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Wednesday March 17, 2021 / Foot Doctor Blog

Toenail fungal infections, also called onychomycosis, are common among older adults. Due to the slow growth of toenails it is easier for fungus to develop in the nail bed. First, nail specimens of affected toenails are obtained by your doctor in order to determine whether a fungal infection is even present. Once results are obtained, the most appropriate treatment plan will be determined. Interestingly, 50% of the nails that look like fungal infections are not infected but are rather just unhealthy toenails. Fortunately, toenail fungus typically does not lead to serious medical problems. Numerous treatments are available, such as oral antifungal medications, topical solutions, and laser therapy. Each of these options have a certain success rate associated with them. Oral medications and laser therapy result in a cure 50-85% of the time. Topical antifungals need to be used for at least 6-12 months of continuous treatment with less than 20% success rate, which can vary slightly between OTC vs prescription topicals. Regardless of what treatment is used, vigilance and patience is necessary for complete resolution.

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ORAL ANTIFUNGAL MEDICATION:

Oral antifungal medication is often the first choice because they are more effective in clearing the infection as compared to topical products. The most used oral option is terbinafine (Lamisil) which acts by slowly replacing the infected nail with clear nail as the new nail grows out. Thus, results from treatment may take 9 months or longer to eliminate an infection.

Prior to taking, be aware that oral antifungals may cause side effects ranging from skin rash to liver damage. In order to start this medication a blood test (hepatic function panel) will be obtained to evaluate liver function. It is not recommended for patients with liver disease or congestive heart failure or those taking certain medications. It is also not advised to consume alcohol while taking Lamisil. Oral antifungal medication is taken daily for 90 days (3 months) or pulse dosed (1 week/month for 3 months).

TOPICAL MEDICATION:

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When oral medication is not an option, topical antifungal solutions are recommended. One prescription option is a nail lacquer called ciclopirox (Penlac). It is used by painting it on all infected nails and surrounding skin once a day. After seven days, you wipe the piled-on layers clean with alcohol and begin fresh applications. You may need to use this type of nail polish daily for at least a year or longer.

Jubia 10% solution is another topical prescription medicine used to treat fungal infections of the toenails. Apply one drop of Jublia onto all affected toenails daily. For the big toenail, you also need to apply a second drop to the end of the toenail using the tip of the brush. Jublia should be applied once daily for 48 weeks, exactly as directed by your doctor.

In doctor’s offices, patients can obtain a different topical developed by The Tetra Corporation called Formula 7, which is the only paraben free soluble tolnaftate antifungal microemulsion fortified with cosmetic ingredients and bactericidal agents. This solution is used by applying a thin layer of Formula 7 over the affected area twice daily (morning and night) allowing the product to penetrate the tissue and reach the fungal growth area.

Overall, there may be a higher success rate of clearance of fungal infection with doctor recommended topical prescription medication as compared to generic over-the-counter topicals. When using topical treatment, make sure to wear well fitting, ventilated shoes and buy absorbent or special synthetic socks that wick the perspiration from your feet.

LASER THERAPY:

Laser therapy is the latest method of treatment for nail fungus. Once such laser treatment is performed with three treatments over a course of eight weeks. Laser treatment of nail fungus has a high success rate when combined with a topical and/or oral antifungal to gain the maximum benefit.

SURGERY:

If all else fails, patients can opt for more aggressive treatment like temporary or permanent toenail removal. Temporary removal is performed to apply the antifungal drug directly to the infection under the nail. Permanent removal is performed if the infection is severe or extremely painful or for toenails which do not respond to medicine.

Along with treatment to the toenails, patients must know that it is important to also address the environment in which your feet live. Using foot powder, clean socks and dry shoes will help or improve the outcome and to prevent reinfection, regardless of treatment chosen. Additionally, the regular use of an ultraviolet light shoe sanitizer, to keep fungus from growing in your shoes, can be very helpful.

Dr. Urja Shah serves patients in our Greenbelt MD and Annapolis offices for your convenience. She obtained her bachelor’s degree in Biological Science majoring in Neurology and Physiology from the University of Maryland, College Park. She pursued her passion for medicine by attending Temple University School of Podiatric Medicine in Philadelphia, PA where she received her doctorate.

References:

1. Formula 7® Solution – The Tetra Corporation; https://www.thetetracorp.com/products/formula-7-solution/
2. Nail fungus – Diagnosis and treatment – Mayo Clinic; https://www.mayoclinic.org/diseases-conditions/nail-fungus/diagnosis-treatment/drc-20353300
3. JUBLIA® (efinaconazole): For the treatment of toenail fungus; https://www.jubliarx.com/

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