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Dear Pharmacist: One of my toenails has developed a yellowish- green fungus that won't go away. - A.M., Boulder, Colo.

Toenail fungus (onychomycosis) is not merely an unsightly cosmetic problem, it sometimes causes physical pain, disfigurement or disability. Once you're infected with fungus, it spreads easily and it's tough to get rid of. Nail fungus is not a topical problem. You may see it on the surface, but those fungal spores are inside you causing dozens of other seemingly unrelated health problems.

If you take medication, you should also change your diet and lifestyle habits in order to prevent the fungus from taking hold again. Step one is no more sugar or grains.

There is no shortage of drugs to kill fungus. They include nystatin, griseofulvin, ketoconazole, fluconazole, itraconazole and terbinafine. Depending on the medication, it could cost you several hundred a month, and side effects range from minor nausea to hair loss and possibly liver or heart failure, so make sure you remain monitored and take routine lab tests. Treatment could take a year. I told you fungus is stubborn. Sometimes people use a prescription nail lacquer called Penlac; I like this option because there are few side effects.

All those creams, sprays, and gels containing anti-fungal ingredients are intended for less challenging skin infections, such as ringworm, jock itch and athlete's foot, but you can certainly try them for toenail fungus. They're easy to find, easy to use and a safe place to start. I think store-brand generic equivalents offer consumers an even better deal because generics always save you money.

The most promising natural is 100 percent tea tree oil, an inexpensive, widely available antiseptic oil from Australia. Tea tree oil has anti-fungal properties because of the terpenoids. Apply it every morning and night to dry nails. Dab it on the area and don't give up because it may take several months before you see results. In the unlikely event that it irritates your skin, discontinue use.

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