Ask the experts
I have toenail fungus in one big toe that's driving me crazy. Is there a home remedy or medicine to cure my fungal nail?
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.
For more information, read our full medical article on fungal nails.
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