Hello, I have had a nail fungus for a good ten years or so. When I first noticed it, I went to my doctor and he game me lamasil which I stopped taking after a few days since it had negative affects on me. Thereafter, I stopped taking care of it and just let it go for a good 7 or 8 years. I eventually grew up and started getting very self conscious of how it looked and wanted to wear sandals and flip flops and not have people think nasty things about me. A few years ago I went to my doctor again and he gave me a topical oil which I used for over a year and did not see any results. About two years ago, I noticed that a vertical brown line was starting to grow from the bottom up. I went to a dermatologist who took a sample of my nail but did not take a sample of the nail bed or from the cuticle. Biopsy came back as of course it being a fungus. He in turn gave me pills to take which I also had to stop taking since it was having a bad affect on my liver. After that, my dermatologist said that he would give me laser treatments which I did two of. They did not clear it but it looks a little bit better then what it was before. Still thick, yellow, crumbling below the nail, nail bed where new nail is growing is darker then the others and the brown line is still there. It is a thick brown line. How did I get this brown line? Did I get it because of the prolonged damage of the nail bed due to the years of having the nail fungus?

Hi,

Welcome to Healcon.

The vertical brown line you have described is more suggestive of Longitudinal Melanonychia (LM) than fungal infection. LM refers to the appearance of vertical pigmented lines in the nail plate. They are very common in darker races like Asians and African Americans, rarer in Caucasians, and appear for no reason whatsoever. They are almost always harmless and nothing to worry about. The only thing to keep in mind is that if at any time in the future the pigment starts to spread diffusely in the rest of the nail, the pigmented band becomes very wide and dark or there is pigmentation of the cuticle and proximal nail fold then melanoma must be ruled out and a nail matrix biopsy will be required.

Coming to the Toe nail fungal infection. If only one nail is affected then complete nail removal along with laser removal of the underlying debris followed by topical antifungal therapy is the treatment of choice in patient’s who cannot tolerate oral antifungals.

Otherwise Toe nail fungus (Onychomycosis) is best treated with oral antifungals like terbinafine and itraconazole and these require a prescription. The dose is 250 mg once a day for 12 weeks for terbinafine and itraconazole 200 mg twice a day for 7 days (1 week) for 3 consecutive months, or 100mg twice a day daily for the same duration.It is rare for a patient to have liver side effects like you had with the terbinafine, I’m not sure what the other oral antifungal was. The success rate is moderate but can be further improved by using a ciclopirox or amorolfine nail lacquer on the affected nail for 6-12 months.

There is one over the counter remedy that has recently got some scientific approval - this is to apply vicks vaporub once a day over the affected nail everyday for 1 year. Nearly 50% patients either get cured or have significant improvement. Apart from this there are really no over the counter measures that work.

Lastly lasers are increasingly being used for treating onychomycosis, especially in cases who cannot tolerate oral antifungals or have not responded to them. There are various lasers on the market most being either Nd:YAG lasers or Diode lasers. Treatment protocols vary from one sitting to 4-6 sittings at weekly intervals and studies have shown response rates as high as 90%. Given your history lasers might be the best way to go if you don’t opt for surgical nail removal and topical antifungals.

Hope this information is useful, please feel free to ask if you have any queries.

•  fungus
•  nail

Patient asked followup Question: 12 years ago

Thank you for your response. I am Caucasian so this is why I am getting very nervous. Is it normal for it to spread to the neighboring nails? I think I can see a pin like brown line in the nail next to my big toe? Do you recommend getting the nail removed entirely just to be on the safe side and hopefully they will be able to clear out the fungus that way? Are there any other reasons for having this vertical brown line especially if I think it's moving to neighboring nails?

You're most welcome. Nail Melanoma does not affect multiple nails together while Longitudunal Melanonychia (LM) often does. The fact that an additional nail is showing changes is nearly conclusive that this is LM, which as I said is harmless. However it would be best to see your doctor to get this confirmed since I cannot see the affected area.

I would recommend getting the entire nail removed if its the only one affected by fungus, but this will be solely to treat the fungus not because I think the brown line needs to be biopsied.

•  biopsy
•  nail