Fungal toenails are a condition caused by a dermatophyte infecting under the nail bed causing the nail to become thickened, yellow, brittle and painful. There are many nail treatments on the market, but not all of them work. So what do you do when you have a fungal nail?
The first step is to make sure it is a nail fungus causing the problem. Not all nail changes are caused by a funus. Dermatitis, psoriasis, smoking, hypothyroid disease and several other conditions can cause changes to the nail. Frequent nail polish use or defficiency in vitamin E, biotin and collagen can also lead to nail changes. A nail biopsy may be required to test for fungus before treatment is started. After the diagnosis of nail fungus is made, there are three options we recommend in the treatment of nail fungus.
-Topicals: Topical medication can be used in certain cases to cure nail fungus. Most over the counter topicals do not work well because they are not able to penetrate the nail plate and get to the fungus under the nail. A few non-perscription medications have been found to be useful such as Formula 3 and Clarus, but in large part, OTC medications do not work well. Perscription topicals such as tolfenate and Jublia have shown to decrease fungal infections and can be a good option for certain types of fungus. Tea Tree Oil and Vick's Vapor Rub have also shown to help to treat symptoms of nail fungus, softening them nails and helping with discoloration. Topicals tend to be less effective then the other treatment options, but they have very few side effects.
-Oral Medication: Lamisil is the current treatment of choice for oral medications. The medication is an oral tablet taken once daily for 3 months. Lamisil is an effective fungal treatment, but does not always cure fungal nails. Cultures may need to be obtained to see if lamisil would work against the infection present in the nail. Other medications may be perscribed based on culture results including sporanox and diflucan. Certain patients may not qualify for oral medication due to liver problems or other medication use. Liver monitoring is performed while taking these medications as they are heavily processed in the liver. If the liver functions are found to be elevated, the medication is stopped and the liver usually returns to normal.
-Nail Avulsion: Removal of the affected toenail has a high success rate for treating fungus. The nail is allowed to regrow and the nail bed is treated with topical medication or oral medication to prevent fungal regrowth. The big toenail takes 9 months to a year to regrow. It is important to know that the nail may continue to grow thickened and yellow even without the presence of fungus due to damage to the nail growth centers.
We do not currently recommend laser treatment for fungal nails as there are not good scientific evidence for their effectiveness. I would also recommend avoiding soaking the nail in bleach or listerine. This can cause other foot problems such as rash, dry skin or chemical burns.
Chris Suykerbuyk, DPM, FACFAS