How do different nail fungus treatments compare in effectiveness. What are the pros and cons of topical vs oral medications for fungal nail infections. Which treatment option offers the best chance of eliminating nail fungus long-term.

Understanding Nail Fungus: Symptoms and Appearance

Nail fungus, medically known as onychomycosis, is a persistent condition that affects many individuals. The primary signs of a fungal nail infection include:

• Brittle or crumbly nails
• Whitish-yellowish or brownish discoloration
• Thickening of the nail
• Changes in nail shape
• Partial detachment of the nail from the nail bed

These symptoms can be unsightly and uncomfortable, prompting many to seek treatment. But what are the most effective options available?

Topical Treatments for Nail Fungus: Polishes and Creams

Topical treatments are often the first line of defense against nail fungus. They come in various forms, including nail polishes and creams, and are available over-the-counter at pharmacies.

Nail Polishes: Amorolfine and Ciclopirox

Two primary antifungal ingredients are used in medicated nail polishes:

1. Amorolfine: Applied once or twice a week
2. Ciclopirox: Application frequency varies, starting with every other day and gradually decreasing

Both treatments require the removal of the old polish layer before applying a new one. Some newer ciclopirox formulations are water-soluble, requiring daily application and removal with water.

Combination Treatment Sets

Some treatment options combine creams with a nail scraper. These sets typically include:

• A urea-based cream to soften the nail
• An antifungal cream containing bifonazole
• A nail scraper (spatula) for removing softened nail material

This treatment approach involves a 14-day cycle of nail softening and scraping, followed by four weeks of bifonazole cream application.

Effectiveness of Topical Nail Fungus Treatments

How well do these topical treatments work? Studies on the effectiveness of nail fungus treatments have shown mixed results:

• Ciclopirox nail polish: After one year, about 32% of users no longer had detectable fungal infections, compared to 10% in the untreated group.
• Urea and bifonazole cream combination: Three months post-treatment, 51% of users showed no visible fungus, compared to 41% who used only urea cream.

However, it’s important to note that many participants experienced a return of the fungal infection over time, suggesting that topical treatments may not provide long-term solutions for all cases.

Oral Medications for Nail Fungus: A Systemic Approach

For more severe or persistent cases of nail fungus, oral medications may be prescribed. These systemic treatments work from inside the body to inhibit fungal growth or eliminate the infection entirely.

Types of Oral Antifungal Medications

Common oral antifungal medications for nail fungus include:

• Terbinafine
• Itraconazole
• Fluconazole

These medications are available by prescription only and typically need to be taken for several weeks or months.

Comparing Topical and Oral Treatments: Efficacy and Side Effects

When deciding between topical and oral treatments for nail fungus, several factors come into play:

Efficacy

Oral medications are generally more effective than topical treatments. They can reach the infection through the bloodstream, potentially providing more comprehensive treatment.

Treatment Duration

Topical treatments may need to be applied for up to a year, while oral medications usually require several weeks to months of treatment.

Side Effects

Oral medications tend to have more potential side effects than topical treatments. These may include gastrointestinal issues, liver problems, or interactions with other medications.

Convenience

Topical treatments require consistent application and maintenance, while oral medications are typically taken once or twice daily.

Factors Influencing Treatment Choice for Nail Fungus

When choosing a nail fungus treatment, several factors should be considered:

• Severity of the infection
• The affected nail area
• Patient’s overall health and medical history
• Potential drug interactions
• Cost of treatment
• Patient preference and compliance

Consulting with a healthcare provider can help determine the most appropriate treatment option based on individual circumstances.

Preventing Nail Fungus Recurrence: Long-term Strategies

While treating nail fungus is important, preventing its recurrence is equally crucial. Some strategies to reduce the risk of future infections include:

• Keeping feet clean and dry
• Wearing breathable footwear
• Using antifungal powders or sprays in shoes
• Avoiding walking barefoot in public areas like locker rooms or pools
• Trimming nails regularly and keeping them short
• Disinfecting nail care tools after each use

Implementing these preventive measures can help maintain healthy nails and reduce the likelihood of fungal infections returning.

When to Seek Professional Help for Nail Fungus

While many cases of nail fungus can be treated with over-the-counter remedies, there are instances where professional medical advice is necessary. Consider consulting a healthcare provider if:

• The infection persists despite consistent use of over-the-counter treatments
• The affected area is large or spreading rapidly
• You experience pain or discomfort in the affected nail
• You have diabetes or a weakened immune system
• There are signs of bacterial infection, such as redness, swelling, or pus

A dermatologist or podiatrist can provide a thorough evaluation and recommend the most appropriate treatment plan for your specific case.

Nail fungus can be a persistent and challenging condition to treat. While topical treatments like medicated nail polishes and creams offer a convenient first-line approach, their long-term effectiveness may be limited. Oral medications provide a more potent systemic treatment but come with potential side effects that need to be carefully considered. The choice between topical and oral treatments should be made in consultation with a healthcare provider, taking into account the severity of the infection, overall health, and individual preferences. Regardless of the chosen treatment, patience and consistency are key, as eliminating nail fungus often requires extended treatment periods. By combining appropriate treatment with preventive measures, individuals can improve their chances of overcoming nail fungus and maintaining healthy nails in the long term.

Nail fungus: Polish, cream or tablets? – InformedHealth.org

Created: January 14, 2015; Last Update: June 14, 2018; Next update: 2021.

Nail fungus can be very persistent. Topical treatment with nail polish may take up to one year. Tablets for treating fungal nail infections usually have to be taken for several weeks or months. They are much more effective than topical treatments, but they have more side effects.

Brittle (crumbly) nails and a whitish-yellowish or brownish discoloration are typical signs of nail fungus. The nails may also become thicker and change shape. The affected part of the nail sometimes detaches from the nail bed. The treatment options for nail fungus include nail polishes and creams as well as tablets. Nail polishes and creams are available in pharmacies without a prescription.

What topical (external) treatments are there?

Nail polishes

Lots of people first try to treat nail fungus with a colorless nail polish. Before applying the nail polish, the affected nail has to be cut and filed down as much as possible. The nail polishes contain the growth-inhibiting and antifungal ingredients amorolfine or ciclopirox. The products differ in how often they have to be used:

• Amorolfine is applied one to two times a week.

• Ciclopirox products are usually applied every other day in the first month, at least twice a week in the second month, and once a week starting from the third month.

With both treatments, the old layer of polish has to be removed using an alcohol swab before applying the new layer. Cosmetic nail polish can be applied on top of the medicated nail polish. Newer ciclopirox nail polishes are water-soluble. They are applied daily, and the remaining polish is removed using water before each new application.

Sets with creams and a nail scraper

Treatment sets that contain two creams and a nail scraper (spatula) can also be used for the topical treatment of nail fungus:

• One cream has urea in it, which softens the nail so it can be removed.

• The other cream contains bifonazole, which has an antifungal effect.

For this treatment, the affected toe or finger first has to be soaked in warm water for ten minutes and then dried. After that, the urea-based cream is applied to the nail, and the nail is covered with an adhesive bandage. After 24 hours, the bandage is removed and the toe or finger is held in warm water again. The softened layer of the nail is then scraped off using a spatula, the cream is applied again and the nail is covered with a new bandage. This treatment is carried out over 14 days. Once the infected part of the nail has been scraped away completely, the skin beneath is treated for another four weeks with a bifonazole cream.

How effective are topical treatments?

So far, only a few studies have looked into topical nail fungus treatments with nail polishes or creams. Because these studies had weaknesses, the results should be interpreted with caution. Amorolfine has not yet been well studied. Ciclopirox polish and treatment sets with urea and bifonazole cream were tested in a few studies.

Research on the effectiveness of nail polish containing ciclopirox showed that, after one year:

• About 10 out of 100 people who did not use ciclopirox no longer had a detectable fungal nail infection.

• About 32 out of 100 people who used ciclopirox no longer had a detectable fungal nail infection.

In other words, treatment with ciclopirox got rid of the fungal infection in about 22 out of 100 people. But even if the fungus had gone away, the cosmetic result wasn’t always satisfying. The nails only looked healthy after treatment in 7 out of 100 people.

Treatment with sets containing urea and bifonazole cream was tested in one study. It was compared with a treatment in which only urea cream was applied and the nail was removed, but without applying bifonazole cream afterwards. Three months after treatment was completed, it was found that:

• No fungus was visible or detectable in about 41 out of 100 people who only used urea cream.

• No fungus was visible or detectable in about 51 out of 100 people who used both urea and bifonazole cream.

In other words, the combination of urea and bifonazole got rid of nail fungus in an extra 10 participants. But there was no difference between the two groups six months after treatment. Also, the fungal infection returned in many participants, so it’s likely that neither of the two treatments can increase the chances of getting rid of the fungus in the long term.

People did not take part in the study if their fungal infection covered more than half of the affected nail area or if the infection started at the base of the nail.

What oral medications are available?

To treat fungal nail infections from inside the body, you can take tablets that inhibit the growth of fungi or kill them. They are all prescription-only. Terbinafine and itraconazole are typically used for this purpose.

• Terbinafine is preferred if the nail fungus is caused by a skin fungus (dermatophyte). This is usually the case.

• Itraconazole is generally used if the nail infection is caused by yeast or mold.

Itraconazole and terbinafine tablets can both be taken either continuously or with breaks between treatments. But they are used differently:

Terbinafine

In continuous treatment, the medication is usually taken once a day for three months (dose: 250 mg).

In treatment with breaks, the medication can be taken as follows:

• 500 mg terbinafine (2 tablets) daily for a week, then a three-week break

• Or: 250 mg terbinafine (1 tablet) daily for four weeks, then a four-week break

Even in this approach, the treatment typically doesn’t take any longer than three to four months.

Itraconazole

In continuous treatment, itraconazole is taken once daily for a maximum of three months. The dose is then 200 mg per day (two 100 mg tablets).

In treatment with pauses, 400 mg of itraconazole is taken daily for a week (two 100 mg tablets in the morning and two in the evening). That is followed by a three-week break in treatment. This treatment also lasts three months or less.

Fluconazole

Fluconazole is only used if other treatments didn’t work or aren’t an option for other reasons. It is taken once a week (dose: 150 mg). But fluconazole has to be taken for about 6 to 12 months to work properly.

How effective are tablets in treating nail fungus?

Tablets for the treatment of nail fungus have been tested in several studies. All participants had an infection on their toenails caused by a skin fungus. Overall, the study results showed that tablets are considerably more effective than nail polishes or creams.

One year after a three-month treatment with terbinafine:

• About 17 out of 100 people who didn’t have this treatment no longer had a detectable fungal nail infection.

• About 76 out of 100 people who had this treatment no longer had a detectable fungal nail infection.

In other words, the treatment with terbinafine got rid of the fungal infection in about 59 out of 100 people.

Itraconazole also proved to be effective. After one year,

• 7 out of 100 people who didn’t have this treatment no longer had a detectable fungal nail infection.

• About 43 out of 100 people who had this treatment no longer had a detectable fungal nail infection.

In other words, the treatment with itraconazole got rid of the fungal infection in about 36 out of 100 people.

Some studies directly compared itraconazole and terbinafine with each other. They confirm that terbinafine is somewhat more effective than itraconazole.

Treatment with breaks is thought to be about as effective as continuous treatment. But that has only been looked into in a few studies.

What side effects and drug-drug interactions do the tablets have?

The possible side effects of itraconazole include headaches, dizziness, stomach and bowel problems, and rashes. Itraconazole can also interact with a number of other drugs. These include cholesterol-reducing and blood-sugar-lowering medications, as well as certain sleeping pills. It is therefore important to let your doctor know about any medication you take. Itraconazole is not an option for people with heart failure (cardiac insufficiency). It also isn’t suitable for women who are pregnant or breastfeeding.

Terbinafine can cause gastrointestinal (stomach and bowel) problems and a temporary loss of taste and smell. It can also interact with certain antidepressants and heart medications. Overall, terbinafine has far fewer drug-drug interactions than itraconazole. Nevertheless, it’s still important to tell your doctor if you are taking any other medication. As a precaution, this medication should not be taken during pregnancy or if you are breastfeeding.

The studies only rarely reported on how often the different side effects occurred. But most people tolerate nail fungus medications well. Only a few people in the studies stopped treatment because of side effects.

But there is a very small risk of liver damage from taking itraconazole or terbinafine. For this reason, people with a liver disease are only given these medications if it’s absolutely necessary.

What can be expected of products such as tea tree oil?

Sometimes home remedies such as applying tea tree oil or vinegar are recommended for the treatment of nail fungus. But there aren’t any good quality studies on whether these or other products help to treat nail fungus.

When are the different treatments considered?

Most doctors recommend treating nail fungus with nail polish or cream if

• not much more than half of the nail is affected by the fungus,

• the base of the nail is not infected, and

• only some nails are affected.

Topical treatment is also usually recommended for children. One reason for this is that most oral medications aren’t suitable for children. Another reason is that children have thinner nails that grow more quickly, so it’s assumed that treatment with nail polish or creams is more likely to work in children than in adults. White superficial onychomycosis is also often treated with a nail polish or cream.

If several nails are infected by the fungus, or if the infection has spread out more on the affected nails, it’s usually necessary to take oral medication. And if the infection started at the base of the nail, it’s highly likely that only tablets will help.

Additional treatments

If the fungal nail infection is severe, tablets can be used in combination with nail polish or cream. For example, if the nail is very thick, urea cream can be used (in addition to taking tablets) to gradually remove or partially file off the affected nail. Combining these treatments may also be an option if there are large collections of fungi beneath the nail. Another option for severe fungal nail infections is professional medical footcare. If the nail is filed off, it’s important to ensure good hygiene and disinfect the area, because the removed nail tissue could contain infectious fungal spores.

Sometimes people with a fungal nail infection are offered laser treatment. This involves shining infrared or ultraviolet (UV) light on the nail in order to kill the fungi. Laser treatments haven’t been proven to work in good quality studies. Because statutory health insurers in Germany don’t cover the costs of this treatment, people have to pay for it themselves.

Which treatment is right for me?

Nail fungus is usually harmless. But many people find discolored or thickened nails unpleasant to look at and want to get rid of the fungus as soon as possible. Fungal nail infections can also spread, and may infect other people. Regardless of the treatment you choose, it will take a while until the nail looks normal again. It’s especially important to be patient where toenails are concerned. It can take a year for a healthy big toenail to grow back. Nail fungus can sometimes be very persistent despite treatment. It can also come back after successful treatment.

Topical treatment (polish or cream) isn’t likely to get rid of a fungal nail infection. Treatment with tablets is considerably more effective and takes less time. But some people can’t take tablets because of the very rare, yet serious risks. How you feel about the pros and cons of the different treatment options is a personal matter. You can also discuss the options with your doctor.

Sources

• Crawford F, Hollis S. Topical treatments for fungal infections of the skin and nails of the foot. Cochrane Database Syst Rev 2007; (3): CD001434. [PMC free article: PMC7073424] [PubMed: 17636672]

• De Berker D. Clinical practice. Fungal nail disease. N Engl J Med 2009; 360(20): 2108-2116. [PubMed: 19439745]

• Deutsche Dermatologische Gesellschaft (DDG), Deutschsprachige Mykologische Gesellschaft (DMykG). Tinea der freien Haut (S1-Leitlinie). AWMF-Registernr.: 013-002. October 2008.

• Eisman S, Sinclair R. Fungal nail infection: diagnosis and management. BMJ 2014; 348: g1800. [PubMed: 24661991]

• Gupta AK, Daigle D, Foley KA. Topical therapy for toenail onychomycosis: an evidence-based review. Am J Clin Dermatol 2014; 15(6): 489-502. [PubMed: 25257931]

• Kreijkamp-Kaspers S, Hawke K, Guo L, Kerin G, Bell-Syer SE, Magin P et al. Oral antifungal medication for toenail onychomycosis. Cochrane Database Syst Rev 2017; (7): CD010031. [PMC free article: PMC6483327] [PubMed: 28707751]

• Tietz HJ, Hay R, Querner S, Delcker A, Kurka P, Merk HF. Efficacy of 4 weeks topical bifonazole treatment for onychomycosis after nail ablation with 40% urea: a double-blind, randomized, placebo-controlled multicenter study. Mycoses 2013; 56(4): 414-421. [PubMed: 23586591]

• IQWiG health information is written with the aim of helping
  people understand the advantages and disadvantages of the main treatment options and health
  care services.

  Because IQWiG is a German institute, some of the information provided here is specific to the
  German health care system. The suitability of any of the described options in an individual
  case can be determined by talking to a doctor. We do not offer individual consultations.

  Our information is based on the results of good-quality studies. It is written by a
  team of
  health care professionals, scientists and editors, and reviewed by external experts. You can
  find a detailed description of how our health information is produced and updated in
  our methods.

How and when to take or use terbinafine

The treatment you use will depend on where the infection is on your body and how severe it is.

For large areas of skin, or if the area is hairy, it’s best to use the spray.

If you buy terbinafine in a pharmacy or shop, follow the instructions that come with your medicine.

Dosage

Your doctor or pharmacist will tell you how much terbinafine to use and how long you need to use it for, depending on your infection.

If you’re using the cream, gel or spray, you’ll usually need to use it once or twice a day.

If you’re using the solution, you only use it once.

If you’re taking the tablets, the usual dose is 1 tablet, taken once a day. You’ll usually take the tablets for 2 to 6 weeks. This depends on the type of infection you have and how serious it is.

How to use terbinafine cream or gel

Put the cream or gel on the infected area once or twice a day for 1 to 2 weeks.

1. Wash your hands before using the cream or gel.
2. Wash and dry the infected skin where the cream or gel will go. If you’re treating your feet, it’s also important to wash and dry between your toes first.
3. Unscrew the cap.
4. Squeeze out a small amount of the cream or gel onto your finger (enough to put a thin layer on your skin).
5. Gently rub it into the infected areas. Avoid putting it near your mouth, lips and eyes.
6. Replace the cap.
7. Wash your hands.

If you’re using the cream or gel on the area between your toes, or on your bottom or groin, you can cover the skin with a clean strip of gauze afterwards. This type of light dressing is available to buy at pharmacies and is especially helpful to use at night.

How to use terbinafine spray

Put the spray on the infected area once or twice a day for 1 to 2 weeks.

1. Wash your hands before using the spray.
2. Wash and dry the infected skin before using the spray. If you’re treating your feet, it’s also important to wash and dry between your toes first.
3. Take the cap off and prepare the spray by pressing the top of the spray down once or twice.
4. Hold the bottle about 10cm away from the infected area and spray until your skin is thoroughly wet. Avoid getting it near your mouth, lips and eyes.
5. Replace the cap.
6. Wash your hands.

If you’re using the spray on the area between your toes, or on your bottom or groin, you can cover the skin with a clean strip of gauze afterwards. This type of light dressing is available to buy at pharmacies and is especially helpful to use at night.

How to use terbinafine solution (Lamisil Once)

The solution for athlete’s foot comes in a tube with a nozzle. It’s a single treatment that you only use once.

Use the solution on both feet even if one of them looks fine. If one foot looks less infected than the other, put the solution on the less infected foot first.

1. Use the solution after a shower or bath. Before using the solution, make sure your feet are dry, including between your toes.
2. Remove the cap.
3. Put the solution all over your toes, including between each toe, and on the sole, top and sides of your foot. This should use about half the tube. Finish treating this foot before treating the other.
4. Do not rub or massage the solution in.
5. Leave the solution to dry on your feet for 1 to 2 minutes.
6. Replace the cap and throw the tube away.
7. Wash your hands.
8. Put on your normal shoes and socks.

Do not wash or splash your feet with any water for 24 hours after using the solution.

After 24 hours, wash your feet with warm, soapy water in the bath or shower and gently pat them dry.

How to take terbinafine tablets

Swallow the tablet whole with a drink of water.

You can take terbinafine tablets with or without food. It’s best to take your tablets at the same time each day.

If you have a fungal nail infection, you’ll probably need to take the tablets for several months. These infections take a while to clear.

How long to take or use it for

If you’re using the cream, gel or spray, you’ll usually need to use it for 1 to 2 weeks. Talk to your doctor if your symptoms do not get better within 2 weeks.

If you’re taking the tablets, you’ll usually take them for:

• 2 to 4 weeks if you have jock itch
• 2 to 6 weeks if you have athlete’s foot
• 4 weeks if you have ringworm
• 6 weeks to 3 months (sometimes longer) if you have a fungal nail infection

It’s important to keep taking or using terbinafine until you finish the course, even if your symptoms get better. Follow the instructions from your doctor or on the leaflet that comes with the medicine.

If you stop using your terbinafine too soon, or if you do not use it as recommended, the fungal infection could come back.

Talk to your doctor if you’re thinking of stopping your treatment for any reason.

If you forget to take it or use it

If you forget to use your terbinafine cream, gel or spray, just use it as soon as you remember and then keep following your usual routine.

If you forget to take a terbinafine tablet, take it as soon as you remember, unless it’s nearly time for your next dose. In this case, just skip the missed dose and take your next one at the usual time. Then carry on until you have finished the course.

Do not take 2 doses to make up for a missed dose.

If you forget doses often, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember your medicines.

If you take or use too much

If you use too much terbinafine cream, gel or spray or use it more often than you need to, it may make your skin irritated or red. If this happens, use less of the cream, gel or spray the next time.

Taking 1 or 2 extra terbinafine tablets is unlikely to harm you.

If you take more than this, you may get side effects including stomach pain, feeling or being sick, diarrhoea, headache or feeling dizzy.

Urgent advice: Contact 111 for advice now if:

• you take a lot of terbinafine tablets at the same time (4 or more) even if you have no side effects
• you take 2 or more terbinafine tablets and have side effects

Call 111 or go to 111. nhs.uk. Call 111 if you need advice for a child under the age of 5 years.

If you need to go to A&E do not drive yourself. Get someone else to drive you or call for an ambulance.

Take the terbinafine packet, or the leaflet that came with your medicine, and any remaining medicine with you.

TERBINORM Spray: overcome the fungus with ease

The number of sunny days is increasing, the thermometer tends to rise, nature is actively changing, mood and, of course, our wardrobe is changing. More and more open things and contact with the outside world. With the onset of heat, the risk of trauma to the open skin of the feet and nails increases, the intense work of the body’s thermoregulation system leads to increased sweating, including the feet, and favorable conditions are formed for the development of a fungal infection. It is difficult to hide this not only a cosmetic problem, in addition, it becomes obvious to others. Therefore, it’s time to purchase a modern effective antifungal agent.

Among antifungal drugs, terbinafine has gained well-deserved popularity due to its pronounced fungicidal action against a wide range of dermatophytes, molds and dimorphic fungi, as well as its safety.

TERBINORM spray (manufactured in Romania) is a topical preparation of terbinafine for the treatment of fungal skin infections caused by dermatophytes of the genus Trichophyton , Microsporum canis and Epidermophyton floccosum . It is advisable to use the drug for such common mycoses as interdigital epidermophytosis of the feet (“athlete’s foot”), inguinal dermatophytosis (“jockey’s itch”), dermatophytosis of the body (ringworm), as well as for versicolor versicolor caused by Pityrosporum orbiculare ( Malassezia furfur ).

The mechanism of action of terbinafine is directed at the enzyme systems of the fungus, which have a low affinity for the human cytochrome system (Burbello A. T., 2007). That is why the drug does not affect the synthesis of human steroid structures (cholesterol, hormones) (Zaichenko A.V., 2013). Many drugs are metabolized by the cytochrome P450 system. Terbinafine has a significant metabolic neutrality and little enters into pharmacokinetic interactions with other drugs (Shtrygol S.Yu., 2006). Thus, terbinafine is the first choice antimycotic for patients receiving drug therapy for concomitant diseases (Vashchenko O.O. et al., 2009). In old age, it is necessary to take into account the severity of systemic action and, accordingly, possible systemic adverse reactions of the drugs used. TERBINORM Spray acts exclusively at the site of application, as less than 5% of the applied dose of terbinafine is absorbed.

The clinical course of mycosis is often complicated by the bacterial flora, so therapy should be complex and include drugs with antimicrobial and anti-inflammatory effects. In studies, a high activity of external forms of terbinafine against gram-positive and gram-negative bacteria was noted (Bolotnaya M. A., 2012). The spray shape allows you to evenly distribute the drug over the surface of the skin. TERBINORM spray is convenient and easy to use, provides quick treatment of fungal lesions, which is especially important in the presence of large lesions or their localization in skin folds, between the toes. It should be noted that in addition to the antifungal action, terbinafine has a high anti-inflammatory activity and pronounced antibacterial properties, and due to lipo- and keratophilicity, it is quickly absorbed into the skin, softening it (Klimova I.Ya. et al., 2007). The spray form has a refreshing, drying , anti-inflammatory and antipruritic effects. Another advantage of TERBINORM spray is that the drug is odorless, colorless and does not leave marks on clothes. The course treatment with TERBINORM spray is 7 days. The drug is used once a day, while creating therapeutic concentrations of terbinafine in the skin layers, which persist for up to 1 week, which determines the post-therapeutic effect of the drug.

Terbinafine in the form of a spray is of interest as a prophylactic to prevent fungal infections in case of an increased risk of fungal infection: when visiting public places (saunas, gyms, swimming pools), the presence of mycosis in family members, a decrease in immune defense, against the background of prolonged antibiotic therapy, and also for the treatment of shoes (reducing the risk of self-infection).

Thus, TERBINORM spray is a necessary drug in a home or travel kit.

TERBINORM Spray: say goodbye to fungus!

Press Service of the Weekly APTEKA

Treatment of FUNGAL NAIL INFECTIONS – Recommendations of the British Association of Dermatologists (translated and adapted by Prof. Svyatenko)

What is the purpose of this article?

This article was written to help you learn more about fungal nail infections . It will tell you what they are, what causes them, what can be done about them, and where you can learn more about them.

What is a fungal nail infection?

Fungal nail infections also known as dermatophytic onychomycosis . The initial fungus that affects the skin of the feet is a common infection of the skin of the feet, especially between the toes. On the skin of the feet, the original fungus lives in the keratin that makes up the outer layer of the skin. When the fungus spreads to the keratin of the nails, fungal infection of the nails occurs .

What causes fungal infections?

foot fungi (known as ‘dermatophyte fungi’ ) cause most fungal nail infections. Less commonly, nail infections are caused by other types of fungi, usually yeasts (eg Candida ) and molds .

These fungi tend to attack nails that are already damaged, as it is easier for the fungus to penetrate. Fungal infections of the toenails are very common (1 in 4 people may be affected at any given time), less common is toenail fungus. Both types are most common in older people, people with weakened immune systems, and people with diabetes and poor peripheral circulation. A warm, humid environment helps fungi grow and cause infection. Wearing tight shoes or using showers, bathrooms, or changing rooms can increase your risk of fungal infections.

Are they hereditary?

Actually, no. However, in some extremely rare cases, there is a genetic risk factor, and other family members may also be susceptible to infection.

What are the symptoms of fungal nail infections?

Initially, there are usually no symptoms. Later, the nails may thicken and become painful when pressed against the inside of the shoe. Then they are difficult to trim. The sight of an infected nail, especially a fingernail, can be embarrassing. An affected nail can ruin socks and tights, and it can also chafe adjacent skin. The skin nearby may also have a fungal infection; it may itch, crack, blister, or appear whitish, especially between the toes.

What do fungal nail infections look like?

nail fungus usually starts at the free edge and then spreads along the side of the nail to the base of the cuticle. Eventually, the entire nail may be affected. Infected areas become white or yellowish, become thickened and flaky. Less commonly, there may be white inclusions on the surface of the nail. The nails on the big toes and little fingers are most susceptible to damage by fungal infections. Sometimes, especially in those who regularly do wet work, such as a housewife or cleaner, the skin around the nail becomes red and swollen. This is called paronychia and can allow infection to enter the nail easily.

How are fungal nail infections diagnosed?

Fungal nail infections are usually diagnosed clinically. Your doctor may take a piece from an infected nail and send it to a lab to see if the fungus can be seen under a microscope or cultured. Sometimes repeat samples may be required.

Many nail problems may only look like fungal infection , such as changes seen in psoriasis after a bacterial infection or an old injury, but antifungal pills will not help. Proper treatment may depend on knowing which fungus is causing problems; it may take several weeks to get results.

Can fungal nail infections be cured?

Yes. However, successful treatment of fungal infection of the nail requires long-term treatment, which can take up to a year. Fingernails are easier to handle. Fungal infections of the nails usually recur, especially on the toes.

How can fungal nail infections be treated?

Fungal infections of the nail are not bothersome in and of themselves, not all of them require treatment. Some people with infected toenails don’t worry about them at all. In this case, they can sometimes be left alone (although the patient must remain careful and try not to spread the infection to other parts of the body and nails, as well as other people).

On the other hand, if infected nails are embarrassing or uncomfortable, they are usually treated. It is important to treat people whose infections can cause serious health problems, such as diabetes or reduced immunity, to prevent potentially serious health problems.

The goal of treatment is to get rid of the fungus: then the nail usually returns to normal. However, if the nail was damaged before it was infected, it will be harder to clean and may return to its original state. Nail infections due to mold and yeast can be very resistant to treatment.

Treatment options include:

• Nail treatments (topical treatments)

Nail treatments do not work as well as oral treatments. They are most effective if the infection is at an early stage. The most commonly used methods are amorolfine-based nail polish, ciclopirox, and thioconazole solution.

They may not be able to clear the deeper parts of the infected nail on their own, but regular removal of the damaged part of the nail with clippers or abrasions may help. Medicines taken by mouth, used in combination with an antifungal agent, increase the chance of a cure. They may need to be used for 4-12 months before the effect is noted.

For hand nail infections the course of treatment is shorter. The cure rate with local treatments alone is about 15-30%. Topical treatment is safe. Redness and irritation may occur.

• Preparations taken by mouth (oral treatment)

Before taking the tablets, the doctor must send the part of the nail to the laboratory to check if the diagnosis of a fungal infection is confirmed.

Three drugs are available for use in the treatment of fungal nail infections:

• Griseofulvin has been used for many years and is the only one of three drugs licensed for use in children. It is only fully absorbed with fatty foods (such as milk and dairy products), and long courses of treatment (6 to 9 days) are usually required.months for fingernails and up to 18 months for toenails). However, only about three-quarters of infected fingernails and one-third of infected toenails are cleared. Frequent relapses are also possible.
• Terbinafine and itraconazole have now largely moved away from griseofulvin. They work better and much faster, although only about 50% of nail infections are cured. Terbinafine should be considered as a first line treatment for dermatophyte fungi (i.e., those that affect the feet). It is taken daily for 6 weeks for handnail infections and for 12-16 weeks for foot infections.
• Itraconazole is effective in the treatment of dermatophytes; it is also useful for treating other fungi such as yeast. It is usually taken in periods – for one week each month – because it is absorbed into the nail cuticle and continues to act for several weeks. Two weekly courses given over 21 days are usually sufficient for fingernail infections and three for toe infections.
• Fluconazole may be effective for Candida fungal infections. It is not currently licensed for fungal nail infections. It appears to be less effective than itraconazole and terbinafine, but remains an alternative for intolerance to the two drugs.
• Other procedures

Laser and photodynamic therapy may be helpful but are less effective than the topical and systemic treatments listed above.

Herbal products are also promoted for treatment of fungal nail infections , but there is no conclusive evidence that they are safe or more effective than standard treatments.

Are there any side effects of the treatment?

Oral treatments are more likely to cause side effects than topical treatments.

Terbinafine sometimes causes a potentially very severe allergic reaction, may slightly worsen skin conditions, and sometimes affects the taste buds.

Itraconazole is not indicated for people who are already taking certain medicines. Your doctor will inform you about this. Both terbinafine and itraconazole can affect the liver, and your doctor may order a blood test to check this before and during treatment.

Although griseofulvin is the only licensed drug for children, many dermatologists prefer terbinafine because it is much more effective.

How do I know if the treatment is working?

The new nail will grow slowly from its base and it may take 6 months to a year after treatment is finished before the nails look normal again. Foot infections clear up faster and more completely than toenails; it may take 18 months for the foot to fully recover.

Surgical nail removal

Sometimes very thick nails that do not respond to pills alone can be removed by surgeons under local anesthesia, but this is rarely done because the level of outcome does not justify surgery.

Self care

• Keep nails short, dry and clean. Use one clipper for infected nails and the other for normal nails.
• Don’t just treat your nails; use an antifungal cream to treat the skin of the foot.
• Avoid cuticle trimming, either by yourself or by a manicurist, as this increases the risk of nail damage and infection.

For toe fungus:

• Wear comfortable, tight-fitting shoes without high heels or tight socks.
• Keep your feet dry, wear cotton socks and change them daily, use breathable shoes. A regular wash in hot water cleans up most contaminated socks, but it can be made more effective by using an antifungal spray before washing. Other clothing generally cannot be contaminated.
• Maintain foot hygiene, including treatment of any infection.
• Wear clean shower shoes when using a shared shower.
• Be especially careful about the hygiene of affected feet.
• Consider seeing a podiatrist if thickened toenails make walking uncomfortable.

This article was translated from the recommendations of the British Association of Dermatologists “Overview Information for the Patient”, adapted into Russian by Professor TV Svyatenko, Dnipro, Ukraine.

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