White Superficial Onychomycosis (WSO) is a recurring nail disorder that affects as much as 14 percent of the US population. In this article, we’ll provide a number of treatment solutions for toenail infections, including medications, habits, treatments, and light therapy. If you are experiencing an onset of WSO or have recurring symptoms, read on to learn about various treatment options, including red light therapy and blue light therapy via our BIOMAX Series panels. WSO can be treated successfully, but it’s important to address the symptoms as soon as possible. Lack of treatment can result in worsening conditions. What Causes White Superficial Onychomycosis? WSO accounts for about a third of all fungal skin infections and half of all toenail diseases. It is often either spread through direct contact with someone or by exposure to clothing or surfaces. Most fungal nail infections are caused by dermatophytic fungi. Included in these are trichophyton rubrum, nondermatophytic yeast, and mold strains. They grow on the upper layers of the nail plate. The term ‘superficial’ refers to observable symptoms of WSO, such as surface yellowing. These fungi and yeasts include Candida. Molds that cause WSO all thrive in a moist and warm environment. That’s why toenail fungus is especially prevalent in those whose feet sweat frequently or with regular exposure to locker rooms. WSO is not the same as Athlete’s Foot, but it can arise due to similar conditions. Trichophyton rubrum is one example, but this is a skin condition, not a toenail infection. Nonetheless, similar treatments do work on both. In the following sections, we take a look at some of the oral therapy solutions for WSO. While these can be effective, they also often come along with side effects. Skip down to learn more about how red light therapy with the BIOMAX Series can treat WSO. Oral Therapy for White Superficial Onychomycosis Oral WSO medications are often more effective than topical treatments. Newer antifungal medications including Triazole and allylamine drugs are now prescribed as first-line medications because of shorter treatment durations, higher success rates in curing the disease, and fewer incidences of recurrence. The most commonly prescribed oral antifungal medications for WSO are some of the following: Terbinafine (Lamisil) Terbinafine is active against dermatophytes, but noticeably less effective against nondermatophytes including yeasts and molds. Terbinafine is often given as a ‘pulse’ treatment (on/off) rather than continuously. Success rates range from mycologic cure rates of 71-82% and clinical cure rates of 60-70%. The side effects of Terbinafine can include rashes, headaches, diarrhea, nausea, stomach aches, indigestion, and muscle or joint pain. Drug interactions could also occur. Itraconazole (Sporanox) Itraconazole is a broad-spectrum antifungal agent that treats both dermatophytes and many nondermatophytic molds and yeasts. Itraconazole is often given as a ‘pulse’ treatment as well. Success rates range from mycologic cure rates of 45-70% and clinical cure rates of 35-80%. The side effects of Itraconazole can include irregular heartbeat, mood changes, increased thirst, numbness, trouble breathing, and muscle pain. Drug interactions could also occur. Fluconazole (Diflucan) This antifungal agent is effective against dermatophytes, some nondermatophytic molds, and Candida species. Fluconazole is often given once weekly for several months with a high success rate. A near 100% mycologic eradication and a 90% clinical cure rate. The side effects of Fluconazole can include chest tightness, difficulty swallowing, fast heartbeat, stomach pain, irregularly colored stools, hives, itching, or skin rashes, and hive-like swelling. Drug interactions could also occur. It’s important to get an accurate diagnosis of the correct dermatophytic or nondermatophytic strain before starting treatment. The wrong treatment or treatment duration could lead to drug resistance, aside from failing to be effective. More than half of patients experience recurrence within a year after the infected area has been treated. However, there are also options for topical treatment. In the next section, we cover some of those in greater detail. Topical Therapy for White Superficial Onychomycosis Topical therapy involves the application of a special nail lacquer to the nail surface. It seems simple enough, but on its own, topical treatment must be used long-term, and often has disappointing results and higher rates of recurrence. It works best when used in conjunction with oral antifungal agents. Nail debridement along with topical treatments is more effective, but it can be painful and time-consuming. Treatment must continue for at least 6-12 months to treat a fungal infection in the fingernails and toenails. Commonly administered topical treatment formulas contain agents such as amorolfine, ciclopirox, and tioconazole. However, according to research reviews, condition improvement is achieved in less than 30% of documented cases. The biggest problem with this approach is that long-term treatment may lead to drug resistance. This is one reason why topical medicines are not as popular as oral antifungal agents. Tips to Avoiding White Superficial Onychomycosis For those who have symptoms of WSO, there are habits that can help increase the chances of recovery. These are also tips for anyone who doesn’t yet have WSO and would like to be careful to avoid getting it altogether. This may especially apply to those in situations where exposure to WSO is more likely. As mentioned, WSO has similar origins and treatments as Athlete’s Foot. In the attempt to manage this, foot hygiene is an important start. Here are some tips for keeping foot hygiene under control: Where possible, choose breathable footwear. Wear 100% cotton or wool socks. Avoid socks with a high synthetic fiber count (synthetics don't breathe, and they trap moisture). Dry the feet thoroughly before putting on socks. Keep your feet dry. This may involve one or several sock changes throughout the day. Avoid going barefoot in locker rooms, public pools, saunas, public hot tubs, and communal showers. Always clean your feet with a disinfecting wipe or antifungal soap just before putting on socks. Sprinkle antifungal powder daily into socks and shoes. Keep toenails trimmed short. Avoid using nail polish on a fungal infection. The polish seals in moisture that fungi need to thrive. Disinfect showers or bathtub floors frequently. Expose your feet to natural sunlight. Ultraviolet, blue, and red wavelengths have anti-microbial properties. Practice excellent wound care on any wounds on the feet or hands. If you already have WSO, these tips can also help reduce recurrence and accelerate healing. These recommendations are also for anyone who may spend lots of time in gyms or in other activities that have common areas where exposure could take place. Aside from medications, topical treatments, and good hygiene, red light therapy is a non-invasive treatment for SWO that also has a host of other general benefits to health and wellness. In the following section, we discuss this in greater detail. Red Light Therapy for White Superficial Onychomycosis Red light therapy can be an effective treatment for WSO, especially for patients seeking treatments without side effects and numerous other benefits to health and wellbeing. The BIOMAX Series panels have a combination of red/near-infrared wavelengths emitted through light-emitting diodes that can support the body’s healing mechanisms. For the first time ever, they offer both blue and red light wavelengths, which work together synergistically. The Antimicrobial Effects of Red Light Therapy Red light can reduce cell numbers in some pathogens. It also has antifungal properties. It is particularly effective at treating fungal skin and nail disease. Reducing the presence of pathogens using light treatment can give the body support to combat remaining pathogens. Therapeutic benefits of red wavelengths also include skin rejuvenation, wound healing, reduced inflammation, and collagen synthesis. Near-infrared light has similar effects with deeper penetration into the body's tissues. There are also several other ways that this treatment can help treat fungal infections. WSO Treatment: Increased Cellular Energy Red light therapy is different from other WSO treatments in that it can also increase cellular energy production. This sets red light treatment apart from treatments that may address the symptoms, but fail to treat the underlying problem. For example, antifungal medications may kill toenail fungus, but they won’t prevent it from recurring. The primary fuel of all cells is adenosine triphosphate (ATP). Factors such as chronic inflammation can interfere with energy production in the cell's mitochondria, leaving cells depleted and unable to successfully fight off pathogens. Red light therapy activates light-sensitive chromophores within the cells and sparks a chain of actions that promote more ATP production. Thus, skin cells have more ‘ammo’ to protect themselves, and immune cells develop a greater ability to fight against pathogens. Increased Circulation Red light therapy can support improved circulation. Increasing circulation to the nail matrix helps white blood cells and other immune cells reach the affected area. The nail matrix is the half-moon-shaped, whitish area at the base of the nail. Increased lymph flow also helps remove dead or damaged pathogens to treat the infection. This is especially important for diabetics who are more prone to fungal infections, and for patients suffering from peripheral artery disease. Red light therapy acts as a vasodilator, which widens the diameter of circulatory vessels. It also promotes the growth of endothelial cells, which make up the walls of blood and lymph vessels. Additionally, it helps during the healing stage, when the nail plate starts to regrow normally. This is important because nails need to grow back smooth and strong, without cracks where fungi can hide and replicate. Increased Keratin Production Just like hair, nails are made up of keratin. Red light therapy stimulates keratin production to support nail growth in the nail matrix once the toenail fungus is eradicated. Reduced Inflammation with Red Light Therapy The body’s typical response to invading pathogens is short-term, acute inflammation. Red light therapy supports this process. However, any ongoing chronic inflammation in the body can lead to mitochondrial dysfunction in the cells. This in turn can damage cells and result in a less effective immune system response. Inflammation also helps create a hospitable environment for fungi. The faster you reduce underlying inflammation, the faster healing can begin. Red light therapy reduces chronic inflammation to support cells in defending themselves against fungi and other infections. Long-Term Safety and No Drug Interactions Red light therapy is a safe, natural, and non-invasive treatment with no adverse side effects. It can be used safely long-term. In the following section, we give some tips for using red light therapy at home. How to Use Red Light Therapy for WSO Red light therapy treatment simply involves exposing your skin to light being emitted by RLT panels. Recommended treatment times are 15-20 minutes per day. We also recommend full-body exposure during treatment to get the maximum effect. Although it may seem counterintuitive, increased coverage to unaffected parts of the skin can also contribute to WSO treatment. Nonetheless, be sure that your feet are bare during treatment and that they receive some light exposure as well. Treating your feet with red light for a few minutes after a shower helps thoroughly dry your feet while killing bacteria and treatment-resistant fungi. Several months may need to pass to start to see results. However, red light therapy may prove to be both an effective treatment for WSO and to give a reduced probability of WSO coming back later, if regular treatment continues. “White Superficial Onychomycosis has a significant impact on quality of life. Symptoms of pain can be physically debilitating causing difficulty with the performance of functional activities of daily living and secondary onset of physical injuries as well as psychosocial and emotional distress. I recommend full-body daily treatments using the BIOMAX panels to encourage a holistic approach to healing without harmful side effects.” Functional Medicine Doctor of Physical Therapy Dr. Alayna Newton, PT, DPT, FAFS Red Light Therapy Solutions for White Superficial Onychomycosis This comprehensive light-based therapy has far-reaching benefits for the body. You can use red light therapy for the following as well: Treat acne Relieve diabetic neuropathy Treat osteoarthritis Relieve inflammatory skin disorders Reduce signs of aging Treat hair loss Relieve low back pain, among many other varied head-to-toe uses! For targeted applications such as WSO, the BIOMAX 300 is a powerful compact light therapy device that you can take with you on your travels. For full-body applications including fungal nail infections, muscle recovery, or neuropathy, the BIOMAX 900 packs incredible power and a large treatment area. All BIOMAX panels are modular, which lets you build a custom array that perfectly suits your needs. Discover more about the many healthcare applications for red light therapy in the PlatinumLED Learning Center. Learn more about the industry-leading BIOMAX series and open the door to full-body health and wellness.
