“Vicks Vaporub for onychomycosis – is it any good?” has been a common question I have been asked by podiatrists and patients many times. It has long been discussed in the lay literature but unevaluated until 2011. Derby et al., (1) published a paper showing that the product had successfully ( and mycologically) cured 5 patients (28%) in a small, uncontrolled study of just 18 patients but we have not heard much since.
Whilst looking through the literature, lovers of weird and wonderful will be interested to learn of a letter due to be published in the Journal of the American Academy of Dermatology. Although one of the shortest papers I have read in a while (120 words to be precise) it suggests a simple, if yet, unusual treatment for fungal foot infection (tinea pedis & onychomycosis).
The procedure is very simple. Patients affected with fungal foot infection should put on a pair of old socks and proceed to dowse them in vinegar. They then sit with their damp-vinegary socks on for 15 minutes and then remove. This is repeated every night until cleared. The authors do stress this is not a sole treatment but should be used alongside the usual anti-fungal drugs.
So what’s with vinegar? It is produced from any fermentable carbohydrate source (such as fruit). Fermentation turns the carbohydrate into alcohol. Then, from here, the bacteria Acetobacter converts the alcohol to acetic acid which gives vinegar its pungent smell and tart flavour. Acetic acid is not the only ingredient of vinegar (most vinegars only have a 4-6% content of acetic acid) it also contains vitamins, mineral salts, amino acids, polyphenolic compounds and non-volatile organic acids.
Its antimicrobial properties have been known since the time of Hippocrates (420 B.C.) and its medical uses have been documented throughout history including wound and surface cleansing, treating hypertension and inducing hypoglycaemia. Many of these uses are no longer medically recommended when more effective and safer products are available. In treating fungal foot infection there is not much evidence and this short communication in the journal offers little more than a suggestion. In an earlier article (http://bit.ly/2qmPiIM) I reviewed the evidence for home treatments for onychomycosis and in one of these brands you will find acetic acid. The assumption being that application of vinegar will eventually acidify the nail plate inhibiting fungal growth.
Does the type of vinegar matter? This is a good question. In the literature there are a couple of references to Apple cider vinegar. Apple cider vinegar also contains malic acid and this has been suggested to hold additional anti-bacterial and anti-fungal properties - albeit this was a study on dentures cleaned in vinegar and not used on the skin (2)!
So for the moment, I probably think that this method is only for the most dedicated patient (who doesn't mind their feet smelling of vinegar), determined to rid their fungal foot infection. Vinegar as an anti-fungal treatment lacks real evidence of effectiveness so for the moment, lets stick to the topical anti-fungal drugs and keep the vinegar for the fish and chips.
1. Derby R, Rohal P, Jackson C, Beutler A, Olsen C. Novel treatment of onychomycosis using over-the-counter mentholated ointment: a clinical case series. Journal of the American Board of Family Medicine : JABFM. 2011;24(1):69-74.
2. Mota A, de Castro R, de Araujo Oliveira J, de OIiveira Lima E. Antifungal activity of apple cider vinegar on Candida species involved in denture stomatitis. J Prosthodont 2015;24(4):296-302.