Caleb Foster
Toenail fungus is a common condition caused by a microscopic organism that thrives in warm, damp environments. While it is not a serious health problem, it can be difficult to cure and often requires long-term treatment. The goal of treatment is to eliminate the fungus and restore the nail. Treatment options include oral medications, such as terbinafine, and topical treatments, such as antifungal creams, nail polishes, and surgical procedures. While oral medications can be effective in eliminating the fungus, they may also carry risks such as potential liver damage. Topical treatments can improve the appearance of nails and may be recommended for children due to their faster nail growth. However, they may not be as effective as oral medications. The choice of treatment depends on various factors, including the severity of the infection and the patient's age and medical history. While nail fungus medication may not directly accelerate nail growth, it can create favourable conditions for healthy nail growth by eliminating the fungus and providing proper care.
| Characteristics | Values |
|---|---|
| Treatment Goal | Get rid of the fungus and restore the nail |
| Treatment Options | Oral medication, nail polish, cream, surgery, chemical avulsion |
| Oral Medication | Itraconazole (Sporanox), Terbinafine (Lamisil), Ciclopirox (Penlac) |
| Oral Medication Side Effects | Liver damage, headaches, rashes, gastrointestinal symptoms |
| Oral Medication Duration | 6 weeks minimum, up to several weeks or months |
| Nail Polish | Amorolfine, Ciclopirox |
| Nail Polish Application | Applied daily or a few times a week, removed with alcohol swab |
| Cream | Clotrimazole (Lotrimin), Terbinafine (Lamisil) |
| Cream Application | Applied daily, applied after cutting and filing the nail |
| Surgery | Surgical removal of infected nail(s) |
| Chemical Avulsion | Application of urea to the nail, covered with a bandage for 7-10 days |
| Nail Growth Time | Up to a year or longer |
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What You'll Learn
Oral medication can be effective but may harm the liver
Oral medication is often necessary when nail fungus has spread to several nails or covered a larger area on the affected nails. While oral medication can be effective in treating nail fungus, certain medications may cause liver damage.
Terbinafine is an oral antifungal medication commonly used to treat nail fungus. It is available by prescription only in tablet form under the brand name Lamisal. The usual dose is 250 mg once daily for 6 weeks for fingernails and 12 weeks for toenails. While terbinafine is effective in treating nail fungus, it has been linked to rare instances of acute liver injury that can sometimes be severe and even fatal.
Cases of terbinafine-induced liver injury have been documented, with symptoms including loss of appetite, pruritus, jaundice, abdominal pain, and elevated liver enzymes. In some cases, liver damage may progress to acute liver failure. The risk of liver injury is rare, with one study finding liver problems in only 0.1% of participants taking terbinafine. However, individuals with pre-existing liver conditions or a genetic predisposition may be more susceptible to liver issues while taking this medication.
Before starting treatment with terbinafine, it is crucial to consult with a doctor and undergo liver function testing. Liver function tests should be repeated 6 weeks after initiating treatment to monitor for any signs of liver damage. If liver damage occurs, discontinuing terbinafine can lead to improvement in liver health within several months. In severe cases, a liver transplant may be necessary.
While oral medication can effectively treat nail fungus, it is important to be aware of the potential risk of liver damage associated with certain medications like terbinafine. Close monitoring and consultation with a healthcare professional are crucial to ensure safe and effective treatment.
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Topical treatments improve nail appearance but may not cure
Topical treatments are often the first port of call for treating nail fungus. This involves applying a colourless nail polish that contains growth-inhibiting and antifungal ingredients such as amorolfine or ciclopirox. Treatment sets containing two creams and a nail scraper (spatula) can also be used for topical treatment. While these treatments can improve the appearance of nails, they may not cure the fungal infection.
Topical treatments are often recommended for children because most oral medications are not suitable for them. Children's nails are also thinner and grow more quickly, so topical treatments are more likely to be effective. For adults, however, topical treatments may not be sufficient to cure the infection. In such cases, oral medications may be prescribed by a dermatologist. These medications can stop nail fungus from growing and eliminate the infection, but they may cause side effects and harm the liver.
It's important to note that treating nail fungus can take a significant amount of time. Even with medication, it can take up to a year or longer for the nail to grow out and return to normal. During treatment, it's recommended to avoid alcohol and stay out of the sun. Additionally, it's crucial to finish the entire course of medication prescribed by your doctor.
While waiting for the nail to grow out, you may still see discolouration and other signs of nail fungus. To improve the appearance of the nail during treatment, you can apply cosmetic nail polish over medicinal nail polishes. Filing down the nail surface before applying topical treatments may also help the medication penetrate more deeply into the nail or nail bed.
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Antifungal nail medicine can be brushed onto the nail
To apply the medicine, one must first cut and file down the affected nail as much as possible. The antifungal medicine is then brushed onto the nail, ideally once or twice a week for amorolfine and every day for ciclopirox. It is important to note that the old layer of polish must be removed with an alcohol swab before applying a new layer. Additionally, the medicine should be applied to the underside of the nail and the surrounding skin. Ciclopirox, in particular, should be left to dry for about 30 seconds before putting on socks or stockings.
It is crucial to maintain nail hygiene and keep the nails clean and dry during the treatment. Different nail care tools should be used for infected and healthy nails to prevent the spread of the fungus. If the toenails are affected, wearing well-fitting, low-heeled shoes is recommended, and going barefoot in public areas should be avoided. Protective shoes and gloves are also advised when engaging in activities that may injure or irritate the nails.
While this treatment method is convenient and effective, it is important to remember that it may take several months before improvements are visible. Patience is essential, as it can take a significant amount of time for the nail to grow back and regain its healthy appearance.
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Surgery or chemicals may be used to remove infected nails
Topical treatments for nail fungus include nail polishes, creams, and solutions. Nail polishes with antifungal ingredients such as amorolfine or ciclopirox are applied one to two times a week. Creams containing antifungal medications, such as terbinafine, are also available but are not suitable for treating nail infections. Solutions such as efinaconazole 10% and tavaborole 5% are prescribed medications that are applied daily for several weeks or months. These treatments are often recommended for children because of their thinner and faster-growing nails. Oral medications, such as terbinafine, are also an option for more aggressive treatment, but they may have side effects and require liver function testing.
The most suitable treatment for nail fungus depends on various factors, including the patient's health, the extent of the infection, and the type of fungus. Dermatologists tailor the treatment plan to each patient's needs, considering their medical history, medications, and the number of affected nails. Treatment for nail fungus can take a significant amount of time, and the infection may persist or recur even after successful treatment. Therefore, patients should be patient and follow their dermatologist's instructions carefully.
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Home remedies are best paired with prescription medication
While prescription medication is often necessary to effectively treat nail fungus, home remedies can be a helpful supplementary treatment. Nail fungus can be persistent and unsightly, and it can take a long time for the nail to grow back and appear healthy again. Therefore, combining prescription medication with home remedies can provide a comprehensive approach to tackling the issue.
Prescription medication for nail fungus typically includes topical antifungal creams, oral antifungal pills, or, in severe cases, nail removal. Oral medications, such as terbinafine, are usually taken daily for 6 to 12 weeks, depending on whether the infection is on the fingernails or toenails. It is important to note that liver function tests may be required before and after taking this medication due to the rare possibility of liver damage.
On the other hand, home remedies offer a more natural and often easily accessible approach to treating nail fungus. For example, ginger essential oil, when diluted with a carrier oil, can be safely applied to the skin and nails. Green tea extract has shown promising results in lab tests against the fungus Candida albicans, although more human research is needed. Similarly, neem oil is gentle and generally well-tolerated, making it suitable for direct application to the affected area.
Additionally, henna leaves have been found to be particularly beneficial in fighting Trichophyton rubrum, the most common cause of onychomycosis. Aloe vera gel, with its rich phytochemical content, can help fight fungal infections and reduce inflammation. Tea tree oil, when combined with oregano, vitamin E, and essential oil of lime, has been shown to effectively stop the growth of various fungi.
Over-the-counter options, such as Listerine mouthwash, which contains the antifungal compound thymol, can be used as a foot soak to treat toenail fungus. Vicks VapoRub, which also contains thymol, has been found to be effective in treating onychomycosis in a small study. These home remedies can be easily incorporated into your routine and may enhance the effectiveness of prescription medication.
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Frequently asked questions
No, nail fungus medication does not make your nails grow faster. Nails usually grow back, but it takes time, ranging from 6 months to a year or more.
It may take at least 6 months to as long as 18 months for nail fungus medication to work. Oral medications like itraconazole and terbinafine have been shown to eliminate the fungus in 10 months for 55% to 70% of people.
Treatment options for nail fungus include oral medications, topical treatments such as nail polish or cream, and surgical or chemical removal of the infected nail. Topical treatments are usually recommended for children due to their thinner and faster-growing nails.
Yes, nail fungus medications can have side effects. Oral medications like terbinafine can cause mild side effects such as headaches, rashes, and gastrointestinal issues. They can also affect liver function, so it's important to get your liver function tested before and during treatment.
To prevent toenail fungus, it is recommended to wear shower shoes or flip-flops in public places like locker rooms or swimming pool decks. Keeping your nails clean and trimmed can also help prevent the fungus from spreading.
