STAY ON TOPIC, DAMNIT ! ! !

Wait. I'd like to apologize for that previous post. It was clearly related to the subject of previous posts. My bad.

Even if you've been plagued with nail infections before, you can get free of fungus with this regime:

1. Get a diagnosis from your doctor or dermatologist. There's always the possibility you have a nail-fungus look-alike, such as psoriasis.

Diagnosis takes two steps. First, your doctor examines a nail sample under a microscope for fungus' links-of-a-chain shape. Second, if he finds a fungus, he then grows the cells for several weeks to find out if you have a regular fungus or candida, a yeast-type fungus. Diabetics, who are prone to foot problems, need extra-careful diagnosis because fungus can leave them open to serious bacterial infection.

* 2. Shed the infected nail and scaling skin. Treatment involves your doctor clipping back your nail to where it's still attached to the nail bed and scraping away scaling tissue. Special tools let the doctor do a more thorough job in his office than you could do at home. The idea is to physically evict the fungus. "It's like cleaning an abscess," says Dr. Scher. "You can use antibiotics but if you don't drain the abscess first, it won't heal."
* 3. Use a prescription antifungal drug. Removing dead tissue gets rid of most of the infection, but not all of it. Antifungal agents taken internally or painted on your nail can help, but choosing which to use is not easy. Because nails are made of dead cells, topical medications penetrate poorly to the fungus inside, explains Lowell Goldsmith, M.D., dermatology professor at the University of Rochester School of Medicine and Dentistry, New York. The most a cream or lotion can do is keep the area free of new fungus while the nail grows out. Topical drugs clear up infections about 40 to 50 percent of the time.

Oral antifungal drugs work by entering the nail matrix, or nail "root"---the white half-moon from which a nail grows. That way, new nail is armed with an antifungal shield against the invading parasite as it grows out. The problem is, you have to keep taking the drug until an entire new nail grows out---4 to 6 months for fingernails, 12 to 18 months for toenails.

The oral drugs for nail fungus are griseofulvin and a newer drug called ketoconazole (used if your fungus is candida or if your infection resists griseofulvin). Possible side effects from both these are headache, nausea and stomachache. Because the drugs may affect your liver and kidneys, you need an initial blood test and additional blood tests every month. Experts report that ketoconazole has in rare cases caused hepatitis. Dr. Scher says he has treated hundreds of patients with griseofulvin and has seen very few reactions to the drug. Both griseofulvin and ketoconazole can interact with certain prescription drugs and neither should be used by pregnant women.

Specialists differ on using oral drugs for nail fungus. Griseofulvin and ketoconazole work for 80 to 90 percent of people who take them, but some doctors say they're not worth the risk. Most approve oral drugs for two cases: fingernail fungus because it's more visible and has a better success rate, and toenail fungus only if your nail is so thickened that it's painful or infected. (Pain from nail fungus is rare.)

Oral drug users may find an unpleasant surprise shortly after they stop treatment---the fungus may come back. "Fifty percent of patients could have a recurrence of fungus within the next year," says Dr. Goldsmith. For some people, the only way to eliminate a fungus is to eliminate the nail---cutting out both the nail and its matrix so that no nail grows back. But that's a drastic step that doctors rarely take.

4. Step up the pressure at home. Besides daily medication, at-home fungus fighting means keeping your nail clipped or filed back so that no nail protrudes beyond the nail bed. What you're doing is eliminating the fungus' base of operations. Dr. Goldsmith advises using two sets of clippers to avoid spreading the fungus around. Keep one to trim only the infected nail and rinse it in alcohol after each use.

Next to trimming, keeping nails desert-dry is your best antifungal insurance. Home vigilance is crucial. If you skip even one day, fungus can get the upper hand and start to colonize your nail again.

5. Regularly touch base with your doctor. If you're using topical medication, it's smart to have your doctor do a cleaning every month or two until your nail grows out.

If you're taking oral drugs, you'll need to see your doctor periodically to assess their effectiveness and to have blood tests to check for any liver problems from the drugs.