Ask Your Doctor
By Jim Little, MD
Medical Director, Family Physicians Group

1. What are the proper treatments for foot fungus? And why would fungus only grow on one foot and not the other?

Foot fungus can be like weeds in your garden.  It is important to recognize it early, and start treatment, before it spreads.  Like weeds, it is possible for them to grow in one area and not another.  There are two main types of fungal infections of the feet: Skin infections or “Athlete’s Foot”, and toenail infections or “Onychomycosis”.

Athlete’s foot occurs when the fungus infects the skin.  It is characterized by cracked and itchy skin, usually in the spaces between the toes.  It can also cause cracking and sometimes blistering on the soles of the feet.  Because the fungus is on the surface of the skin, the best treatment is usually creams, sprays or powders available over the counter.  Just like mold in your basement, fungus tends to grow best in damp locations, which is why it likes the spaces between your toes.  It is very important to wear shoes that are well ventilated, and dry your feet thoroughly after exercise or bathing.  Apply a medication like Lamisil or Lotrimin Ultra cream twice daily on a regular basis for 3-4 weeks (at least one full week after the rash is gone) to prevent reoccurances.  The fungus can also live in your shoes and socks.  Make sure to wash your socks in hot water, and air-dry your shoes thoroughly.  I also recommend using an athlete’s foot spray or powder inside your shoes at night.  This will help kill any fungus lurking inside your shoes.

Onychomycosis, or fungal infection of the toenails, can be more difficult to treat.  The symptoms of this are thickened and sometimes cracking toenails, with yellow or grey discoloration.  The problem with toenail fungus is that it actually grows beneath the toenail, and is therefore impossible to get topical medications to work well.  There are several topical medicines available, including a clear “nail polish”, but in my experience they do not work well.  There are several pills available to treat nail fungus, but they also have limitations.  The biggest limitation is cost.  It typically costs about $1000 for 3-4 months worth of the medicine.  Most insurance companies consider this to be a “cosmetic” problem, and will not cover the medicine.  Other limitations include risk of rare but serious side effects such as liver failure, or severe skin reactions.  Finally, if you do decide to treat the infections, it will take 6-12 months for the new “healthy” nail to grow back, and there is about a 50% chance that the fungus will return. 

2. My scalp and forehead are dry and starting to peel and flake? What is this a sign of? And what should I do about it?

There are many types of skin problems that can cause peeling or flaking of the scalp, but one of the most important ones is a pre-cancerous skin condition called “Actinic Keratosis”.  These small rough patches in the skin feel a little bit like sandpaper when you rub your fingers over them.  They tend to occur in the sun-exposed areas of the scalp, ears, face and arms.  The reason these are important is that over time, if left untreated, they can turn into certain types of skin cancer.  The good news is, we have a variety of excellent treatments available for these.  One option for treatment is freezing with liquid nitrogen in our office.  Freezing or “cryo-therapy” works best for smaller lesions when there are only a few spots present.  For patients with larger numbers of actinic keratosis, another option is a topical medication called Efudex, or 5-Fluorouracil.  This cream is applied to the spots by the patient 3-4 weeks.  It will kill the precancerous cells, and cause new, healthy skin to grow back in its place.  During and just after the treatment, the skin will become red and irritated as the old skin is replaced with healthy skin.  This is a very effective treatment, but does require good teamwork between the patient and physician. 

3. Why are newborns supposed to sleep on their backs more than their sides or stomach?

The safest position for newborn babies to sleep is on their backs.  Just remember the phrase “Back to Sleep”.  This is the opposite of what most of our mothers and grandmothers were taught, but medical research has shown that sleeping on the back results in a significant reduction in the risk of Sudden Infant Death Syndrome, or SIDS.  In addition, there are several other steps that can reduce the risk of SIDS.  Babies should sleep in their own cribs, not in bed with their parents.  Babies sleeping in bed with adults have a risk of being suffocated by the parent, the bedding or the bed frame.  If the parent wants to be closer to the baby, a safer alternative is to place the crib or bassinet close to the parent’s bed.  The crib should have a firm mattress, and avoid placing pillows, sheepskin or loose bedding/blankets in the crib.  Recent studies also show that a pacifier while sleeping may reduce the risk of SIDS.  A pacifier can be offered to the baby when they go to sleep, but should never be forced.  Finally, smoking doubles the risk of SIDS, even if the parents smoke “outside”, so we strongly encourage parents to quit smoking. 

Family Physicians Group provides this “Ask the Doctor” column as a service to the community.  We may not be able to answer all questions in this column, and the answers to these questions are not a substitute for a visit with your physician.

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