Visit Nail'n'Toe on Facebook
Nail'n'Toe online anti fungal store
foot care for toenail fungus
Care kits for fungus treatment

Nail Fungus: To Treat Or Not To Treat

maginified image of fungu sporesThe question has come across the mind of anybody who has fungal nails. After you have given up on topical anti-fungal preparations from a local pharmacy or the Internet you go to a doctor to ask the question. And the answer is… Nothing really works.

Oral drugs work better than topical ointments but you need to check your liver every month to make sure you are not getting yourself into more trouble.

Any doctor will also tell you that if fungal nail infection is not treated, it won’t go away, it will get worse and may seriously impair the quality of life. So what do you do?

Topical drugs

A general treatment plan, which is typically prescribed by a podiatrist, will include a topical preparation with undecenoic acid and chloroxylenol in oil based tincture as the first line treatment. Antifungal topical medicine (anti-fungal creams, lotions, gels, and lacquers) are applied to the infected nail and surrounding areas of the skin. The plethora of topical antifungal agents includes terbinafine (Lamisil), ciclopirox (Penlac), ketoconazole, oxiconazole nitrate, miconazole, butenafine, econazole, clotrimazole, naftifine, chloroxylenol + undecylenic acid, undecylenic acid, betamethasone + clotrimazole, sertaconazole, sulconazole, tolnaftate.

Topical medicines are unable to penetrate the nail plate. They may provide short term relief but recurrence is not unusual after discontinuing use. E.g. a prescription lacquer, painted on the toenails daily for 48 weeks, has a complete cure rate of less than 10 percent.

Over-the-counter creams and ointments may provide temporary and limited relief, but generally do not help treat the fungus. FDA conducted a research and published this report about the lack of efficacy of topical antifungal agents in 2004. No major advances have been made since then.

If topicals are unsuccessful, and depending on patients health, oral antifungal treatment may be attempted.

Oral antifungal agents

Antifungal pills are used for severe fungal nail infection. Modern systemic antifungal drugs, such as itraconazole, fluconazole, terbinafine, ketoconazole and griseofulvin, have a more favorable risk-benefit ratio than previously used medicine and are currently used in the treatment of fingernail and toenail fungal infections and dermatophyte infections of glabrous skin in adults following unsuccessful topical therapy.

These drugs are expensive and may have serious side effects. Elderly and individuals with liver or heart problems should not take them. Children should not take them. Oral antifungals require patient compliance for long periods of time, have a significant risk of liver toxicity, prolonged loss of taste, and life threatening drug interactions. Fungal resistance can occur when the oral antifungal agents are used for a long time. Most doctors agree that the efficacy of drug therapy is in the range of 40-50%.

In cases of onychodystrophy, the toenails are very unlikely to get better and treatment with oral medications not only lowers effectiveness rate, but may be contraindicated.

treatment options for nail fungus

Topical + Surgery

Removal of an infected nail is used for severe or recurring fungal nail infections. Topically applied anti-fungal drugs may work somewhat better after a surgical removal or chemical dissolution of the nail plate.

In nonsurgical nail removal, a urea ointment is put on the nail, softening and dissolving it for easy removal.

In surgical nail removal, the infected nail and tissue is fully removed (avulsion) or partially removed (debridement).

Some podiatrists prefer aggressive nail debridement plus application of topical preparation (e.g. Naftin) in a gel form. The patient is asked to rub the gel into not only the nail but the posterior nail fold. Some patients demonstrate clearing of the nail, that is, the new nail growth emanating from the matrix.

Surgery is often ineffective and the traumatic procedure leaves patients without a nail for months at risk for re-infection.

Combination treatment

Conventional therapy of onychomycosis is prolonged and often frustrating, which is why combination therapy involving topical, oral and surgical measures has been advocated as the treatment of choice. However, most recent studies demonstrate that surgical nail avulsion with topical antifungal agents is not a very encouraging modality for the treatment of onychomycosis. The fungus apparently survives the surgery and the application of topical drugs does not kill it. Mycological, clinical and complete cure is statistically insignificant.

To learn more about efficacy of different medications review the list of clinical studies conducted in the U.S. for the treatment of Onychomycosis.

Recurring infections and prevention

Even after successful treatment a fungal nail infection can return, either as a new infection or as regrowth of the original fungi. Severe toenail infections, particularly those involving a big toe, are difficult to treat and tend to recur.

A comprehensive therapy that includes laser treatment of Onychomycosis is becoming the procedure of choice.

Comments are closed.