that in a subtropical climate, it's impossible to stay completely dry; we can only prevent it.
I'm sorry for the long message, and I appreciate your patience in reading it.
I am eager to hear your opinion, thank you.

A Yi, 30~39 year old female. Ask Date: 2019/08/10

Dr. Wu Yuxin reply Dermatology

The best treatment for fungal infections is a combination of internal and external therapies.
Itchiness and rashes are often caused by repeated scratching.
What can be done to prevent athlete's foot and subsequently nail fungus from recurring? The answer lies within yourself: maintaining cleanliness and dryness is the key.
If you keep insisting that it's impossible to achieve this, then a complete cure will truly be unattainable.

Reply Date: 2019/08/10

More Info

Managing toenail fungus and skin issues, especially in the context of a demanding job like cleaning, can be quite challenging. Your situation involves multiple factors, including a fungal infection (likely onychomycosis, or toenail fungus), skin irritation, and the impact of a humid work environment. Here’s a comprehensive approach to managing these issues effectively.

Understanding Toenail Fungus and Skin Conditions
Toenail fungus is a common condition that can cause discoloration, thickening, and even crumbling of the nail. It often develops in warm, moist environments, making your work conditions particularly conducive to fungal growth. The fact that you are experiencing persistent discoloration in your toenail suggests that the infection may still be active, or that the nail is growing out slowly, which is typical as toenails can take several months to fully grow out and show improvement.

Treatment Options
1. Oral Antifungal Medications: You mentioned that you are taking an antifungal medication (likely Terbinafine or a similar drug). This is a crucial step as oral medications can penetrate the nail bed and effectively treat the infection from within. It’s important to continue this medication as prescribed, even if you miss a dose occasionally. Consistency is key.

2. Topical Treatments: Using over-the-counter antifungal creams or ointments can complement your oral treatment. While these may not penetrate the nail as deeply, they can help treat any superficial fungal infection on the skin surrounding the nail. Applying these treatments regularly can help manage symptoms and prevent the spread of infection.

3. Hygiene Practices: Maintaining good foot hygiene is essential. After work, ensure that you wash your feet thoroughly and dry them completely, especially between the toes. Consider using a foot powder to keep your feet dry throughout the day. Avoid wearing wet socks or shoes, as moisture promotes fungal growth.

4. Footwear Choices: Since you work in a cleaning job and wear rain boots, it’s crucial to allow your feet to breathe whenever possible. When you’re not working, opt for breathable footwear. If you must wear rain boots, consider moisture-wicking socks that can help keep your feet dry.

5. Skin Irritation Management: The red, painful skin you described could be due to friction from wet clothing or a secondary fungal infection. To alleviate this, ensure you change out of wet clothes promptly. If you experience chafing, applying a barrier cream can help protect the skin. For the itching and irritation, topical corticosteroids may provide relief, but these should be used under the guidance of your dermatologist.

Preventing Recurrence
1. Regular Monitoring: Keep an eye on your toenails and skin. If you notice any changes or worsening symptoms, consult your dermatologist promptly.

2. Lifestyle Adjustments: While it’s understandable to prefer showering in the morning, consider adjusting your routine to ensure you’re washing off sweat and bacteria from the previous day. Showering after work and before bed can help reduce the risk of fungal infections.

3. Diet and Health: Maintaining a balanced diet and staying hydrated can support your immune system, which is crucial in fighting off infections. If you have concerns about your liver health and medication interactions, discuss these with your healthcare provider.

4. Environmental Control: Since you live in a humid climate, consider using a dehumidifier in your home to reduce moisture levels, which can help prevent fungal growth.

Conclusion
Managing toenail fungus and skin issues requires a multifaceted approach that includes medication, hygiene practices, and lifestyle adjustments. It’s important to remain patient, as fungal infections can take time to resolve. Regular follow-ups with your dermatologist will help ensure that your treatment plan is effective and adjusted as needed. If you experience persistent symptoms or new concerns, don’t hesitate to reach out for professional advice. Your health and comfort are paramount, and with the right strategies, you can achieve better outcomes.

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