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Treatment for Onychomycosis (Toenail Fungus)

As a follow up to my previous blog, Nail Fungus – Better to be Prevented than Treated, I wanted to review treatment options for toenail fungus.  It is important to keep in mind that there are no guarantees with treatment and that the rate of recurrent infection is high.  For best results, it is critical to disinfect footwear as fungal spores can live in your shoes and be a source of reinfection.  Concurrent fungal skin infections, such as Athlete’s foot, must also be addressed and treated in conjunction with fungal nail therapy.

Fungal nail infections can be categorized as mild, moderate and severe.  Treatment options vary based on the severity as well as the type of fungus causing the infection.  Results are not immediate and it may take several months to see improvement in the nails.

Treatment options:

  • Topical – Over-the counter and prescription options. Liquids are applied to the nail plate and creams, gels and powders are applied to the skin or in between the toes.
  • Oral – Prescription oral medications include Terbinafine (Lamisil) and Itraconazole (Sporanox).  These medications typically work faster than topical medications, however they may have serious side effects and patients need to be monitored with periodic blood work.  These medications are also contraindicated in patients with certain medical conditions or those who are taking certain prescription medications.
  • Laser – Thermal vs. Non-Thermal 
    • Thermal lasers work by heating the tissue being treated.  Extreme caution is required with patients who have inadequate sensation. Thermal cameras can be used to monitor the nails during treatment to avoid injury.  
    • Non-Thermal or”Cold Lasers” use low-intensity emission that stimulates the treated area. 

To achieve best results, combination therapy if often used.  Keep in mind that there is no quick fix for toenail fungus.  On average toenails grow about one millimeter per month. Therefore patience is key, as it can sometimes take up to 1 year for a healthy nail to grow.