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Oral lamisil for toenail fungus: Uses, Dosage, Side Effects, Interactions, Warning

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Lamisil (Terbinafine) – Side Effects, Interactions, Uses, Dosage, Warnings

Side Effects

What are the side effects of Lamisil (Terbinafine)?

Get emergency medical help if you have signs of an allergic reaction (hives, difficult breathing, swelling in your face or throat) or a severe skin reaction (fever, sore throat, burning in your eyes, skin pain, red or purple skin rash that spreads and causes blistering and peeling).

Seek medical treatment if you have a serious drug reaction that can affect many parts of your body. Symptoms may include: skin rash, fever, swollen glands, flu-like symptoms, muscle aches, severe weakness, unusual bruising, or yellowing of your skin or eyes. This reaction may occur several weeks after you began using terbinafine.

Some people taking terbinafine have developed severe liver damage leading to liver transplant or death. It is not clear whether terbinafine actually caused the liver damage in these patients. In most cases, the patient had a serious medical condition before taking terbinafine.

Call your doctor at once if you have symptoms of liver damage, such as nausea, upper stomach pain, vomiting, loss of appetite, tiredness, dark urine, clay-colored stools, or jaundice (yellowing of the skin or eyes). These events can occur whether or not you have ever had liver problems before.

Also call your doctor if you have:

  • changes in your sense of taste or smell;
  • depressed mood, sleep problems, lack of interest in daily activity, feeling anxious or restless;
  • pale skin, easy bruising, unusual bleeding (nose, mouth, vagina, or rectum), purple or red pinpoint spots under your skin;
  • swelling, rapid weight gain, little or no urinating;
  • blood in your urine or stools;
  • weight loss due to taste changes or loss of appetite; or
  • skin sores, butterfly-shaped skin rash on your cheeks and nose (worsens in sunlight).

Common side effects may include:

  • diarrhea, nausea, gas, stomach pain or upset;
  • rash;
  • headache;
  • abnormal liver function tests.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Terbinafine (Oral Route) Proper Use

Proper Use

Drug information provided by: IBM Micromedex

Take this medicine exactly as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. To do so may increase the chance of side effects.

This medicine comes with a Medication Guide and patient instructions. Read and follow the instructions carefully. Ask your doctor if you have any questions.

Terbinafine tablets may be taken with food or on an empty stomach. However, it is best to take terbinafine oral granules with food.

To help clear up your infection completely, it is very important that you keep using this medicine for the full time of treatment, even if your symptoms begin to clear up or you begin to feel better after a few days. Since fungal infections may be very slow to clear up, you may need to take this medicine for several weeks or months. If you stop taking this medicine too soon, your symptoms may return.

This medicine works best when there is a constant amount in the blood. To help keep the amount constant, do not miss any doses. Also, it is best to take the doses at the same times every day. If you need help in planning the best time to take your medicine, check with your doctor.

If you are using the oral granules, you may sprinkle the contents on a spoonful of pudding or other soft, non-acidic food such as mashed potatoes. This mixture must be swallowed immediately without chewing. Do not use applesauce or fruit-based foods. If you will need two packets of oral granules with each dose, you may sprinkle the content of both packets on one spoonful or two spoonfuls of non-acidic food.

Avoid caffeine (coffee, soda, chocolate) while you are using this medicine. Terbinafine may cause caffeine to stay in your body longer than usual.

Dosing

The dose of this medicine will be different for different patients. Follow your doctor’s orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.


  • For oral dosage form (granules):


    • For tinea capitis (fungus infections of the scalp):


      • Adults—Dose is based on body weight and must be determined by your doctor. The dose is usually 250 milligrams (mg) once a day for 6 weeks.

      • Children 4 years of age and older and weighing over 35 kilograms (kg)—Dose is based on body weight and must be determined by your doctor. The dose is usually 250 mg once a day for 6 weeks.

      • Children 4 years of age and older and weighing 25 kg to 35 kg—Dose is based on body weight and must be determined by your doctor. The dose is usually 187.5 mg once a day for 6 weeks.

      • Children 4 years of age and older and weighing less than 25 kg—Dose is based on body weight and must be determined by your doctor. The dose is usually 125 mg once a day for 6 weeks.

      • Children younger than 4 years of age—Use and dose must be determined by the doctor.

  • For oral dosage form (tablets):


    • For onychomycosis (fungus infections of the fingernails):


      • Adults—250 milligrams (mg) once a day for 6 weeks.

      • Children—Use and dose must be determined by the doctor.

    • For onychomycosis (fungus infections of the toenails):


      • Adults—250 milligrams (mg) once a day for 12 weeks.

      • Children—Use and dose must be determined by the doctor.

    • For tinea corporis (ringworm of the body):


      • Adults and teenagers—250 milligrams (mg) once a day for 2 to 4 weeks.

      • Children—Use and dose must be determined by the doctor.

    • For tinea cruris (ringworm of the groin; jock itch):


      • Adults and teenagers—250 milligrams (mg) once a day for 2 to 4 weeks.

      • Children—Use and dose must be determined by the doctor.

    • For tinea pedis (ringworm of the foot; athlete’s foot):


      • Adults and teenagers—250 milligrams (mg) once a day for 2 to 6 weeks.

      • Children—Use and dose must be determined by the doctor.

Missed Dose

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

If you miss a dose of terbinafine tablets, take it as soon as you can. If your next regular dose is less than 4 hours away, wait until then to use the medicine and skip the missed dose.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Portions of this document last updated: Sept. 01, 2021

Copyright © 2021 IBM Watson Health. All rights reserved. Information is for End User’s use only and may not be sold, redistributed or otherwise used for commercial purposes.


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Terbinafine (Oral Route) Precautions – Mayo Clinic

Precautions

Drug information provided by: IBM Micromedex

It is important that your doctor check the progress of you or your child at regular visits to make sure that this medicine is working properly. Blood tests may be needed to check for any unwanted effects.

If your or your child’s symptoms do not improve, or if they become worse, check with your doctor. You may need to take this medicine for several weeks or months before your infection gets better.

This medicine may cause a serious type of allergic reaction called anaphylaxis. Anaphylaxis can be life-threatening and requires immediate medical attention. Call your doctor right away if you have a skin rash, itching, hives, trouble with breathing or swallowing, or any swelling of your hands, face, or mouth while you or your child are using this medicine.

This medicine may cause serious liver problems, including liver failure. Check with your doctor right away if you start having nausea or vomiting, dark urine, light-colored stools, stomach pain, or yellow eyes or skin while you or your child are using this medicine.

This medicine may cause problems with your sense of taste or smell. Tell your doctor right away if you or your child have change or loss of sense of smell, change in taste or loss of taste, poor appetite, or weight loss.

You may become depressed when taking this medicine. Tell your doctor right away if you or your child thinks this medicine is causing changes in your mood or behavior. Other symptoms include feeling very sad or empty, irritable, lack of appetite, loss of interest or pleasure, restlessness, trouble concentrating, or trouble sleeping.

Serious skin reactions can occur with this medicine. Check with your doctor right away if you have blistering, peeling, or loosening of the skin, red skin lesions, severe acne or skin rash, sores or ulcers on the skin, or fever or chills while you or your child are using this medicine.

This medicine can temporarily lower the number of white blood cells in your blood, increasing the chance of getting an infection. If you can, avoid people with infections. Check with your doctor immediately if you think you are getting an infection or if you or your child get a fever or chills, cough or hoarseness, lower back or side pain, or painful or difficult urination.

This medicine may make your skin more sensitive to sunlight. Tell your doctor right away if you or your child have a red, scaly skin rash or unusual sensitivity of the skin to the sun. Use a sunscreen when you are outdoors. Avoid sunlamps and tanning beds.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

Portions of this document last updated: Sept. 01, 2021

Copyright © 2021 IBM Watson Health. All rights reserved. Information is for End User’s use only and may not be sold, redistributed or otherwise used for commercial purposes.


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A Week of Oral Terbinafine Pulse Regimen Every Three Months to Treat all Dermatophyte Onychomycosis

J Fungi (Basel). 2019 Sep; 5(3): 82.

Anarosa B. Sprenger

1Santa Casa de Curitiba Hospital, Clinic of Diseases and Surgery of the Nail Apparatus, Department of Dermatology, Praça Rui Barbosa, 694, 80.010-030 Curitiba, Brazil

Katia Sheylla Malta Purim

2Hospital de Clínicas de Curitiba—Universidade Federal do Paraná (UFPR), Clinic of Dermatology, Rua General Carneiro, 181, 80.060-900 Curitiba, Brazil

Flávia Sprenger

3Univerdidade Federal do Paraná (UFPR), Rua General Carneiro, 181, 80.060-900 Curitiba, Brazil

Flávio Queiroz-Telles

4Hospital de Clínicas de Curitiba—Paraná Federal University (UFPR), Department of Public Health, Rua General Carneiro, 181, 80.060-900 Curitiba, Brazil

1Santa Casa de Curitiba Hospital, Clinic of Diseases and Surgery of the Nail Apparatus, Department of Dermatology, Praça Rui Barbosa, 694, 80.010-030 Curitiba, Brazil

2Hospital de Clínicas de Curitiba—Universidade Federal do Paraná (UFPR), Clinic of Dermatology, Rua General Carneiro, 181, 80.060-900 Curitiba, Brazil

3Univerdidade Federal do Paraná (UFPR), Rua General Carneiro, 181, 80.060-900 Curitiba, Brazil

4Hospital de Clínicas de Curitiba—Paraná Federal University (UFPR), Department of Public Health, Rua General Carneiro, 181, 80.060-900 Curitiba, Brazil

Received 2019 Aug 21; Accepted 2019 Sep 3.

Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).

Abstract

Terbinafine has proved to treat numerous fungal infections, including onychomycosis, successfully. Due to its liver metabolization and dependency on the cytochrome P450 enzyme complex, undesirable drug interaction are highly probable. Additionally to drug interactions, the treatment is long, rising the chances of the appearance of side effects and abandonment. Pharmacokinetic data suggest that terbinafine maintains a fungicidal effect within the nail up to 30 weeks after its last administration, which has aroused the possibility of a pulse therapy to reduce the side effects while treating onychomycosis. This study’s goal was to evaluate the effectiveness of three different oral terbinafine regimens in treating onychomycosis due to dermatophytes. Sixty-three patients with onychomycosis were sorted by convenience in three different groups. Patients from group 1 received the conventional terbinafine dose (250 mg per day for 3 months). Group 2 received a monthly week-long pulse-therapy dose (500 mg per day for 7 days a month, for 4 months) and group 3 received a 500 mg/day dose for 7 days every 3 months, totaling four treatments. There were no statistical differences regarding the effectiveness or side effects between the groups. Conclusion: A quarterly terbinafine pulse regimen can be a possible alternative for treating onychomycosis caused by dermatophytes.

Keywords: administration, allylamines/terbinafine, Arthrodermataceae/drug effects, drug compounding, humans, onychomycosis, oral, antifungal agents/administration, dosage/adverse effects/pharmacology

1. Introduction

Onychomycosis due to dermatophytes, yeasts, and non-dermatophyte molds comprises 50% of all cases of nail disease [1]. Known individual risk factors for its development are nail trauma, age, smoking, immunosuppression, obesity, psoriasis, and other causes of onychodystrophy, peripheral arterial disease, and diabetes mellitus [2,3,4,5,6]. Male patients have been reported to have more severe and chronic onychomycosis [7].

The susceptibility to onychomycosis is inherited and it is often observed among family members. Some studies revealed the existence of polymorphisms in genes of the major histocompatibility complex related to higher susceptibility to onychomycosis from dermatophytes, particularly haplotypes HLA-DR8 and HLA-DR1 [8,9,10,11]

The estimated global prevalence of onychomycosis is 5.5% [12]. More than 60% of these infections are caused by dermatophytes, mainly Trichophyton rubrum, Trichophyton mentagrophytes, Epidermophyton floccosum, and Microsporum spp. The remaining infections can be due non-dermatophyte molds, predominantly Scopulariopsis brevicaulis, Aspergillus spp., Acremonium, Fusarium sp.p, Alternaria alternata, and Neoscytalidium spp., or to yeasts, such as Candida albicans [13].

Trauma caused by shoes produces toenail changes, especially in people with orthopedic changes that cause faulty poor adaptation of the feet in shoes, that are identical to some onychomycosis at the time of clinical presentation [14]. Most toenails abnormalities are, in fact, due to the pressure exerted by shoes and not by fungi. It has already been observed that the presence of non-dermatophyte molds in a dystrophic nail could be considered a secondary niche of colonization in a nail previously damaged by trauma, rather than onychomycosis [15].

Aside from the high prevalence, onychomycosis has therapeutic challenges. The available therapeutic arsenal is not vast, and there are high rates of resistance and recurrence, making it a noteworthy public health issue [16,17].

Topical and oral antifungals are the treatment options for onychomycosis. Topical therapy is used in children and adults with mild to moderate onychomycosis or for single affected digits. Ciclopirox and amorolfine are the most used topical agents, and recently, tavaborole and efinaconazole have been introduced in North America [18,19,20].

FDA-approved oral treatment for onychomycosis includes terbinafine and itraconazole, and fluconazole is used off-label. Due to fewer collateral effects and higher cure rates, terbinafine is usually preferred over itraconazole [21]. The standard dosage is 250 mg per day for 6 weeks for fingernails or 12 weeks for toenails. [22]. Some pharmacokinetic studies have shown that terbinafine can be detected in the nail plate in concentrations above the minimal inhibitory concentrations for dermatophytes and other fungi 36 weeks post-treatment [23,24,25]. Pulse regimens have been proposed to reduce the side effects and risks of interaction with other medication. Most studies have shown a superior efficacy of terbinafine compared to itraconazole pulse regimens and similar efficacy compared to a conventional terbinafine dose [26,27].

The standard dose for a terbinafine pulse regimen is 500 mg per day for 7 days a month, twice or three times for fingernails and three to four times for toenails [28].

Zaias and Rebell [29] have described considerable terbinafine efficacy utilizing a quarterly pulse therapy regimen for the treatment of distal subungual onychomycosis (DSO) caused by T. rubrum.

We performed an open non-randomized study in which standard terbinafine regimens were compared with a pulse terbinafine regimen of 500 mg/day for 7 days every 3 months to treat onychomycosis caused by dermatophytes.

2. Materials and Methods

2.1. Patients

In total, we included 63 patients (34 women, 29 men) aged between 24 and 70 years who had visited the Dermatology Outpatient’s Clinic at Santa Casa de Curitiba Hospital between August 2013 and July 2016. Those aged 18 years or older and diagnosed with dermatophyte onychomycosis based on clinical manifestations and confirmed using mycological culture were eligible to participate. Patients with less than 25% of the nail affected by the disease, liver or kidney impairment, pregnant or lactating were excluded. All participants signed an informed consent term.

Two measurements were taken of infected nails before, during the appointments, and at the end of each group treatment. The first one was the length of the nail plate from the free edge to the proximal nail fold, and the second one was the length of the visible fungal-infected portion. The percentage of the compromised nail was then calculated.

Data concerning age, sex, occupation, sport activities, comorbidities, and concomitant use of medications were recorded. Patients were divided into three groups, according to their order of attendance.

In Group 1, 20 patients received continuous 250 mg terbinafine for 3 months. In Group 2, 21 patients received a terbinafine 500 mg monthly pulse regimen, for 4 months. In Group 3, 22 patients received terbinafine 500 mg/day for 7 days, every 3 months and completed four pulse regimens.

Patients of Group 1 were asked to attend the hospital monthly. Patients of Group 2 had appointments every 2 months. Patients of Group 3 attended the hospital every 3 months. During the appointments, all patients were examined, questioned concerning any possible side effects, and received a new supply of terbinafine containing 28 tablets.

Mycological cultures were provided for all patients who completed the study.

2.2. Evaluation of Therapeutic Response

The degrees of improvement were classified as follows: total cure (TC), clinical disease-free nail and a negative mycological culture; mycological cure (MC), <25% of nail impairment and a negative mycological culture; clinical improvement (CI), <25% of nail impairment and a positive mycological culture; therapeutic failure (TF), unchanged clinical examination or worsening and a positive mycological culture.

2.3. Statistical Methodology

For the quantitative variables, a comparison between treatments was undertaken using a Kruskal–Wallis non-parametric test, suitable for the analysis of independent samples and variables with interval measurements without normal distribution [30]. For the group comparisons, in relation to the categorical variables, a non-parametric chi-square test was applied. In all tests, a p value of 5% was considered statistically significant.

2.4. Demographic Characteristics

shows the patients’ demographic characteristics. A possible occupational relationship refers to occupations that may lead to greater exposure to fungi on the feet or hands, such as those requiring the use of safety shoes and those in which patients had been exposed to humidity, heat, or trauma. Sport activities were also considered, as trauma is a relevant factor in the speed of growth of a nail plate and, therefore, in the recovery of infected nails. Gender, age, previous treatments, which are also relevant factors in a treatment response, were evaluated, as was the concomitant use of other medications that can interact with terbinafine [31].

Table 1

Demographic characteristics (n = 63).

Demographic Characteristics Group 1 Group 2 Group 3 Total
1. Age
Average 47 48 48.27 47.78
n 20 21 22 63
Minimum 26 27 24 24
Maximum 67 70 70 70
2. Sex
Female (%) 12 (60.00%) 12 (57.14%) 10 (45.45%) 34
Male (%) 8 (40.00%) 9 (42.86%) 12 (54.55%) 29
Total 20 21 22 63
3. Occupation (%)
Possible occupational relationship 6 (30.00%) 9 (42.86%) 5 (22.73%) 20
No possible occupational relationship 14 (70.00%) 12 (57.14%) 17 (77.72%) 43
Total 20 21 22 63
4. Previous Treatment
No (%) 18 (90.00%) 19 (90.48%) 22 (100%) 59
Yes (%) 2 (10.00%) 2 (9.52%) 0 (0.00%) 4
Total 20 21 22 63
5. Sports Activities (%)
None (%) 9 (45.00%) 17 (80.95%) 17 (77.27%) 43
Effect on the feet (%) 2 (10.00%) 2 (9.52%) 0 (0.00%) 4
No effect on the feet (%) 9 (45.00%) 2 (9.52%) 5 (22.73%) 16
Total 20 21 22 63
6. Use of Medicines
No interaction (%) 14 (70.00%) 19 (90.48%) 18 (81.82%) 51
Antidepressants (%) 4 (20.00%) 1 (4.76%) 1 (4.55%) 6
Beta-blockers (%) 1 (5.00%) 0 (0.00%) 1 (4.55%) 2
Immunosuppressants (%) 1 (5.00%) 0 (0.00%) 0 (0.00%) 1
>1 Possible interaction (%) 0 (0.00%) 1 (4.76%) 2 (9.09%) 3
Total 20 21 22 63
7. Comorbidities
None (%) 13 (65.00%) 15 (71.43%) 16 (72.73%) 44
Diabetes (%) 0 (0.00%) 0 (0.00%) 1 (4.55%) 1
Obesity (%) 1 (5.00%) 1 (4.76%) 1 (4.55%) 3
Hypothyroidism (%) 2 (10.00%) 1 (4.76%) 0 (0.00%) 3
Depression (%) 2 (10.00%) 3 (14.29%) 1 (4.55%) 6
Immunodeficiency (%) 1 (5.00%) 1 (4.76%) 1 (4.55%) 3
>1 Comorbidities (%) 1 (5.00%) 0 (0.00%) 2 (9.09%) 3
Total 20 21 22 63

The isolated fungi in the mycological cultures were Trichophyton sp, T. rubrum, T. mentagrophytes, and Microsporum gypseum ().

Table 2

Fungus Group 1 Group 2 Group 3 Total
Trichophyton sp (n, %) 15 (75.00%) 13 (61.90%) 12 (54.55%) 40
Trichophyton mentagrophytes (n, %) 2 (10.00%) 4 (19.05%) 5 (22.73%) 11
Trichophyton rubrum (n, %) 3 (15.00%) 4 (19.05%) 4 (18.18%) 11
Microsporum gypseum (n, %) 0 (0.00%) 0 (0.00%) 1 (4.55%) 1
Total 20 21 22 63

The hallux was the most affected nail (n = 43) in all three groups, followed by the 4th, 5th, and 3rd toenail and the thumbnail (n = 20). There was no significant difference among the groups regarding the distribution of affected fingers or toenails ().

Toenails and fingernails affected (n = 63). Nail disease distribution according to groups before the treatment.

According to the clinical classification proposed by Baran and Hay [32], most patients were identified with a distal lateral subungual onychomycosis (DLSO) with subungual onycholysis (n = 35), followed by DLSO with subungual hypertrophy (n = 25), total dystrophic onychomycosis (TDO) (n = 7), proximal subungual onychomycosis (PSO) (n = 3), and superficial onychomycosis (SO) with deep invasion (n = 1). Nine patients had more than one nail type of onychomycosis in different nails; therefore, for the clinical classification, the sample included 71 affected nails ().

Clinical classification according to groups (n = 71). Clinical classification according to groups before the treatment. DLSO + subungual hypertrophy: distal lateral subungual onychomycosis with subungual hypertrophy; DLSO + Onycholysis: distal lateral subungual onychomycosis with onycholysis; SO + Deep Invasion: superficial onychomycosis with deep invasion; PSO: proximal subungual onychomycosis; TDO: total dystrophic onychomycosis.

3. Results

In total, 43 patients completed the study comprising 14, 14, and 15 patients in Groups 1, 2, and 3, respectively. Thirteen (92.86%), 10 (71.43%), and 13 (86.67%) patients from groups 1, 2, and 3, respectively, presented with TC, MC, or CI ().

Response to terbinafine (n = 43). TF: therapeutic failure; CI: clinical improvement; MC: mycological cure; TC: total cure.

After applying the chi-square test, no significant difference was observed between the groups (p = 0.280) concerning the response to terbinafine. However, among the patients who finished the study, the majority (83.72%, p = 0.001) showed at least one degree of improvement (TC, MC, or CI).

3.1. Relationship between Treatment Results, Affected Nails, Clinical Classification, Presence of Comorbidities, Use of Medications, and Isolated Fungi

shows clinical and microbiological data, such as treatment results, affected nails, clinical classification, presence of comorbidities, use of medications, and isolated fungi for all participants that finished the study.

Table 3

Treatment results, affected nails, clinical classification, comorbidities, use of medications, and isolated fungi. TC: total cure, MC: mycological cure, CI: clinical improvement, TF: therapeutic failure.

Result Fingernails/Toenails Clinical Calssification Comorbidities Medications Isolated Fungi
TC Right hallux DLSO + onycholysis 0 0 Trichophyton sp
TC Right hallux DLSO + hypertrophy 0 0 Trichophyton sp
TC Right hallux + 4rth left toenail DLSO + hypertrophy 0 0 Trichophyton sp
TC Halluces DLSO + hypertrophy depression antidepressant Trichophyton sp
TC Right hallux DLSO + hypertrophy depression antidepressant Trichophyton sp
TC Halluces DLSO + onycholysis 0 0 T. rubrum
TC Right hallux DLSO + hypertrophy 0 0 T. mentagrophytes
TC Left hallux DLSO + onycholysis hypothyroidism 0 T. rubrum
MC Halluces DLSO + onycholysis obesity + depression antidepressant Trichophyton sp
MC Right hallux DLSO + onycholysis 0 0 T. mentagrophytes
MC Halluces DLSO + onycholysis 0 0 Trichophyton sp
CI Halluces DLSO + onycholysis 0 0 Trichophyton sp
CI Halluces DLSO + onycholysis 0 0 Trichophyton rubrum
TF Right hallux DLSO + hypertrophy hypothyroidism 0 T. rubrum
TC Right hallux DLSO + onycholysis depression 0 T. mentagrophytes
TC Right hallux DLSO + onycholysis hypothyroidism 0 Trichophyton sp
TC 4rth Right fingernail DLSO + onycholysis 0 0 Trichophyton sp
TC Halluces DLSO + hypertrophy 0 0 Trichophyton sp
TC Halluces DLSO + onycholysis 0 0 T. rubrum
TC Halluces DLSO + onycholysis depression antidepressant Trichophyton sp
TC Left hallux DLSO + hypertrophy 0 0 Trichophyton sp
TC Right hallux DLSO + onycholysis HIV antiretrovirals Trichophyton sp
MC Left hallux DLSO + onycholysis 0 0 Trichophyton sp
CI Halluces DLSO + onycholysis 0 0 T. mentagrophytes
TF Right hallux + 2nd left toenail DLSO + onycholysis 0 0 T. rubrum
TF Halluces PSO + SO 0 0 Trichophyton sp
TF Halluces DLSO + hypertrophy 0 0 T. mentagrophytes
TF Halluces DLSO + hypertrophy + DLSO + onycholysis 0 0 Trichophyton sp
TC Right hallux + 3rd left toenail DLSO + hypertrophy depression antidepressant T. mentagrophytes
TC 2nd right + 3rd left toenails TDO 0 0 Trichophyton sp
TC Right hallux TDO obesity 0 Trichophyton sp
TC Right hallux DLSO + onycholysis 0 0 Trichophyton sp
TC 2nd right toenail DLSO + onycholysis + TDO obesity + depression antidepressant T. rubrum
TC Left hallux DLSO + hypertrophy 0 0 Trichophyton sp
TC Left hallux DLSO + onycholysis + TDO diabetes o Trichophyton sp
TC Right hallux DLSO + onycholysis 0 0 Trichophyton sp
TC Halluces DLSO + onycholysis 0 0 T. rubrum
TC 2nd right + 2nd left toenails TDO 0 0 Trichophyton sp
TC 2nd right toenail DLSO + hypertrophy 0 0 Trichophyton mentagrophytes
CI Halluces DLSO + onycholysis 0 0 Trichophyton sp
CI 3rd right + 3rd left toenail DLSO + hypertrophy 0 0 T. mentagrophytes
TF Halluces DLSO + onycholysis 0 0 Trichophyton sp
TF Halluces DLSO + onycholysis 0 0 T. mentagrophytes

3.2. Dropouts and Side Effects

Twenty patients did not complete the study, five (7.93%) of them because of side effects. The other 15 (23.90%) patients dropped out for personal reasons.

The most observed side effects were gastralgia (Group 2, n = 4, Group 3, n = 1) and cutaneous rash (Group 1, n = 1). None of these patients had comorbidities or used medications that could interact with terbinafine. ().

Table 4

Dropouts and side effects.

Side Effects/Dropout Group 1 Group 2 Group 3 Total
None 14 (70.00%) 14 (66.67%) 15 (68.18%) 43
Gastralgia 0 (0.00%) 3 (14.28%) 1 (4.55%) 4
Cutaneous rash 1 (5.00%) 0 (0.00%) 0 (0.00%) 1
Did not complete
(personal reasons)
5 (25.00%) 4 (19.05%) 6 (27.27%) 15
Total 20 21 22 63

4. Discussion

Since its introduction, terbinafine has been considered more effective than other antifungals available to treat dermatophytosis [33,34,35,36].

Undesirable side effects have been associated with terbinafine use, especially during a long treatment period, including gastrointestinal side effects, cutaneous rash, headache, myalgia, and, rarely, hepatotoxicity, drug-induced lupus erythematosus, Sjogren’s syndrome, Stevens–Johnson syndrome, toxic epidermal necrolysis, alopecia, and psoriasis [37,38,39,40].

Terbinafine is metabolized in part by the cytochrome P450 isoenzymes, particularly CYP2D6, which explains the lower rates of drug interactions in comparison with other anti-fungal agents [41,42]. Terbinafine is contraindicated in patients with allergy to terbinafine or in patients with liver dysfunction and it may be used with caution with selective serotonin reuptake inhibitors, C1 antiarrhythmics, and monoaminoxidase inhibitors [43,44]. Seven patients that completed this study used antidepressants, six of them presented with TC, and one with MC.

Some studies have shown terbinafine presence in nails in concentrations above the minimal inhibitory concentrations of 0.0015–0.01 mg/ml for dermatophytes and 0.06–0.025 mg/ml for other fungi, e.g., Aspergillus species, for more than 36 weeks post-treatment and high plasmatic levels 12 weeks after the beginning of treatment [16,20,25,33,45]. The use of terbinafine for onychomycosis has been compared with that of other anti-fungal agents, especially itraconazole, or even with terbinafine itself in different types of regimens associated or not with a topical treatment. Most studies have focused on the administration of terbinafine doses between 250 and 500 mg per day for 3 or 4 months or on intermittent therapy involving 4 weeks of terbinafine followed by a 4-week period off terbinafine, and then additional 4 weeks of terbinafine treatment [46,47].

This study aimed to determine whether a longer drug interval period could result in effectiveness rates similar to or higher than those described for other regimens (of approximately 57%) in previous studies [48,49] and also if the proposed regimen can be more economical. The demographic variables in our study were similar to those in other terbinafine comparative studies [7,28,50]. The three groups showed similar TC, MC, and CI rates.

Compared to the Zaias and Rebell’s study [29], which described efficacy using a 250 mg quarterly terbinafine regimen pulse for onychomycosis caused by T. rubrum, in our study, two patients of Group 3 (13.33%) had TC and one patient (6.66%) had clinical improvement of onychomycosis caused by T. mentagrophytes. We opted for the 500 mg quarterly dose in order to compare the efficacy with that of the standard 500 mg monthly dose used in most of the published studies based on pulse regimens. In addition, this is the terbinafine dose of pulse regimen utilized in Brazil. Further studies with a more significant number of participants are necessary to compare the effectiveness of the trimester schemes of oral terbinafine in the treatment of all types of dermatophyte onychomycosis.

Treatment outcomes for onychomycosis can also vary according to age, clinical presentation, comorbidities, and the use of medications that may interact with antifungal treatments [32,51,52]. DLSO with hypertrophy with or without dermatophytoma, PSO, and TDO can be more resistant to treatment. SO may be difficult to treat if associated with immunodeficiency [53,54]. This study did not reveal significant differences between the outcomes and the clinical presentation, the presence of comorbidities, or the concomitant use of medications, probably because of the limited number of participants.

The asymmetric gait nail unit syndrome (AGNUS), firstly described by Zaias et al. in 2012, is caused by repetitive toe trauma in a closed shoe in patients with asymmetric walking due to orthopedic abnormalities. The resulting nail changes can undoubtedly be clinically identical to onychomycosis [55]. In our study, the possible orthopedic abnormalities were not evaluated, but cultures were performed before and after the treatment, confirming that all participants had onychomycosis. In future onychomycosis studies, the evaluation of the concomitant presence of AGNUS can be useful, since it can change the clinical classification and the cure criteria.

As life expectancy is increasing globally, it is common for patients with onychomycosis to present with comorbidities and take more than one long-term medication [36,56,57,58,59]. As the speed of nail growth decreases with age, terbinafine is a good treatment option because it can enhance the speed of growth in the nail plate; therefore, the portion of compromised nail plate grows faster to the free edge and can be eliminated through cutting [58,60,61]. All groups in this study comprised some patients with comorbidities. The most common were depression (n = 7), obesity (n = 5), hypothyroidism (n = 3), diabetes (n = 1), and HIV active infection (n = 1). Only one patient with a comorbidity, who had hypothyroidism, presented with TF.

The pulse regimen therapy (groups 2 and 3) had the lowest cost of treatment. Group 1 used a total of 84 tablets, while groups 2 and 3 used 56 tablets each. The quarterly pulse regimen had the same cost compared to the conventional terbinafine pulse regimen but might be more financially appealing since patients are required to purchase a second terbinafine supply only six months after the start of treatment [48,62,63].

The long drug rest interval may compromise adherence to treatment due to patients forgetting the quarterly dose, which is an issue that can be addressed through counseling patients, family members responsible for them, or, eventually, caregivers of elderly persons using a simple reminder message recorded on their cell phone [64].

5. Conclusions

Despite the limited sample, a pulse therapy regimen using terbinafine 500 mg per day for a week every three months was found to be a potentially useful alternative in the treatment of onychomycosis by dermatophytes. Further studies involving a more significant number of patients are necessary to confirm the effectiveness of this treatment regimen.

Acknowledgments

We sincerely thank Nardo Zaias for kindly providing essential references and suggestions for the preparation of this manuscript.

Abbreviations

CI clinical improvement
DLSO distal lateral subungual onychomycosis
MC mycological cure
SO superficial onychomycosis
TC total cure
TDO total dystrophic onychomycosis
TF therapeutic failure
AGNUS asymmetric gait nail unit syndrome

Author Contributions

Conceptualization, Methodology, Validation, Resources: A.B.S.; Data Curation, Original Draft Preparation and Writing: A.B.S. and F.S.; Writing, Review & Editing: A.B.S., K.S.M.P., F.S., and F.Q.-T.; Supervision: K.S.M.P. and Flavio de F.Q.-T.

Funding

The Terbinafine used in this study was donated by Cristália Pharmaceutical Chemical Ltd. This company had no role in the design, execution, interpretation, or writing of the study.

Conflicts of Interest

The authors declare no conflicts of interest.

References

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

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

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

Terbinafine: antifungal medicine for skin infections

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.

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

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

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 are 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 are 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 comes in a tube with a nozzle. It is 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 on the sole, top and sides of your foot and all over your toes, including between each toe. This should use about half the tube. Finish treating this foot before treating the other.
  4. Leave the solution to dry on your feet for 1 to 2 minutes.
  5. Replace the cap and throw the tube away.
  6. Wash your hands.
  7. 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.

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

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

What if I forget to take it or use it?

If you forget to use your terbinafine cream, gel or spray, do not worry. Just apply 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 as normal until you have finished the course.

Do not take a double dose 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 remember your medicines.

What if I take 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 red or irritated. 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 need to go to hospital take the packaging, or the leaflet that came with your medicine, and any remaining medicine with you.

How to effectively use Lamisil when treating fungal nail infections.

Lamisil and onychomycosis – getting the most out of oral terbinifine

I had an interesting conversation this morning with a carpenter who came to see me regarding a fungal infection of the toe nails.  My first thought was, ‘smart man’ in that it’s early spring and he’s getting a jump on treatment prior to sandal season.  He proceeded to tell me that he had already done one 90 day round of oral Lamisil, one year ago, that seemed to work well on the lesser nails, but he still had an infection of the great toe nails.  He posed an interesting question to me; how often can or should he use Lamisil and what really is the most effective way to go about using Lamisil.

History of Lamisil clinical trials

Oral Lamisil, also known as terbinafine, is used to treat fungal infections of the finger nail and toe nail (onychomycosis).  The origin of Lamisil use for nail infections is interesting.  McNeil Pharmacueticals was the lab that originally developed Lamisl to treat aspergillosis, a fungal infection of the lung that commonly affects immune compromised patients such as AIDS patients or those folks undergoing chemo-therapy for cancer.  What McNeil found was that terbinafine treated the aspergillosis but remarkably terbinafine also treated each and every patient’s fungal toe nail infection.  McNeil had created a new and unique marketing opportunity.  Could McNeil bypass doctors and market directly to consumers?  Most of us know the answer to that question.  McNeil had one of the most successful television and print marketing campaigns in the history of prescription drugs.  As a provider, in the early 1990s, I had a McNeil rep in my office virtually every day.

Is Lamisil effective in resolving nail fungus?

Is Lamisil effective in resolving nail fungus?  Well, yes and no.  In the short term, yes, it can be very effective.  The summary of terbinafine dosing from Rxlist.com sums up what most clinicians consider to be the community consensus for oral dosing of terbinafine for finger nail and toe nail treatment of onychomycoisis;

Fingernail onychomycosis: One 250 mg tablet once daily for 6 weeks. Toenail onychomycosis: One 250 mg tablet once daily for 12 weeks. The optimal clinical effect is seen some months after mycological cure and cessation of treatment.

At this dosing, the majority of fungal nail infections do clear.  But unfortunately, the recurrence rate of fungal nail infections is quite high with recurrence rates as high as 90% in 3-5 years.

If Lamisil is an effective but non-lasting solution, how can we make that solution better?

Take more Lamisil?  Take Lamisil more frequently?

The goal of any pharmaceutical treatment is to use the least amount of medication to affect a cure.  But there’s more to this specific fungal problem than what initially meets the eye.  There’s a number of contributing factors to recurring fungal infections of the nail, the most important of which is moisture.  Fungus is a plant.  Water the plant with perspiration and you’re bound to see fungus recur. An easy win in finding a long term cure for onychomycosis is to dry the foot.  Easy wins include:

  • Frequent changes of socks
  • Rotate shoes, leaving 24 hours between use
  • Use a drying agent like Onox to inhibit perspiration
  • Topical over-the-counter agents used to treat onychomycosis

I always feel like a success when I can divorce my patients from being dependent upon pharmaceuticals.  When it comes to the treatment of dermatophytosis (fungal infections of the skin) and onychomycosis (fungal infections of the nail) I’m a big fan of tea tree oil-based products.  I get it, I know the chemistry.  Pharmaceutical-grade agents are more effective as a short term solution but create a dependency on prescriptions.  That’s the beauty of tea tree oil products.

How do I use tea tree oil products to treat fungal infections of the skin and nail?

I told my carpenter patient to think of the treatment of dermatophytosis and onychomycosis as daily hygiene, just like brushing your teeth.  Start using tea tree oil products when you start using Lamisil.  When your Lamisil script is complete, continue using the tea tree oil products.  The benefits can be significant and prolong the clear time of the nails, decreasing the need for repeat dosing of Lamisil.

And lastly, here’s a treatment guide for the treatment of onychomycosis.

Jeff

Jeffrey A. Oster, DPM

Medical Advisor
Myfootshop.com

Updated 12/24/2019

Lamisil from fungus: instructions for use, analogue

The drug “Lamisil” is widely used against fungus. This medicine is considered one of the most reliable medicines in the treatment of fungal diseases. An antifungal drug can be used for children from 2 years of age, and even for pregnant women, but only on strict indications. Without fail, before the start of the therapeutic course, a consultation with a specialized doctor must be passed and the instructions for the use of “Lamisil” must be studied.

Active substance and form of release

There are many medicines for the treatment of nail fungus. They are produced in the form of ointments, sprays, varnishes, there are antifungal drops for nails and preparations of a gel-like consistency. Most of the release forms have the medication “Lamisil” and such a variety does not leave a single chance for fungi to continue to dwell on the skin or nails.

In whatever form the drug “Lamisil” is produced, the active ingredient in its composition is terbinafinum (terbinafine).

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Lamisil tablets

Oral administration of antifungal agents is indicated for moderate and severe lesions.

To cure skin or nail fungus, topical treatment is sometimes not enough, and doctors prescribe oral antimycotic drugs. Eliminates the fungus from the inside “Lamisil”, presented in tablet form. The pills consist of 250 mg of active ingredient and they are packaged in blisters of 7, 14 and 28 pieces each.Auxiliary components are:

  • MGPC;
  • Aerosil;
  • food additive E572;
  • sodium glycolate.

It is important to know that the tablets contain a large amount of terbinafine. Therefore, it is advisable to use them in the advanced stage of fungal infection, as well as in chronic mycoses. Prescribed tablets “Lamisil” for nail fungus, skin, mucous membranes. Helps “Lamisil” against foot fungus, as well as hair lesions.

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Solution and spray

An effective remedy for mycosis – a solution or spray “Lamisil”, which needs to be treated both affected and healthy nail plates to prevent the spread of infection.The solution “Lamisil Uno” against nail fungus is suitable for patients over 15 years old. The composition also contains the active substance terbinafinum (1%) and auxiliary components. The liquid is poured into laminated tubes, the capacity of which is up to 4 g. The spray from the fungus is in a bottle equipped with a spray tip.

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Antifungal cream and varnish

The drug is used to prevent fungus.

“Lamisil” against toenail fungus is best used in the form of varnish or cream.The varnish is intended only for surface treatment and has proven itself well in the treatment and prevention of fungal nail infections. Nail polish is sold in jars equipped with an applicator. The varnish contains 1% of the active substance.

Treatment of nail fungus with “Lamisil” is carried out with the help of a cream. This form of medication allows you to quickly get rid of the nail fungus and prevent the spread of the infection to other parts of the limbs. The cream is a whitish, viscous fluid mixture that contains 10 mg of terbinafine.It is produced in tubes made of aluminum, with a volume of 15 and 30 g.

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Gel and ointment

For external treatment of areas of the body affected by fungus, manufacturers suggest using a gel or ointment “Lamisil”. They contain an active substance in a volume of 10 mg. The thick mass is placed in aluminum tubes with a capacity of 15 and 30 g, which are packaged in cardboard packages that protect the medicine from the penetration of sunlight.

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Therapeutic action

The agent acts on the cause and symptoms of fungal infection.

The medical product “Lamisil” has a wide spectrum of action, the main purpose of which is to destroy a fungal infection that can settle anywhere. A common place of localization of the fungus is the feet, nails of the hands and feet. The medication has a fungicidal effect, therefore it has found application in the treatment of fungal diseases of the mucous layer, hair, skin and nails. Terbinafine, penetrating into the body, directs its action to reduce the concentration of ergosterol. This is due to the ability to suppress the biosynthesis of stearins in the structure of fungi.Terbinafine does not affect the metabolism of medications, in particular hormonal ones. “Lamisil” helps against fungus quickly and effectively, therefore, already on the 3rd day after the start of use, improvements are observed. Final recovery with regular use of the drug occurs in 3-5 weeks.

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Indications and contraindications

Purpose Restrictions
  • epidermophytosis;
  • defeat by fungi from the genus dermatophyton of the inguinal zone;
  • candidiasis and mycosis of the dermis, mucous membrane and nail plate;
  • fungal infection of the stratum corneum;
  • diaper rash caused by settled spores of fungi;
  • cracks, itching, exfoliation of the epidermis on the feet;
  • lesion of inflammatory skin areas by fungal spores.
  • hypersensitivity of drug constituents;
  • malignant tumors;
  • liver and kidney dysfunction;
  • alcohol dependence;
  • age of the child in accordance with that specified in the instructions specifically for each form of the drug.

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Instructions for the use of “Lamisil” against fungus

Before you start using the drug “Lamisil” against nail fungus, you need to consult your doctor.

Before applying the drug externally, it is necessary to carry out hygienic procedures.

It is categorically contraindicated to give the medicine to the child or to use it yourself without a previously passed diagnostic examination. “Lamisil” is available in various forms, and only a specialized physician can determine which one is necessary for the treatment of mycosis. The tablets are prescribed in a course of 4 to 52 weeks. The therapeutic scheme is determined by the doctor individually for each patient.For the feet, where the fungus lives, apply the ointment “Lamisil”, which is applied once a day to the affected area with a thin layer. The duration of treatment reaches 4 months, but the first improvements will already be noticeable in 25-30 days. The “Lamisil” solution is used to treat the fingers of both feet once a day. The fungal focus is destroyed with the gel twice a day, and the nail plate is lubricated with varnish once every 72 hours.

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Medicinal analogue

If it is not possible to use “Lamisil” for the treatment of mycosis, doctors prescribe an analogue.Structural analogues for the active ingredient:

  • “Tsidokan”;
  • Atifin;
  • Terbizil;
  • “Lamitel”;
  • “Exifin”;
  • Miconorm;
  • Binafin;
  • “Fungoerbin”;
  • “Mycoterbin”;
  • Terbifin;
  • Exeter.

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Side effects and overdose

Usually “Lamisil” is well tolerated, but sometimes allergic reactions occur, manifested in the form of itching, burning, urticaria and redness of the skin.Even less often, the appearance of vomiting, nausea and dyspeptic manifestations is possible. The same symptoms are possible in overdose when the drug is taken in high doses. There is no specific antidote and treatment is aimed at removing the active substance from the body and relieving the accompanying symptoms.

TOP-11 remedies for nail fungus

Nail fungus is a fairly common problem – 10-20% of the population is diagnosed with onychomycosis.This disease can be contracted in a beauty salon, in the pool or in the shower of a fitness club. Fungus-affected nails turn gray-yellow, dull and thicken. They can also become thinner and crumble. In this case, there is a pronounced itching and burning sensation. The result is psychological and physical discomfort.

A disease such as onychomycosis has not only a cosmetic drawback. The fungus develops in the subungual space and can enter the bloodstream. The pathogen spreads throughout the body, which becomes the cause of general allergization.It is for this reason that it is necessary to start treatment when primary symptoms appear and continue therapy until the healthy nail plate grows back completely.

Many do not know how to choose pills for toenail fungus. Everything is quite simple – you need to give preference to drugs from well-known pharmacological companies. You should also rely on the degree of progression of onychomycosis and the area of ​​damage to the nail plate. Offers a ranking of the best medicines for fungus. We have collected the most effective drugs that quickly eliminate the problem without causing adverse reactions, provided that the manufacturer’s recommendations are followed.

Classification of preparations for nail fungus

The rating of remedies for nail fungus includes several categories of drugs that differ in the method of application:

  • For local therapy (varnishes, solutions, ointments). Effective in the early stages of progression. Apply to the nail plate 2-3 times a day. The active components penetrate deeply, suppress the pathogen and prevent the progression of the disease.
  • For oral use (capsules and tablets).Prescribed in the event that local therapy does not give the desired result. As a rule, drugs for internal use are necessary for patients aged 50 and over, with damage to 2 or more nails, with complete detachment of the nail plate and in the case of significant thickening of the nail.

Before starting treatment, a diagnosis should be carried out to determine the causative agent of the disease. The fact is that the fungus is of several types and reacts differently to the active substances that make up the composition.There are also drugs that have a systemic effect, comprehensively affecting the problem.

Groups of drugs

For fungal diseases, drugs are used that can be classified according to their chemical composition:

  • Group of azoles (synthetic antifungal agents). Synthetic medicines that are effective against fungal infections. When using azoles, it is important to take into account their spectrum of activity, toxicity and pharmacokinetic profile.Many drugs belonging to this group are unacceptable to take in the presence of concomitant diseases and during pregnancy.
  • Allylamines (synthetic antimycotics). They are prescribed only if the disease is widespread. They have a fungicidal effect, blocking the early stages of biosynthesis. In this case, a violation of the vital activity of the pathogen of mycosis occurs. Allylamines have a large list of contraindications that must be considered before use.
  • Group of polyenes (antibacterial drugs). They damage the cytoplasmic membrane of pathogenic fungi, destroying the osmotic barrier of the cell. Polyenes are distinguished by a wide spectrum of activity against various fungal diseases. They cause a number of complications, so the recommended dosage should be strictly adhered to.

Causes of nail fungus

Onychomycosis is accompanied by active exfoliation of skin and nail scales, which remain in large quantities on different surfaces.Infection occurs at the moment of contact of epithelial fragments with the skin of a healthy person. That is why so often infection occurs in public places (beauty salons, saunas, baths, etc.).

Wood objects such as benches and decks are the most dangerous. This is due to the fact that the fungus penetrates under the scales and multiplies in a humid environment. Pathogens are also transmitted through tiles and carpets. Sharing of bed linen, towels and shoes is unacceptable.

Drug rating

The best remedies for toenail fungus are selected depending on the effectiveness, the severity of side reactions, the stage of disease progression and the spectrum of action of the active components. Also, drugs should be easy to use and affordable.

No. 1 – Exoderil (Sandoz, Austria)

Antifungal agent for external use. Developed on the basis of such an active substance as naftifine hydrochloride.This is the best remedy for fungus on the feet due to the fact that the effect is achieved almost instantly. Release form – dropper bottle of 10, 20 and 30 ml.

The mechanism of action of “Exoderil” is to inhibit a substance that destroys pathogenic microorganisms at the cellular level. A solution of 1% concentration is effective against dermatophytes and yeasts. The drug acts in a complex way, preventing secondary bacterial infection.

Method of application – local treatment.The dosage is set individually and depends on the available indications. Adverse reactions may occur in the form of burning, redness and dryness of the skin at the sites of application.

# 2 – Lotseril (Galderma, France)

A remedy for fungus, which is in 2nd place in the rating. The drug is presented in the form of a 5% solution of amorolfine hydrochloride and is intended for external use for the treatment of affected surfaces. It has a pronounced fungicidal (destroys fungal cells) and fungistatic (slows down the growth of a pathogen) action.

“Lotseril” is effective against:

  • yeast fungi;
  • dermatophytes;
  • mold fungi;
  • actinomycetes.

The solution is prescribed for onychomycosis with damage to 2/3 of the nail plate. It is widely used to prevent damage to healthy nails by fungus. Can be used if a family member is sick to prevent infection.

Contraindicated for use during pregnancy and lactation.It is also not recommended to apply in case of hypersensitivity to amorolfine.
When using the solution, it is unacceptable to use cosmetic varnish. It is unacceptable to use files with which nails affected by the fungus are processed for healthy nail plates.

Also “Lotseril” is produced in the form of nail polish. The drug effectively copes with the problem with complex use. During treatment, it is unacceptable to use cosmetic nail polish.There should always be a dense film of medical varnish on the nail plate. If it is damaged, the layer should be renewed to exclude the possibility of air and moisture penetration inside.

# 3 – Oflomil (Glenmark, India)

Medicinal nail polish containing amorolfine hydrochloride. An antifungal agent is applied to the affected nail plate. This is the best remedy for nail fungus, which gives a quick and lasting effect.Oflomil not only eliminates fungus, but also restores the nail tissue, improving aesthetic performance.

The active substance of Oflomil varnish damages the cytoplasmic membrane of the fungus, disrupting the biosynthesis of sterols. The drug has high activity against dermatophytes, yeast and dimorphic fungi.

When applied to nails, the active substance penetrates through the nail plate into the nail bed within 24 hours. The required concentration remains in the nail plate for 7-10 days, which allows you to eliminate the symptoms of onychomycosis and stop the progression of the disease.

No. 4 – Mikoderil (Pharmstandard-Leksredstva, Russia)

Considering the reviews, the solution “Mikoderil” is a good remedy for the fungus. The active ingredient, naftifine hydrochloride, belongs to allylamines. It acts by reducing the formation of ergosterol, which is one of the constituents of the cell wall of the fungus. Possesses a wide spectrum of activity against various pathogenic microorganisms that cause secondary infection with mycoses.

Has a complex effect, effectively solving the problem of onychomycosis. The symptoms of the disease quickly fade away after the first use of the solution. Relapses, subject to the recommendations for the use of the drug, are almost completely excluded.

Not recommended for pregnant and breastfeeding women. An absolute contraindication is hypersensitivity to naftifine. It is unacceptable to apply to the wound surface.

To achieve the effect declared by the manufacturer, you need to undergo a full course of treatment.If therapy is interrupted until the affected nail grows back, the disease may resume. Can be used to combat onychomycosis and fungal infections of the skin.

# 5 – Mycosan (Serrix, Netherlands)

A local antifungal agent that, when applied to the nail, forms a film that prevents the pathogen from multiplying. The active ingredient, the rye enzyme filtrate, acts on the problem in a special way.

This is the best medicine for toenail fungus, which has a double effect:

  • destroys the lipid membrane of pathogenic microorganisms, causing their death;
  • creates unfavorable conditions for the growth of fungi.

The drug “Mycosan” promotes regrowth and restoration of nails. It is widely used for the treatment and prevention of onychomycosis. Eliminates the likelihood of delamination and increased fragility of the nail plates.

The set includes serum in a tube equipped with an applicator brush, disposable nail files (10 pcs.) and instructions for use. It is recommended to read the manufacturer’s recommendations before use.

# 6 – Candide (Glenmark, India)

Topical cream that contains clotrimazole. The active substance disrupts the synthesis of ergosterol (a constituent of the cell membrane of fungi). Increases the concentration of hydrogen peroxide to a critical level, which also leads to the death of the pathogen. Available in the form of powder and solution for external application.

The drug does not destroy lactobacilli, acting selectively. Does not cause pronounced adverse reactions and has practically no contraindications. “Candide” is the best medicine for nail fungus, which is effective against mycoses and complicated secondary infections. The course of therapy depends on the degree of progression of the disease and on the form of the pathogen. Do not interrupt the treatment. Otherwise, relapses are possible.

It is permissible to use in the 2nd and 3rd trimester of pregnancy only if the benefits to the mother outweigh the potential risks to the fetus.The cream can cause side effects such as allergic reactions, itching, rashes and flaking. It is not recommended for use in case of hypersensitivity to clotrimazole.

No. 7 – Nitrofungin (Teva, Czech Republic)

Solution for external use, which is developed on the basis of chloronitrophenol. Has a pronounced antifungal and antibacterial effect against gram-negative and gram-positive bacteria.

Apply to damaged areas with a cotton swab 2-3 times a day. Treatment should be continued until the clinical symptoms of onychomycosis completely disappear. In the future, to prevent relapse, you need to use “Nitrofungin” 2-3 times a week. As a preventive measure, it is enough to apply 1-2 times a week for a month.

No. 8 – “Mizol” (Evalar, Russia)

Solution for external use that contains naftifine hydrochloride.The antifungal agent belongs to the group of allylamines. The mechanism of action is to reduce the production of ergosterol, which is a constituent of the cell wall of the fungus.

In order to achieve a therapeutic effect, you need to undergo a full course of treatment. Therapy should not be interrupted until the symptoms of the disease are eliminated. The drug is not suitable for children and pregnant women. Also can not be used in case of hypersensitivity to naftifine.

No. 9 – Batrafen (Sanofi Aventis, Germany)

Cyclopirox based nail polish.The antifungal agent has a broad spectrum of action. Efficiency is based on the inhibition and elimination of components that are necessary to maintain the vital activity of pathogenic microorganisms that are the causative agent of the disease.

Varnish “Batrafen” has a pronounced antibacterial effect against most gram-negative and gram-positive microorganisms. The drug is applied directly to the affected nail plate. To prevent the spread of onychomycosis, it is recommended to process all nails.

Before applying Batrafen varnish, follow the manufacturer’s recommendations:

  • cut off the grown free edge of the nail;
  • file the nail plate so that the surface becomes uneven.

The varnish should be applied every other day for a month. Further, it is enough to process the affected areas 2 times a week for 4 weeks. The duration of treatment directly depends on the degree of progression of the disease.

In the course of treatment, side reactions may occur, such as itching and burning, peeling and hyperemia of the skin. It is not recommended to use during pregnancy and lactation due to the lack of clinical experience for these groups of patients.

No. 10 – “Mikospor” (Bayer, Germany)

Ointment for external application based on bifonazole and urea. Antifungal ointment has a wide range of antimycotic effects.The fungicidal effect is achieved when the proper concentration is reached after application after 6 hours. Resistant strains of fungi are rare.

The action of the drug is due to a combination of active substances:

  • urea softens the keratin of the affected nail plate, promoting a deeper penetration of bifonazole;
  • bifonazole destroys the causative agent of onychomycosis at the cellular level.

The Mikospor ointment should be applied once a day.It is unacceptable to use in the first trimester of pregnancy and during breastfeeding. Possible adverse reactions such as dermatitis, splitting of the nail plate, maceration and erythema. Burning, itching and allergic rashes are possible. Use with caution in case of hypersensitivity to miconazole, clotrimazole and econazole.

No. 11 – “Clotrimazole” (Medana Pharma Terpol Group, Poland)

The solution “Clotrimazole” is developed on the basis of the active substance of the same name.In a low concentration, it stops the reproduction of pathogenic microorganisms, in a high dosage, it leads to their death. Increases the level of hydrogen peroxide to critical levels, which is a guarantee of the complete destruction of fungal cells. In this case, relapses are minimized.

Can be used to treat onychomycosis, fungal skin lesions and erythrasma. The dosage is selected individually, depending on the degree of progression of the disease. To prevent the development of relapses, treatment should be completed.

Not recommended for use with sirolimus and tacrolimus. Otherwise, there is an increase in the concentration of active components in the blood. It is unacceptable to use in the first trimester of pregnancy.


Conclusions

Many people are interested in whether it is possible to treat nail fungus yourself. The TOP contains the best remedies for fungus that are effective against onychomycosis. The drugs have no serious contraindications and, if the instructions for use are followed, they practically do not cause adverse reactions.

It is important to start treatment at the initial stage of disease progression in order to exclude the development of complications. Otherwise, you cannot do without the advice of a specialist. At the initial stages of onychomycosis development, it is enough to use a solution or varnish. Further, you can not do without ointments and oral medicines. Please note that pills can negatively affect the condition of the gastrointestinal tract (gastrointestinal tract).

References:
http://medpuls.net/node/2516
https: // yandex.ru / health / turbo / articles? id = 6961
https://www.rlsnet.ru/fg_index_id_250.htm
https://www.vidal.ru/drugs/clinic-group/230

👆 Safe means for treatment of nail fungus in children

The immunity of young children is constantly forced to fight various pathogens, including fungi. At the same time, the body sometimes cannot cope with their negative effects and the child develops nail fungus. It develops very rapidly, so it is necessary to find an effective medicine for the fungus for children as soon as possible.

What Parents Should Know?

Every parent should understand how to treat nail fungus in children under 7 years of age and older? The speed of recovery depends on the parents, therefore, after the diagnosis of the fungus of the articles is made and the medicine is prescribed, you need to adhere to certain recommendations:

  1. Be sure to disinfect all of your baby’s shoes, floors and toys. Acetic acid and formalin are suitable for shoes. You can also pour boiling water over the insoles and then dry them.
  2. When treating nail fungus in children with drugs, you need to constantly change tights or socks. They should be washed in hot water: exposure to boiling water for five minutes destroys fungal spores. Personal items of the baby should be ironed after washing.
  3. Each family member must have a separate foot towel, scissors and slippers.
  4. It is necessary to determine if other family members have the fungus. If it is found, you will have to find a remedy for foot fungus for children and adults.
  5. It is necessary to teach the child to thoroughly dry their feet, paying special attention to the interdigital space.
  6. Before using topical medications to treat a child’s nail fungus, the top layer of the plates must be removed by using a file.

Neglecting these rules, even an effective medicine for treating nail fungus in a child from one year old will not work, so pay attention to all of this.

What medicines are treated for children?

Caring parents are looking for the most effective pills for nail fungus for children, but in reality, local preparations – ointments and creams – are more effective.Medicines for children should not have side effects and should effectively fight the disease.

Any pediatrician will confirm to you that the most effective cure for nail fungus for children is a cream or ointment. They act precisely on the lesion, suppress the activity of the fungus and stop the development of pathogenic microbes. They are applied in a thin layer to areas thoroughly washed with tar soap. You can also use a potassium permanganate solution for disinfection. Nail fungus varnish in children, ointments and creams are more useful in the early stages of the disease, in the later stages oral agents are needed.

Among the best preparations for nail fungus suitable for children, the following are distinguished:

Diflucan. The drug is based on fluconazole and is considered the safest drug. It is sold in pharmacies in three forms:

  • Suspension. This medicine can be used to treat nail fungus in babies from birth. The product has an orange flavor, and the exact dosage should be determined by a pediatric dermatologist.
  • Gelatin capsules. They are given to children for oral administration.They act very quickly, fighting various pathogenic microorganisms. This remedy for nail fungus is suitable for children from 7 years old, but sometimes doctors make exceptions.
  • Solution. A solution of fungus in children is treated only in a hospital. It is administered by droppers, but injections are also possible.

Exoderil is another good drug against fungus on the feet and nails. It quickly eliminates unpleasant symptoms, but it must be used with caution. Do not apply this ointment to areas with open wounds or calluses.It is necessary to strictly adhere to the dosage, trying to process only the nail plates, without smearing the drug on the skin.

Lamisil. Useful for treating nail fungus from two years of age. It inhibits the reproduction of harmful microorganisms and starts the processes of regeneration of the damaged nail. It is also used in the treatment of fungus in the ears.

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The effectiveness of traditional methods

Folk remedies for nail fungus in children are used only with the permission of a doctor.If you decide to try one of these remedies yourself, you can make the situation worse, so be careful.

Foot baths from milkweed decoction are very helpful for the treatment of mycosis of the feet. To prepare the product, you will need 300 g of grass, which you need to fill with a glass of boiling water. On a steam bath, euphorbia must be insisted for half an hour, and then it is filtered and poured into a basin. The child needs to steam feet in the solution for a quarter of an hour, and then they are rinsed with clean water and dried.In addition, after a folk remedy for fungus, it is better to treat the nails with ointment.

Antifungal ointment can be prepared independently from a chicken egg and a spoonful of vegetable oil. After thoroughly mixing the ingredients, use the mass to treat sore spots. You need to store this ointment in the refrigerator, but no more than three days.

In the list of folk remedies for the treatment of toenail fungus in children, baths with salt (sea and table) help. In a liter of hot water, you need to dissolve 100 g of both types of salt, and then the baby needs to steam his feet in this solution.Baths relieve itching, start the recovery process and can be used in addition to medications for fungus.

For the treatment of nails in children, you can use the bath against the fungus with a decoction of celandine. It is also possible to pyrene tea tree oil in a small concentration for the treatment of mycosis.

Correct preventive measures

After the treatment of nail fungus in children with drugs from a pharmacy or folk remedies is completed, you need to strictly monitor the baby’s health.It is important to boil all of your child’s personal belongings.

You need to change your baby’s underwear every day at high temperatures. A child should not walk barefoot in kindergarten or at home. If someone has a fungal disease at home, everyone needs to be cured, and in the process of treatment, direct contact with the child should be excluded. As medical practice shows, all family members have the same symptoms and the way the pathology develops.

Teach your child to regular and thorough personal hygiene, and after that, the baby should dry thoroughly with a towel, especially between the fingers.Constantly monitor the condition of your child’s nails and, if necessary, remove the top layer with a nail file, as it contains the highest concentration of pathogenic bacteria.

If the doctor has prescribed any nail fungus medication for your child, you must use it and follow through with the therapy. Even if the visually affected areas heal, a relapse is not excluded. In this regard, be sure to complete the course of treatment and engage in prevention.

90,000 Clinical Study Onychomycosis: Erchonia LUNULA – Clinical Trials Register

Inclusion Criteria:

– Onychomycosis present in at least one nail of the big toe, identified as a current bacterial / fungal infection, classified by the investigator as onychomycosis, with nail on visual examination shows a somewhat thickened nail plate with a cloudy appearance and slight discoloration (from white to yellow or brown).

– Subject is willing and able to refrain from using other (non-research related) treatments. (traditional or alternative) for the treatment of toenail onychomycosis throughout the study involved.

– Subject is willing and able to refrain from using nail polish, such as nail polish. and / or colored nail polishes throughout the study period.

Exclusion criterion:

Disease thorns extending to the nail matrix of the affected toenail (s) of the big toe.

– Infection affecting the socket of the affected toenail (s), eg genetic nail disorders, primary disorders.

– Affected toenails on the big toe have a clean (unaffected) nail plate length of less than 2 mm. behind the proximal fold.

– Presence of dermatophytoma (defined as thick masses of fungal hyphae and necrotic keratin between the nail plate and the nail bed) on the affected nail (s) of the big toe.

– Chronic plantar (moccasin) dermatophytosis of the foot.

– History of current or previous skin and / or nail psoriasis.

– Concomitant lichen planus.

– Onychogryphosis.

– Any of the following conditions of the affected toenail are present: proximal subungual onychomycosis; white superficial onychomycosis; dermatophytoma or “yellow thorn / streak”; exclusively lateral disease

– Associated problems / abnormalities of the large toenail (s)

– Any abnormality of the affected toenail (s) of the big toe that may interfere with the normal appearance of the nail, if successful get rid of the infection.

– Failure of the affected thumbnail (s) to become normal according to the investigator.

– A history of repeated failures with previous treatments for onychomycosis.

– Injury of the affected toenail (s) of the big toe.

– Oral antifungal use within the last 6 months.

– Use of topical antifungal agents within the last month.

– Previous surgical treatment of the affected big toe (s).

– Subject is unwilling or unable to refrain from using other (non-research related) treatments. (traditional and alternative) for the treatment of toenail onychomycosis throughout the study involved.

– Subject is unwilling or unable to refrain from using nail cosmetics such as nail polish. and / or colored nail polish until the end of study participation.

– Cancer and / or treatment of any type of cancer within the past six months.

– Peripheral vascular disease or peripheral circulation disorder.

– History of uncontrolled diabetes mellitus.