Medicine Information

Warning: This article is for information only and can not be used to supplement your doctor's advice. You should contact your doctor for nail fungus treatment.

Treatment Of Toe Nail Fungus

Medical Care:

Several years ago the medical management of OM was limited to topical therapy and 2 unreliable systemic drugs: griseofulvin and ketoconazole. Topical therapy is beneficial only for mild cases involving the very distal nail plate. The use of griseofulvin and ketoconazole is plagued by high relapse rates (70-85%), prolonged treatment regimens (10-18 mo for toenails), constant laboratory monitoring, and numerous adverse effects. The introduction of newer oral agents has revolutionized the medical treatment of OM and reduced potential adverse effects and drug interactions. As the rate of recurrence remains high, even with newer agents, the decision to treat should be made with a clear understanding of the cost and risks involved as well as the risk of recurrence..

Topical antifungals

The use of topical agents should be limited to cases involving less than half of the distal nail plate or for patients unable to tolerate systemic treatment. Agents include amorolfine (approved in other countries), ciclopirox olamine 8% nail lacquer solution, sodium pyrithione, bifonazole/urea (available outside the United States), propylene glycol-urea-lactic acid, the imidazoles, and the allylamines.

Topical treatments alone are generally unable to cure OM because of insufficient nail plate penetration. Ciclopirox solution has been reported to penetrate through all nail layers but has low efficacy when used as monotherapy. It may be useful as adjunctive therapy in combination with oral therapy or as prophylaxis to prevent recurrence in patients cured with systemic agents.

Oral therapy

The newer generation of oral antifungal agents (itraconazole and terbinafine) has replaced older therapies in the treatment of nail fungus. They offer shorter treatment regimens, higher cure rates, and fewer adverse effects. Fluconazole (not approved by the Food and Drug Administration [FDA] for treatment of nail fungus) offers an alternative to itraconazole and terbinafine. Derivatives of fluconazole may also be available soon. The efficacy of the newer antifungal agents lies in their ability to penetrate the nail plate within days of starting therapy. Recent evidence shows better efficacy with terbinafine than other oral agents.

To decrease the adverse effects and duration of oral therapy, topical and surgical treatments may be combined with oral antifungal management.

Surgical Care:

Surgical approaches to nail fungus treatment include surgical nail avulsion and matrixectomy by chemical or mechanical means. Chemical removal by using a 40-50% urea compound should be reserved for patients with very thick nails or for those who may not tolerate mechanical avulsion.

Removal of the nail plate should be considered an adjunctive treatment in patients undergoing oral therapy.

A combination of oral, topical, and surgical therapy can increase efficacy and reduce cost.

Activity: Activity does not need to be limited during treatment, but patients should be educated about avoiding direct contact with high-risk areas in public places.

More Articles: