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`Ask Well: Leaving Nail Fungus Untreated - The New York Times
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`31):: New flork fiimes
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`Ask Well: Leaving Nail Fungus Untreated
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`By Anahad O'Connor October 11, 2013 12:01 am
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`Q I
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`s there any health risk to allowing a toenail fungus to exist
`untreated over the long term?
`I have avoided using oral drugs for chronic toenail fungus because I don't want to risk
`liver damage. Which raises the question: Is there any health risk to allowing a toenail
`fungus to exist untreated over the long term? Thanks!
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`Reader Question - 2645 votes
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`A
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`Fungal infections of the nail can be difficult to treat. As a previous Ask Well
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`column noted, plenty of remedies exist, but none are certain. And the one considered
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`most effective, the drug Lamisil, is associated with rare cases of liver damage.
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`So it is no surprise that some people would consider covering up their feet and
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`turning a blind eye to the problem. Most healthy young adults who ignore it will
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`probably not notice any immediate issues. But over time, as the fungus progresses
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`from the tip of the nail toward the cuticle, it can make the nail thick, discolored and
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`brittle, and pain and inflammation become more likely.
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`In about one out of two dozen cases, the fungus migrates to other parts of the
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`body, like the hands, back and legs, said Dr. Boni E. Elewski, a professor of
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`dermatology at the University of Alabama at Birmingham who specializes in nail
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`disorders. Older people or those taking medications that weaken the immune
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`system, like chemotherapy drugs and corticosteroids, are particularly susceptible.
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`“If you don’t treat it, you have an organism living in your nail that could
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`spread,” she said. “In most people, it probably won’t go beyond the foot. But there
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`are some people who are at risk of getting it in the fingernails and other places.”
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`httpszllwell.blogs.nytimes.coml2013/10/11lask-weII-Ieaving-naiI-fungus-untreated/
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`Kaken Exhibit 20 80
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`Acrux V. Kaken
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`IPR2017-00190
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`8/1/2017
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`Ask Well: Leaving Nail Fungus Untreated - The New York Times
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`The other problem with ignoring nail fungus is that the fungus creates cracks
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`and openings in the skin where bacteria can sneak in and cause infections. For
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`people who have nerve damage and poor circulation -- someone with diabetic
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`neuropathy, for example -- this can have serious consequences.
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`“Podiatrists frequently cite this as a cause of diabetic amputations,” Dr. Elewski
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`said. “The fungus paves the way for bacteria, and it can definitely be a problem.”
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`If the side effects of Lamisil are your concern, Dr. Elewski said, then alternatives
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`are on the horizon. Two promising new topical treatments —- Efinaconazole and
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`Tavaborole -- are expected to be released next year. Nail lacquers can also be
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`effective but require regular application. And it is better to begin treatment early.
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`“The longer you wait,” Dr. Elewski said, “the harder it is to treat.”
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`Do you have a health question? Submit your question to Ask Well.
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`A version of this article appears in print on 10/15/2013, on page D6 of the NewYork
`edition with the headline: Leaving Nail Fungus Untreated.
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`© 2017 The New York Times Company
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