One of the joys of warm weather is being able to wear sandals outdoors; unless of course you're one of the 20 percent of Americans afflicted with toenail fungus.

One of the joys of warm weather is being able to wear sandals outdoors; unless of course you're one of the 20 percent of Americans afflicted with toenail fungus. An infection of the toenail by either fungi, yeasts or molds is the leading cause of dystrophic nails. Dystrophic nails appear crusted, thickened, yellow and brittle. Toenails are much more commonly dystrophic than fingernails with the first and fifth toenails most frequently involved. Treating dystrophic nails is extremely challenging because the infection involves the entire nail plate as well the surrounding tissue. So how do you best treat dystrophic nails?

The most effective therapy for dystrophic nails damaged by toenail fungus is oral medication. When oral anti-fungal medication is taken it can be incorporated into the infected nail plate for greater efficacy. The two most commonly prescribed agents are Lamisil and Sporanox. Both are taken for 12 weeks and are relatively effective and generally well tolerated; however, they're not harmless. Lamisil can occasional cause liver toxicity and Sporanox interacts with many other medications and can cause heart problems.

Treating dystrophic nails with oral medications is far from a guaranteed cure; in addition, individuals who successfully eradicate a toenail fungal infection have a significant risk for recurrence. To improve the chances of obtaining a cure the removal of the infected nail plate is sometimes advocated in conjunction with taking oral medication. Since toenail removal is both inconvenient and painful this approach is considered when only one nail plate is involved.

The anti-fungal nail lacquer Penlac has also had some limited success at treating dystrophic nails caused by a toenail fungus. It needs to be applied to the affected nails and the surrounding skin nightly and washed off weekly. It's safe but most effective when used for early toenail infections. Removing the dystrophic nail significantly improves the potential for success. Unfortunately, Penlac must be meticulously applied for 48 weeks for any reasonable success.

There are many topical anti-fungal creams and lotions available to treat fungal infections on the skin; several including Mentax and Lotrimin Ultra have shown modest efficacy against toenail fungi though they have limited ability to penetrate nail plates. They need to be applied to dystrophic nails for a full year and ideally should be used in combination with oral medications for maximum effect.

Dozens of anecdotal folk and homeopathic remedies have been proposed to treat dystrophic nails over the years. Some of the more popular therapies include Australian tea tree oil, Vicks vapor rub, Listerine soaks and topical grapefruit seed extract. None have ever been shown to be any better than placebo and all usually require a full year of daily therapy.

If your dystrophic nail is fortunate enough to be cured then make every effort to avoid becoming reinfected. Change your socks daily and don't share them with others. Make sure your shoes fit properly. Avoid walking barefoot at pools or in communal shower areas.

* Because most dystrophic nails cause no pain or discomfort treatment with potentially harmful oral medications must be carefully weighed.
* It's usually a good idea to confirm that your distorted crumbling nail is infected by a fungus, yeast or mold before treating your dystrophic nail with anti-fungal medications. This can be done by sending nail clippings for fungal culture.
* The natural course of toenail fungus is to gradually spread and affect other toenails.