PUBLISHED: 2:27 PM on Wednesday, June 27, 2007
Watch where you step if you want to look good in open-toe shoes
LUBBOCK, Texas - Summer is sandal season but some people may be leery of wearing flip flops if their toenails are thick and discolored.

Nail polish may mask nail fungus but it won't solve the problem in time for a trip to the beach or a barbecue at the lake.

"If it's there, it likely will only go away if it's treated," said Dr. Cloyce Stetson, chairman of the dermatology department at the Texas Tech Health Sciences Center.

Fungal infection of the nail, or onychomycosis, is characterized by a progressive change in a toenail's quality and color, which is often ugly and embarrassing, according to the American Podiatric Medical Association.

"Nail fungus is an infection of the nail by fungus which usually is ... a specific type of fungus that likes living on human skin," Stetson said.

The most common cause of nail fungus is an organism called trichophyton rubrum.

Summer weather can't be blamed for the onset of nail fungus, Stetson said. People tend to notice and recognize nail fungus during the warmer months as they begin to wear open-toed shoes and walk in bare feet more frequently.

Toenails are especially vulnerable around damp areas where people are likely to be walking barefoot, such as swimming pools, locker rooms and showers.

Stetson said he does not believe nail salons put people at risk for nail fungus.

"I think the data on exactly where people acquire fungus is mixed," he said. "Some argue that junior high and high school showers are where it's acquired.

"The way I would put it would be, I think it's a fungus that's in our environment. It's everywhere, and it likes to be on certain people."

Most people's immune systems can fight off the organism that causes nail fungus, Stetson said. People with weakened immune systems are more likely to develop nail fungus.

Oftentimes nail fungus is present with scaling on the feet, Stetson said.

This symptom as well as discoloration, thickening and shape distortion of the nail can be treated with over-the-counter topical treatments or shoe powders.

If topical treatments don't work, Stetson said there are prescription-strength oral and topical medications available.

However, depending on the severity of the case, many health insurance companies view nail fungus as a cosmetic condition and therefore won't pay for aggressive anti-fungal treatment, Stetson said.

Patients who suffer from nail fungus that is causing pain typically will have prescription anti-fungal medication covered by insurance, Stetson said.

The oral treatment for nail fungus requires a patient to take a pill every day for three months and generally requires a lab test after about six weeks to make sure the medication isn't having a negative effect on his liver.

The medication is usually well tolerated.