Toenail fungus is also known as onychomycosis and it represents one of the most common fungal infections in the general population. Unfortunately, toenail fungus is difficult to treat and it can take up to one year to enjoy healthy nails again. Most people are unaware of all the potential treatments that are available for this condition, trying various remedies without any success.
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In this article, we will talk about the best toenail fungus treatments, presenting the opinion of specialists on the matter as well.
Oral antifungal medication
Antifungal drugs can be administered orally, especially if the fungal infection is more severe. Two of the most recommended drugs are terbinafine (Lamisil) and itraconazole. It is worth mentioning that the treatment with oral antifungal drugs can last between six and twelve weeks, depending on the severity of the infection. By taking the treatment precisely as instructed, the new nail will grow healthy, without any fungal infection (basically, the infected part will gradually be replaced).
In severe cases, the oral treatment can extend up to a couple of months, in order to eliminate the infection completely. In general, oral antifungal drugs provide satisfactory results, the success rate being lower in elderly patients, who also suffer from pre-existing conditions (such as diabetes or peripheral vascular disease). In many situations, the best success rate is guaranteed by using oral medication and topical treatments simultaneously.
Despite being efficient in treating toenail fungus, this medication often leads to discomforting side-effects. These vary from skin rash to gastrointestinal complaints and even liver damage, causing the patient to stop or change the treatment. Upon deciding to administer oral antifungal medication, the doctor will perform regular blood tests, in order to make sure that no complications have occurred. Oral antifungal medication is contraindicated in patients who suffer from certain medical problems, such as congestive heart failure or chronic liver disease. Pregnant or breastfeeding women are not allowed to take oral antifungal medication, as it can harm the fetus or the baby.
Nail polish (medicated)
Topical treatments are often used for toenail fungus, with medicated nail polish being quite effective. The active substance in the antifungal topical treatment is Ciclopirox. In general, it is recommended that the treatment is applied not only to the infected toenail but also on the surrounding skin (once a day). After a week has passed, the affected toenail must be cleaned and the application continued. Topical treatments take longer to act, so you might have to use the medicated nail polish for as long as one year (in order to get rid of the infection completely).
Nail cream (medicated)
Antifungal cream is another topical treatment recommended for toenail fungus. For the best results, it is recommended to soak the toenails in water and then apply the antifungal cream on the ones that are infected. Also, the efficiency of the topical treatment can be increased by filing or thinning the nails first. The application of urea cream can soften the nails and, thus, allow for the medicated antifungal cream to work more efficiently.
The doctor can recommend the surgical removal of the nail, in the situation that the infection is too severe, causing extreme pain and preventing the patient from walking or even standing. The surgical removal is also recommended in the situation that the fungal infection does not respond to other forms of treatment.
Before you get scared, you should know that, upon removal, a new nail will grow. However, you have to be patient, as the growth is slow and it may take up to one year how have a fully grown toenail. Depending on the severity of the infection, the doctor might decide to remove only a part of the toenail or go for the complete removal. It is also possible to apply antifungal cream to the toenail bed after the surgical removal, so as to eliminate the fungal infection completely.
In the past few years, more and more specialists have drawn attention to laser therapy being suitable as a form of treatment for toenail fungus. Today, various studies have confirmed that both laser and other light-based therapies could be used to treat fungal infections, especially in combination with antifungal cream. However, it is important to mention that such treatments are not yet widely available; moreover, they are quite expensive and rarely covered by basic health insurance.
According to a study published online on the US National Library of Medicine, lasers are often present as suitable treatments for patients suffering from toenail fungus. It is highlighted that laser treatment could represent a viable alternative to other forms of treatments, especially in patients who suffer from chronic liver disease and who cannot take oral antifungal medication (this being processed through the liver). However, the author of the study draws attention to the fact that further research is necessary, in order to attest the efficiency of laser treatments on a long-term period (and also determine the type of toenail fungus which responds best to said treatment).
In a paper written on the subject of photonic therapeutics and diagnostics, we are informed that “eye-safe” erbium glass laser could be used for the efficient treatment of toenail fungus. According to the authors of this paper, laser devices can be successfully used for the treatment of toenail fungus, as an alternative to conventional oral antifungal medication. The authors of the paper draw attention to the fact that oral antifungal drugs often have discomforting side-effects and they can also interact with other medication, increasing the risk for serious complications (heart and liver failure). They also highlight the fact that, while oral drugs require long-term administration, laser treatments require only one or two sessions to treat toenail fungus.
You might not expect the famous mentholated ointment to be a suitable form of treatment for toenail fungus but it actually is. The novel treatment was confirmed as effective in a study published in the Journal of the American Board of Family Medicine. The participants to the study were asked to apply the mentholated ointment on their affected toenails and were followed-up, in order to ascertain the actual results of the said treatment.
Participants to the study presented a significant change whereas the health of the affected toenails was concerned. Moreover, the application was 100% safe, without any side-effects or complications reported. Authors of the study concluded that the mentholated ointment represents a novel, yet cost-effective alternative for the treatment of toenail fungus.
Things to remember about the toenail fungus treatment
First and foremost, just because someone says a treatment is the best, this does not mean it works the same for you. It is important to visit a medical specialist and discuss about the available treatment options, both topical and oral. At the same time, it is important to avoid conditions that might favor the recurrence of the fungal infection, such as excess warmth and moisture.
Even though the debridement of the nail is not a treatment per say, it can be performed, in order to reduce the pressure and pain experienced at the level of the nail. It is important to understand and remember that nail debridement only acts on the symptoms and not actually on the fungus.
According to an article presented by the American Orthopaedic Foot&Ankle Society, it is possible to address the symptoms of toenail fungus using natural remedies, such as vinegar. However, the authors of the article draw attention to the fact that their effects have not been fully discovered and further research is still necessary. In the same article, we are once more reminded that one of the most effective ways of treating toenail fungus is by combining topical applications with oral antifungal drugs.
The decision to remove the affected nail can be taken only by the doctor and you have to understand that it will take a long period of time for the nail to grow back. The advantage is that the symptoms are going to improve quite rapidly, even though antifungal treatment might still be necessary for the toenail bed.
Regardless of the chosen form of treatment, it may not be started before the mycological confirmation of the infection. The doctor needs to know the kind of fungal infection he/she is dealing with, in order to recommend the best form of treatment.
Even though no one likes to think about that possibility, it can happen that the fungal infection fails to respond to treatment. In fact, it is estimated that between 20 and 30 percent of all cases of toenail fungus do not respond to any form of treatment, with the surgical intervention remaining the only available option.
People who have low immunity, poor compliance or those whose nails have stopped growing are more likely to experience treatment failure. The same goes for those who exhibit poor absorption or even fungal resistance. It is important to understand that the fungus will develop quite extensively in the subfungual area, which might prevent the topical medicated treatments from being properly absorbed. In such situations, the doctor will most likely recommend the partial or total removal of the affected toenail, continuing to apply the medicated cream on the nailbed.
One cannot say for certain which is the best toenail fungus treatment, as this is dependent on a wide range of factors, including the type and severity of the infection, pre-existing medical conditions and rate of response to the said treatment. Antifungal oral medication is most efficient when administered at the same time with topical solutions but not everyone can take such treatments. Laser treatments could represent the answer to the problem but further research is necessary to assess the long-term efficiency in regard to treating toenail fungus.
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 Journal of Foot Ankle Research, issue 7, 27th of July 2014. Retrieved from the US National Library of Medicine. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4124774/
 SPIE Photonics West, Paper no.8565-31, 2013. Retrieved from Kigre. http://kigre.com/files/er168.pdf
 Journal of the American Board of Family Medicine, vol.24, no.1, Jan-Feb 2011. Retrieved from the Journal of the American Board of Family Medicine. http://www.jabfm.org/content/24/1/69.full
 American Orthopaedic Foot & Ankle Society, informational leaflet. Retrieved from the website of the American Orthopaedic Foot & Ankle Society. https://www.aofas.org/footcaremd/conditions/ailments-of-the-big-toe/Documents/Toenail-Fungus.pdf