Onychomycosis (Toenail fungus) is a problem that affects millions of people around the world. Onychomycosis can be mild and cause only cosmetic problems. However, for some people, changes in nail structure can cause pain and even lead to secondary bacterial infections.
Onychomycosis is notoriously difficult to treat, mainly because the fungus spreads throughout the nail, including the nail bed. In addition, the structure of the nail is not easily penetrated by topical drugs.
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This article explores the different topical medications and procedures that can help treat onychomycosis, either alone or with the help of oral antifungal medications.
If you have toenail fungus, it’s a good idea to see a podiatrist for an evaluation of your nails. This can help determine the most effective treatment.
Diagnosis usually involves nail clipping or a biopsy of the nail and nail bed. The nail sample is then sent to a lab to be cultured, examined under a microscope, and/or exposed to potassium hydroxide (called a KOH test) to determine if the cause is fungus.
One of the main reasons why nail treatments fail is because people think of bacterial nail infections as fungal infections. By working with a podiatrist, you can not only confirm that the cause is fungus, but also determine which fungus you have.
Onychomycosis is diagnosed by taking a sample of the nail and evaluating it in a laboratory. This may involve microscopic examination of the nail, KOH testing, or fungal culture.
A more commonly used topical antifungal is Penlac (ciclopirox). This is a brush-on paint that is applied to the nails and usually takes a few months. Penlac is recommended for cases of mild to moderate onychomycosis where the infection has not spread to the center of the nail’s growth (called the stroma).
Notably, Penlac only targets certain types of fungi (including those called Trichophyton rubrum). It is less effective at controlling resistant fungal strains.
Studies have shown that less than 12% of Penlac users partially or completely clear their symptoms. Because of this, most doctors will combine Penlac with other forms of antifungal treatment, including oral antifungals such as Daflucan (Fluconazole) or Lan Meishi (Terbinafine),
another topical antifungal called Jublia (efluconazole) was approved by the U.S. Food and Drug Administration in 2014. Studies have shown that Jublia is two to three times more effective than Penlac in treating nail fungus, but costs nearly nine times more ($750 and $85, respectively).
Children tend to respond better to topical nail treatments than adults because their nails are thinner and more porous.
Penlac (ciclopirox) and Jublia (efinaconazole) are two topical antifungal medicines available by prescription that can help treat onychomycosis. Jublia has been shown to be more efficient than Penlac, but at a much higher cost.
If you decide to use topical medication, monthly debridement (removal of affected nail tissue) will help the medication penetrate more deeply. This is usually done by a podiatrist with the help of a topical urea cream to help thin the nails.
Studies have shown that debridement with a urea-based topical medication can significantly improve symptoms of onychomycosis after one to two weeks.
When using urea, you need to cover the nail with a waterproof bandage (called an occlusive dressing). This helps ensure that the urea seeps into the nail and doesn’t get wiped off.
Urea ointment is available by prescription in a 40% formulation (trade name Cerovel) and retails for about $20. An extra-strength 45% formula (sold under the Uramaxin GT brand) costs about $250.
Monthly nail debridement helps topical medications penetrate deeper into the nail. The procedure usually includes a topical urea cream that helps thin the nail plate.
There are plenty of over-the-counter (OTC) topical antifungals on pharmacy shelves, and most of them promise more than they deliver. If you have particularly thick nails or late signs of a fungal infection (such as discoloration and texture changes), these medications are unlikely to be beneficial no matter how long you use them.
However, if you have mild onychomycosis on the ends of your nails, an OTC product like Lamisil (terbinafine) cream can provide relief along with regular debridement. A 0.46-ounce tube of generic Lamisil cream costs about $12.
Over-the-counter topical antifungals such as Lamisil (terbinafine) may help treat mild cases of onychomycosis limited to the ends of the nails. OTC products are unlikely to help moderate to severe cases involving nail plates or beds.
Several home remedies have been promoted as nail fungus treatments. These include Tea Tree Oil, Coconut Oil, and Vicks VapoRub. Each has antifungal properties and an oily texture for easy absorption.
tea tree oil
While clinical evidence remains scant, a small study concluded that 100% Melaleuca alternifolia (Tea tree) oil is as effective at treating nail fungus as 1% clotrimazole antifungal ointment. About 50% of tea tree oil users reported improvement, although relapse rates were high.
Coconut oil contains caprylic and capric acids, which some claim to clear all types of nail fungus.While there is little evidence to support these claims, research suggests that capric acid can inhibit Candida albicans (fungi associated with yeast infections) in test tubes.
Can it do the same with particularly hearty fungi such as Trichophyton rubrum is suspicious.
A small study involving Vicks VapoRub showed promising results in people with onychomycosis. After 48 weeks, 10 of the 18 participants had partial resolution of symptoms and 5 had complete resolution.
A 2016 study echoed these findings in people with HIV. However, results are usually short-lived and most recur within a year.
Remember, home remedies lack rigorous testing. Further trials are required before any method can be recommended.
Tea tree oil. Coconut oil and Vicks VapoRub are three common home remedies for onychomycosis. Currently, clinical evidence to support its use is limited.
Onychomycosis is a fungal nail infection. This infection is notoriously difficult to treat and often requires a podiatrist to choose the best course of treatment. Topical medications are one such option, especially if you don’t like taking them.
These include over-the-counter topical antifungals like Lamisil, prescription topical antifungals like Jublia and Penlac, and home remedies like tea tree oil. Coconut Oil and Vicks VapoRub. To help with treatment, your doctor may recommend monthly nail debridement to thin the nails and allow the medication to penetrate more deeply.
Frequently Asked Questions
How do you treat toenail fungus with Lamisil pills?
Lamisil (terbinafine) is an oral medication. Treatment of fungal infections usually involves taking a 250 mg tablet daily for three months. Some doctors recommend taking Lamisil for one week in a row, not for three weeks, and then start taking it for another week until you finish treatment.
Can laser treatment cure toenail fungus?
In some cases, laser treatment can completely cure toenail fungus. Results vary, with cure rates ranging from 30% to 61%. It may take about four months of continued treatment to see significant improvement or full recovery.