Fungal Nails

  • Medical Author:
    Kyoung Min Han, DPM, AACFAS

    Dr. Kyoung Min Han is a podiatrist (foot and ankle specialist) practicing in Southern California. Dr. Han completed her undergraduate education at the University of California, San Diego, and went on to the New York College of Podiatric Medicine to pursue her medical training. She returned to her native Southern California to complete a three-year foot and ankle surgical residency, followed by subspecialty training in a sports medicine fellowship.

  • Medical Editor: Melissa Conrad Stöppler, MD
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

Quick GuideNail Color and Texture: What Nails Say About Your Health

Nail Color and Texture: What Nails Say About Your Health

What is the treatment for fungal nails? (Continued)

Oral antifungal therapy works about 50%-75% of the time, depending on the medication. It can take nine to 12 months to see if it has worked or not, because that is how long it takes for the nail to grow out. Even when therapy works, the fungus may come back about 20%-50% of the time. Currently, an oral antifungal therapy is considered the best treatment for toenail fungus because of higher cure rates and shorter treatment duration compared to topical therapy.

Prescription oral medications that are effective against nail fungus include the following:

  • Griseofulvin (Fulvicin, Grifulvin, Gris-Peg): This drug has been the mainstay of oral antifungal therapy for many years. Although this drug is safe, it is not very effective against toenail fungus. Disappointing long-term results have been reported. Newer agents have largely supplanted it.
  • Terbinafine (Lamisil): This drug is taken daily for 12 weeks for toenails and six weeks for fingernails. The drug is safe, effective, and produces few side effects. However, it must be used with caution in patients with liver disease. This medication is also affordable.
  • Itraconazole (Sporanox): This is often prescribed in "pulse doses" -- one week per month for two or three months. It can interact with some commonly used drugs such as the antibiotic erythromycin or certain asthma medications. It is considered the treatment of choice for onychomycosis caused by Candida yeast and non-dermatophytic molds.
  • Fluconazole (Diflucan): This drug may be given once a week for several months. The dosing of this drug may need to be modified if the patient has impaired kidney function or is taking it simultaneously with certain other medications. It is not as effective as Lamisil or Sporanox and should be used cautiously in patients with liver disease.
  • A doctor will determine whether a simple blood test is needed to check for liver disease.

There are several innovative treatments that are still being tested:

  • Laser therapy or photodynamic therapy uses application of light-activated agents onto the nail followed by shining light of a proper wavelength on the nail.
  • Use of electrical current to help absorption of topical antifungal medications into the nail: This is also called iontophoresis.
  • Use of a special nail lacquer that changes the micro-climate of the nail to make it inhospitable for the fungus to grow: If this works, it may be an inexpensive way to treat this problem in the future.

One way to definitively get rid of toenail fungus is by surgery. Surgical treatment of onychomycosis involves nail removal. However, this often only provides temporary relief, and recurrence is common unless additional antifungal medication (oral or topical) is simultaneously used. However, surgical removal may be warranted when the affected nail is associated with other factors such as trauma and or infection.

Are there home remedies for toenail fungus?

The Internet is filled with anecdotal information on how to cure toenail fungus using home remedies. Vinegar is a commonly recommended home remedy. Some people apply various oils such as tea tree oil, coconut oil, essential oils, and oil of cedar leaf (such as Vicks VapoRub) to their nails as well. The effectiveness of these home remedies is highly doubtful. Application of household bleach and hydrogen peroxide is also not recommended due to lack of evidence that these treatments work. These agents can also cause unwanted skin irritation. Thickened nails that have been affected by fungus can be difficult to trim. Using topical urea cream will soften the nail and make it easier to trim. These creams do not require a prescription.

Are there over-the-counter treatments for toenail fungus?

The definition of over-the-counter (OTC) products means that they are available by ordinary retail purchase, not requiring a prescription or a license. Although there are few OTC medications aimed to treat fungal nails, many of these medications have not been tested and therefore are not approved by the U.S. Food and Drug Administration (FDA) for the treatment of onychomycosis. Most OTC agents are aimed at treating fungal infection of the skin rather than the nail. Some medications list undecylenic acid and/or propylene glycol as main ingredients. These ingredients inhibit fungal growth; however, they may not adequately penetrate the nail to be effective in treating fungal nails.

Reviewed on 2/13/2017
References
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IMAGES:

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