Fungal nail infections, also known as “onychomycosis,” are very common. It occurs in 10%-12% of the general population but becomes more common as we age. The prevalence is 20% in those older than 60 years and 50% in those older than 70 years. It is also most common on the big toenail.
What is the most effective antifungal medications for toenail fungus?
Toenail fungi treatments will vary depending on your symptoms. Your healthcare provider should look into multiple factors medical help you to decide on the right treatment plan for you. It can be tailored to your individual needs. In general antifungal medicines are the most effective at curing and eliminating toenail fungal infections.
Treatments for toenail fungus break down into three categories:
1) Prescription treatments: these have the most evidence to support they work, as they need to go through large clinical studies to be approved by the FDA.
2) Over the counter medications: these are usually topical treatments that do not typically go through FDA review but many drugs are believed to have an active ingredient that is inhibits fungus growth
3) Homeopathic/home remedies: These are ingredients typically found in nature or their derivatives believed to prevent fungus growth.
Oral medications, or those that come in pill form, generally work more quickly than topical medications for toenail fungus treatment. They also have higher cure rates and the overall treatment time may be shorter than topical options. Pills to treat the infection, however, will require a prescription. It is also important to note that improvement will continue AFTER oral therapy is stopped, and it may take 9 to 12 months for you to see full results. Your healthcare provider will make sure you are not taking an medicines that could have any drug interactions as well as assess all your medical conditions. Combining oral drugs and topically applied antifungals can help improve treatment success.
The top treatments for toenail fungus are:
- Terbinafine (Lamisil)
- Itraconazole (Sporanox)
The best pill for toenail fungus is terbinafine. Evidence suggests it works better than the alternatives with the fewest side effects. Terbinafine results in resolution of toe nail fungus 76% of the time. Common side effects may include headaches, skin rash, and vomiting. It is taken once a day for 6 to 12 weeks.
Another good pill for toenail fungus is itraconazole. Itraconazole results in cure 63% of the time. Side effects can include headaches, stomach upset, and respiratory infection. Itraconazole is also taken once a day for 6 to 12 weeks.
Other oral medications that are available to treat toenail fungus
Commonly used to treat yeast infections, oral fluconazole (Diflucan) is another pill sometimes used to treat fungus. Fluconazole is alternative to terbinafine and itraconazole for those patients that may not be able to take either of the other medications. It’s not approved by the Food and Drug Administration (FDA) for this use. Fluconazole is taken once a week for 12 months.
Topical Solution Prescription Treatments
Ciclopirox (Penlac Solution) is another topical medication used to treat fungal infections of the fingernails and toenails. It comes as a pale yellow solution supplied with a brush applicator and is applied once daily for 8- 12 months.
Jublia (efinaconazole Solution) comes as a topical solution that is applied directly to the nail once daily for 48 week to the affected toenail fungus. Jublia is applied to affected toenails once daily using a flow through brush applicator and should be applied to the affected toenail once daily for 48 weeks. Jublia topical solution works similar to ciclopirox in that it stops the growth of the nail fungus.
How well does Jublia work?
In two clinical trials 17.8% (trial 1) and 15.2% (trial 2) of participants using Jublia were completely cured compared with 3.3% (trial 1) and 5.5% (trial 2) of participants using a placebo. The “complete cure or almost complete cure” rate for Jublia was 26.4% (trial 1) and 23.4% (trial 2) (compared with 7.0% (trial 1) and 7.5% (trial 2)).
How much does Jublia cost?
According to GoodRx, one 4ml bottle of Jublia costs $796.45 at CVS. Some patients may qualify for coupons or discounts from the manufacturer.
Laser treatment options
Another option is special laser beam to diagnose this infection. The FDA’s newest technology has been used to temporarily increase the clearness of nail fungi but has no cure. Laser treatments have a less favorable cure rate when compared with oral therapy. Your medical professional will rarely recommend a laser for nail infections.
Over the counter treatments:
Treating nail fungus is not as easy as treating a yeast infection as the infection lives between the toenail and nail bed. This makes getting eliminating it more difficult because if you treat it topically, only some of the medication penetrates the toenail plate and the nail bed and often not enough to kill the fungus. Many over the counter treatment can be found in your local pharmacy but the data is limited on its actual success as they do not go through the same review process as FDA approved prescription treatments. Mild infections may benefit from such treatments.
Similar to OTC treatments, there is limited data on success of homeopathic treatments. Some of the more common home remedies include the following:
- Tea tree oil
- Vicks VapoRub
- Oregano oil
- Lavender oil
Symptoms of Toenail Fungus
Toenail fungus often starts as a white or yellow spot on the tip of your toenail. As the fungi grow, they spread deeper into your nail, causing discoloration, thickening, and crumbling of the nail. The affected nail may also become misshapen or split.
If you have toenail fungus, you may notice one or more of the following symptoms:
- White, yellow, or brown discoloration of your toenail
- Thickening or crumbling of your toenail
- Distortion of your toenail’s shape
- Splitting of your toenail
- Odorless debris building up under your toenail
If you notice any of these symptoms, it’s important to see a Healthcare professional that can diagnose and prescribe a treatment that is best for you
How does someone get a fungal nail infection?
Anyone can get a fungal nail infection as it can be transmitted from contact with someone that has it or from the environment. Some people may be more likely than others to get a fungal nail infection, including older adults and people who have the following conditions:
- A nail injury or foot deformity
- Hyperhidrosis (a disorder that makes you sweat a lot)
- Weakened immune system
- Venous insufficiency (poor circulation in the legs) or peripheral arterial disease (narrowed arteries reduce blood flow to the arms or legs)
- Fungal skin infections on other parts of the body, such as Athlete’s Foot
Can I wear nail polish if I have toenail fungus?
You could be trying to cover your discoloured toenails with a polish. The issue is if you are using a topical prescription medication, this inhibits the medicine from working which is why this is not recommended by healthcare providers. Also because fungus thrives on damp surfaces, wearing nail polish can cause fungal infections to worsen.
What can happen if left untreated?
Outside of scaring small children or potential mates, some times nothing but that really depends on your overall health condition and immunity. For example if you have diabetes or a weakened immune system, toenail fungus can lead to complications such as a skin infection known as cellulitis, which can progress to a life threatening condition. Pain is one of the most common reported symptoms of nail fungus.
About the Author: Neil Sadick, MD FAAD, FAACS, FACP, FACPH
Dr. Neil Sadick is known as one of the best dermatologists in the world. Author of more that 300 journal articles and over 20 books, he is one of the most influential people in Dermatology. Known as “the Doctor’s doctor” he travels the world training other dermatologists. All of this, along with Dr. Sadick’s research, has led to global innovation in Dermatology.