December 9, 2012
Vicks VapoRub may be a cheap, effective and safe topical treatment for foot fungus (also known as onychomycosis) among people living with HIV, according to results from a pilot study presented at ID Week 2012.
Onychomycosis is common in both the general population (affecting about 6% to 8%) and among those living with HIV. Studies have shown about 15% to 40% prevalence in people living with HIV, but data is limited, according to study author Mariea Snell, M.S.N. "Infection is associated with more advanced immunodeficiency and usually presents as proximal onychomycosis, which is often harder to diagnose and treat than other forms of this disease," Snell told TheBodyPRO.com.
Snell, from BJK People's Health Center and Washington University in St. Louis, Mo., and colleagues followed 20 patients with toenail fungus for 48 weeks, with patient visits every 12 weeks. The patients were 90% male and 55% African American, with an average age of 46 years. Ninety-five percent were on antiretroviral therapy, with 60% having a viral load below 50 copies/mL. The median CD4 count was 399 cells/mL.
None of the patients involved in the study had previously used an antifungal therapy to treat their onychomycosis. "Antifungal therapies are the mainstay of treatment and can be administered topically or orally," Snell said. "Topical treatment is not as efficacious as oral therapy but both are associated with high rates of treatment failure and relapse. At present, oral terbinafine is the first line treatment for onychomycosis, but the drug interactions with many antiretrovirals and liver toxicities made it not an option for these patients."
The participants self-treated by topically applying Vicks VapoRub to affected toenails for a maximum of 24 weeks. At each visit, a digital photograph of the affected toenail was taken and a clinical assessment was made. For the first two visits, treatment adherence and tolerability were determined. (Non-adherence was defined as missing more than 20% of topical applications in any 12-week period.)
To measure the change in fungus, the most affected nail was overlaid with transparent film and the affected area was outlined. The outline was transferred to a template, which was then divided into eight segments, each covering 12.5% of the area. The total percentage of affected segments was recorded. Nail clearance was calculated as the median percentage cleared in total affected nail segments from baseline to week 24.
After 24 weeks, 15 of the 18 participants for whom complete data were available had seen clearing of their most affected nail, with a median clearance of 25%. Two of these participants had total resolution of their infection. Two of the three participants with no nail clearing were non-adherent. A total of 21 jars of Vicks VapoRub were used, each costing $5.38.
After 48 weeks, eight of the 15 participants seen had stable or improved clearance of their most affected nail. The treatment was well tolerated, with no side effects reported. Quality of life had improved, with fewer participants reporting that they felt embarrassed by their nails or felt discomfort/pain when wearing shoes.
The inspiration for conducting this study came about due to a series of coincidences, Snell recalls. "I have a friend that works for a podiatry practice, and we called them to help us with a patient that had suffered from this for many years," she said. "It became a very emotional issue for him, and he was desperate to have this treated. When we consulted with them for a treatment option, they told us that no studies had been done to support VapoRub, but they had patients tell them that it works. We thought it would be worth a try."
Because the treatment of onychomycosis is difficult overall, with limited and costly options, these early findings suggest that Vicks VapoRub could prove to be a cheaper, safer and more effective alternative. The researchers noted that topical application of the product for more than 24 weeks may be required for full nail clearance. Snell plans to do another study with a larger sample size, an added control group and increased treatment duration.
Warren Tong is the research editor for TheBody.com and TheBodyPRO.com.
Follow Warren on Twitter: @WarrenAtTheBody.