Question: My 3 year old son smashed his finger in the door at day care last November. Since then, his finger has swelled and oozed puss and blood several times. We have been to the doctor many times and have been through many rounds of antibiotics. We finally stamped out the infection but now there is fungus on the nail of the finger. We have been applying Nizoral until we are sick of it. This has been going on since May! When will the fungus go away? The doctor says fungus is very hard to kill. This has been very hard to maintain with a 3 year old boy who likes to get dirty. Is there any other solution for stamping out this fungus? We are at our wits end with this. Tired of bandages and ointment! What can we do?

Dear Lesley, Last night I had bad dreams about fungal nails. Your story reminded me of the seemingly interminable battle I have had with them. Mine began when I was in college and rowed on the crew team. I had athlete's foot that eventually spread into the toenails.

The nails of our fingers and toes are tremendously effective barriers. This barrier makes it quite difficult for a superficial infection to invade the nail. Once an infection has set up residence, the same barrier that was so effective in protecting us against infection now works against us, making it difficult to treat the infection.

Fungus rarely invades an intact nail. Usually, there is some kind of trauma such as that experienced by your son. Prolonged wetness can also allow the barrier to be breached. Sometimes a prolonged athlete's foot condition can even breach an intact nail. Usually, it is some combination of these methods. Fungal infections can also be a problem for people wearing acrylic nails. This happens because the fungus becomes trapped next to the natural nail in a warm, dark, moist environment for a prolonged period of time. Long-term bandages over the nails can have the same effect.

Fungal nails usually begin with an opaque white or silvery area at the distal (outside) edge of a nail. The fungus gradually works its way inward. As the fungus grows, the nail thickens and can become quite painful.

My Own Story (I) - Frustration

When I first noticed that I had a fungal nail, I began treating myself with over-the-counter athlete's foot medicines -- one after another. It soon became evident that while they were effective in treating the athlete's foot, they were of no value in helping the nail condition. I went to see a physician and eventually went through a large number of more potent anti-fungal creams, including Nizoral, which you've used so liberally. Sometimes this seemed to slow the progression of the fungal infection, but the onward march across the nail was relentless. I later learned that the treatment was a little more effective if I gently filed the outer surface of the nail, thus making the barrier less complete, and immediately applied the Nizoral. This was much more work, and resulted in a small improvement in efficacy. Later, I learned from a podiatrist that this could be enhanced further by using an electric tool, called a dremel drill, to gently buff the outermost layer off the nail before applying the Nizoral. I tried this, but was also disappointed with the results. I have, however, known people who have had success with this method.

In the beginning, I was told that two oral agents were available for treatment of fungal nails. One of them is called griseofulvin. It requires daily treatment -- 6 months for fingernails and 12 to 18 months for toenails. Even prolonged therapy does not always lead to a cure. With griseofulvin, recurrences are quite frequent. I eventually tried this medication, but was not able to tolerate it due to nausea. I also tried the other oral medication that had been suggested, ketoconazole (Nizoral), the oral form of the same medicine you have been trying as a cream. Oral Nizoral is another long-term, daily treatment. This is more effective in treating fungal nails, but it can have even more side effects than griseofulvin. I needed to stop taking this medicine because of the effect on my liver. Both of these oral agents are available for children.