Treatment for Fungal Toenails

Fungal nail infections can be difficult to treat. Over the counter medications available at the pharmacy or online are rarely helpful. At home remedies like vinegar or bleach soaks are even less effective. Severe infections, or a fungus that persists for more than a few months often requires medical attention.

●     Laser Treatment: Laser devices work by two processes called photothermolysis and photobiomodulation. Photothermolysis occurs as the laser emits pulses of light energy that target fungal cells and produce heat.  In response to the heat, the infected tissue is gasified and decomposed, destroying the fungus and the surrounding skin and nail. The heat from the lasers also has a sterilizing effect, which helps prevent new fungal growth. Photobiomodulation occurs when the laser applies light energy in the range of the infrared electromagnetic spectrum (870, 930, 1,064 nm) to the nail bed. This  stimulates the metabolism of cells, improves microcirculation, and inhibits the fungal multiplication.  Laser treatment is associated with high rates of negative cultures—which means that a laboratory microscopic test for a fungal infection typically doesn't show evidence of infection after treatment.

●     Oral antifungal drugs: These drugs are often the first choice because they clear the infection more quickly than do topical drugs. Options include terbinafine (Lamisil) and itraconazole (Sporanox). These drugs help a new nail grow free of infection, slowly replacing the infected part.
You typically take this type of drug for at least three months. Treatment success rates with these drugs appear to be lower in adults over age 65.
Oral antifungal drugs may cause side effects ranging from skin rash to liver damage. Because of the potential for liver toxicity, blood tests to check liver function are necessary before these drugs can be prescribed. Often, the blood levels are checked midway through treatment to make suer that the liver is able to tolerate the medication.

●     Prescription topical medication: Your doctor may prescribe an antifungal nail polish called ciclopirox (Penlac). You paint it on your 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 almost a year.

●     Surgery: Removal of the nail in its entirety, with subsequent treatment of the infected nail bed with a topical antifungal cream is a less popular option. This procedure can be painful and creates a wound on the toe. People with any sort of peripheral vascular disease, diabetes are not good candidates, as they are less likely to heal well from the nail removal wound. Healing time, including new nail regrowth, is slow, approximately eight months.

You may not be sure which treatment is most appropriate for you. A toenail consultation is ideal for anyone who is unsure of what would be the best way to get rid of their infected toenails. Your doctor can evaluate your toenails as well as the skin on your feet. You can have all of your questions answered about efficacy, safety, medicine side effects, treatment time, etc. The visit is designed to help you come up with the appropriate treatment plan for you.

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