Topical treatments for toenail fungus

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Onychomycosis , or toenail fungus , is a problem that affects millions of people around the world. Onychomycosis can be mild and cause only cosmetic problems, but for some, changes in the structure of the nails can cause pain and even lead to a secondary bacterial infection .

Onychomycosis is very difficult to treat, mainly because the fungus is found throughout the nail, including the nail bed . Also, local agents cannot easily penetrate the structure of the nail itself.

Although oral antifungals can often kill the fungus systemically, they are not suitable for everyone due to cost, side effects, or personal aversion to the pill. For this, some local remedies can help.

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Diagnostics

If you have toenail fungus, it's always a good idea to see your doctor for an evaluation of your nails so they can determine the most appropriate treatment .

One of the main reasons nail treatments don't work is because people self-diagnose and treat a bacterial infection such as a yeast infection. By contacting your doctor, you will not only be able to confirm that a fungus is the cause, but also determine which strain of the fungus you have.

Prescription antifungal medications

One of the most commonly prescribed topical antifungals is penlac (ciclopirox), a varnish that is applied directly to the nail with a brush, usually for several months. Penlac is recommended for mild to moderate cases of onychomycosis in which the infection has not yet spread to the growth center of the nail (known as the matrix).

It is important to note that Penlac only targets certain types of fungi (including the main form known as Trichophyton rubrum ) and is less able to control drug resistant strains. In fact, studies have shown that less than 12% of patients treated with Penlac experience partial or complete clearance. To this end, most podiatrists often combine Penlac with other forms of antifungal therapy.

Another well-known topical antifungal is Jublia (efinaconazole ), which was approved for use by the FDA in 2014. The oral drug Lamisil (terbinafine) is also an effective option.

Children are generally more susceptible to topical nail fungus treatments, in part because their nails are thinner and more porous than adult nails.

Nail wound removal.

If you decide to use a topical remedy, monthly debridement (removal of the affected nail tissue) by a podiatrist will help the medication penetrate the affected tissue better. This may include using a topical urea cream to thin the nail and remove debris from the nail bed.

Research has shown that wound debridement with a urea-based topical treatment can significantly improve onychomycosis symptoms after one to two weeks.

During treatment, the nail will need to be covered with a waterproof dressing known as an occlusive dressing. Some people find the dressing cumbersome, but it helps to make sure the urea gets into the nail and doesn't.

The ointment is sold by prescription in a 40% formulation (under the brand name Cerovel) for about $ 20. A 45% hardened compound (sold under the brand name Uramaxin GT) costs about $ 250.

Over-the-counter treatments

There are many over-the-counter topical antifungals on the shelves, most of which promise more than they deliver. If you have particularly thick nails and / or severe signs of a fungal infection (such as discoloration and texture changes), these over-the-counter products are unlikely to be beneficial, no matter how long you use them.

If you have mild onychomycosis that is limited to the tips of your nail, over-the-counter products such as Lamisil cream (terbinafine) can provide relief when combined with regular wound cleaning and continuous use for four to six months. Lamisil All Purpose Cream costs about $ 12 for a 0.46 oz tube.

Home remedies

Various home remedies have been popular as cures for nail fungus. These include tea tree oil , coconut oil, and Vicks VapoRub. Each of these products has antifungal properties and an oily texture that makes it easy to absorb.

Although clinical data remains scarce, a small study using 100% Melaleuca alternifolia (tea tree) oil found it to be as effective in treating nail fungus as 1% clotrimazole antifungal ointment. In total, about 50 percent of tea tree oil consumers reported an improvement, although the relapse rate was high.

Coconut oil contains caprylic acid and capric acid, powerful antimicrobial agents that some believe can completely eradicate nail fungus. Although there is little clinical evidence to support these claims, research has shown that capric acid can inhibit Candida albicans (a type of fungus that causes yeast infections) in vitro.

It remains questionable whether the 9% capric acid found in coconut oil can achieve the same effect with a particularly potent fungus like Trichophyton rubrum .

On the other hand, a small study with Vicks VapoRub has shown promising results. After 48 weeks, 10 of 18 participants achieved partial relief of nail fungus symptoms and five achieved complete disappearance.

In a 2016 study published in the Journal of the AIDS Nursing Association, these results were confirmed in people with HIV. However, the results were generally short-lived and, in most cases, relapses occurred within a year.

Keep in mind that home remedies do not go through rigorous testing and further testing is needed before recommending any of them.

Frequently asked questions

  • Lamisil (terbinafine) is taken by mouth in tablet form. Treating yeast infections generally requires taking 250 milligrams (one tablet) every day for three months. Sometimes doctors recommend taking the drug continuously for a week, not taking it for three weeks, and then starting again for a week until your treatment ends.

  • In some cases, yes, laser treatment can completely cure toenail fungus. Research results varied widely and overall cure rates were reported to be between 30% and 61% of people with toenail fungus. It may take about four months of consecutive treatment for a full recovery or a significant improvement in the condition of the nails.

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