ultimate guide nail fungus treatment

The Ultimate Guide to Nail Fungus Treatment

If you suffer from nail fungus, your best chance to get rid of it is to consult a dermatologist or podiatrist and have them recommend the best nail fungus treatment for your case. Before you get there, however, finding out more about the available nail fungus treatment options will help you come to terms with your condition and prepare for what’s coming.

There is 3 nail fungus treatment categories available:

  1. Surgery, laser, iontophoresis, and chemical procedures
  2. Prescription treatments
  3. Over-the-counter treatments

Obviously, there are several options available for each of the above treatment categories. Their effectiveness will depend on their specific, on the severity of the infection, and on the fungus causing it. That is why consulting a doctor is so important. Before you get to a specialist, let’s find out more about the treatment options available in each category.

Surgery, Laser, and Other Invasive Nail Fungus Treatment Options

Surgery seems to be the most efficient solution to get rid of nail fungus. It involves removing the affected nail, and is, therefore, invasive and painful (even when local anesthetics are applied, patients will still experience post-surgery pain and discomfort).

Since fungal infection recurrences are common after nail removal surgery, specialists often recommend additional oral or topical antifungal treatments. Due to the associated costs, pain, and discomfort, surgery is the procedure of choice only in nail fungus cases associated with infections or trauma.

Other innovative nail fungus treatment options less invasive than surgery but very promising in terms of efficiency are:

  • Laser therapy: Also known as photodynamic therapy, it involves applying light-activated agents onto the affected nail and using light beams of a certain wavelength to activate them and improve treatment response.
  • Iontophoresis: This procedure uses electrical current to boost the absorption of topically applied antifungal medication into the nail.
  • Nail lacquer: Specialists have been recently testing the use of a special nail coating that alters the nail’s microclimate to make it unsuitable for fungus growth. It is the least invasive and the most promising procedure in this category.

Prescription-Based Nail Fungus Treatment Options

If you decide the above-described procedures are too invasive, expensive, or uncomfortable for you, prescription-based medication will be your next choice. You have two options: oral and topical treatments.

Oral treatments seem to be the most convenient, as they have higher success rates, they last less, and they are easier to administer than topical treatments. They have 50%-75% success rate and 20-50% recurrence rate. On the other hand, topical treatments have fewer side effects, but they involve application routines that can last up to one year.

Here are the most popular oral nail fungus treatment options available on prescription:

  • Terbinafine / Lamisil – It is one of the safest, most effective, and most affordable drugs for nail fungus. Treatment with it lasts from 6 weeks for fingernail fungus to 12 weeks for toenail fungus. Although it has mild side effects, it might negatively affect anyone suffering from liver disease.
  • Itraconazole / Sporanox – Doctors usually prescribe it in “pulse doses”, the most common recommendations being for 1 week of administration every month, for up to 3 months. It works best against Candida onychomycosis non-dermatophytic molds. It may interact with erythromycin and some asthma medications.
  • Fluconazole / Diflucan – This nail fungus treatment usually involves weekly administration over several months. It may affect kidney function and interact with other drugs, so doctors determine the right dosage according to the patient’s needs and medical history. It is less effective than the other 2 treatment options discussed above, and may negatively impact liver function.
  • Griseofulvin / Grifulvin, Fulvicin, Gris-Peg – Although safe and commonly prescribed to treat nail fungus, its long-term results as toenail fungus treatment have been disappointing.

If the above treatment options fail, you suffer from kidney or liver disease, or you are taking meds they might interact with, you can try a topical nail fungus treatment. The most popular treatment options available are:

  • Ciclopirox / Penlac (8% solution) – It is a nail lacquer usually prescribed for nail fungus that has not spread to the lunula (the white part of the nail). It has a rather low-efficiency rate (up to 10%) and does not work in patients with weak immune systems. It requires daily applications to the affected nail for periods of up to 1 year. You should remove the lacquer and wipe your nail clean with alcohol every week. Evidence suggests that antifungal nail lacquers based on amorolfine prevent recurrences in 70% of the cases, but the substance has yet to become widely available in the U.S.
  • Efinaconazole / Jublia – It received approval in 2014 as nail fungus treatment for infections with Trichophyton mentagrophytes and Trichophyton rubrum. It requires a daily application for up to 48 weeks. It may cause ingrown toenails, and local pain and dermatitis.
  • Tavaborole / Kerydin – It is a rather new treatment option with indications (daily application for up to 48 weeks) and side effects (ingrown toenails, local pain, and dermatitis) similar to efinaconazole.

Nail Fungus Treatment Over the Counter

Some people find it cumbersome to visit their doctor and get a prescription for treating nail fungus, especially when the condition doesn’t interfere with their lifestyle. Going to the pharmacy and buying some over-the-counter (OTC) treatment seems more convenient.

If you are one of those who prefers OTC treatments, and you suspect you have nail fungus, there are several options available for you. However, before trying them, keep in mind that most options lack FDA approval and clinical evidence of their effectiveness as nail fungus treatment.

Their active substances are usually skin antifungal agents and may not have the same effects on the nails. For example, many of the treatments available rely on propylene glycol and/or undecylenic acid to inhibit fungal growth, but there is no evidence they can actually penetrate the nail to inhibit nail fungus growth.

More than that, just like prescription topical treatments, these too require repeated application over long periods (over 1 year) and may have side effects (local dermatitis, allergies, pain, etc.). Considering all these, you would be better off consulting a doctor. They will identify the type of fungus infecting your nail and prescribe the most effective nail fungus treatment for you, taking into account potential side effects and interactions with any drugs you are taking.

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