What are the most effective treatments for toenail fungus. How do topical solutions compare to oral medications. What are the success rates of different toenail fungus treatments. How long does it take to treat toenail fungus effectively. What are the potential side effects of toenail fungus medications.

Understanding Toenail Fungus: Symptoms and Diagnosis

Toenail fungus, medically known as onychomycosis, is a persistent condition that affects millions of people worldwide. Recognizing the symptoms is crucial for early diagnosis and effective treatment. The most common signs include:

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

If you notice these symptoms, it’s important to consult a healthcare professional for a proper diagnosis. They may perform a visual examination, take nail clippings for laboratory analysis, or use specialized diagnostic tools to confirm the presence of fungal infection.

Topical Treatments for Toenail Fungus: Nail Polishes and Creams

Topical treatments are often the first line of defense against mild to moderate toenail fungus infections. These treatments come in various forms, including medicated nail polishes and creams. How do these topical solutions work?

Antifungal Nail Polishes

Two primary active ingredients are found in antifungal nail polishes:

1. Amorolfine: Applied once or twice a week
2. Ciclopirox: Applied more frequently, with a gradually decreasing schedule

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

Treatment Sets with Creams and Nail Scrapers

Another topical option involves treatment sets containing two creams and a nail scraper:

• Urea cream: Softens the nail for easier removal
• Bifonazole cream: Provides antifungal action

This treatment typically spans 14 days for nail removal, followed by four weeks of bifonazole cream application to treat the underlying skin.

Effectiveness of Topical Toenail Fungus Treatments

While topical treatments are widely available and often the first choice for many patients, their effectiveness can vary. Studies on these treatments have shown mixed results:

Ciclopirox Nail Polish

Research indicates that after one year of treatment:

• 32% of people using ciclopirox no longer had detectable fungal infections
• Only 10% of untreated individuals saw similar results

However, it’s important to note that cosmetic improvement was observed in only 7% of treated cases.

Urea and Bifonazole Cream Set

A study comparing urea cream alone to a combination of urea and bifonazole cream found:

• 51% of participants using both creams showed no visible fungus after three months
• 41% of those using only urea cream had similar results

Despite these initial improvements, long-term effectiveness remains questionable, as many participants experienced fungal recurrence.

Oral Medications for Toenail Fungus: A Systemic Approach

For more severe or persistent cases of toenail fungus, oral medications may be prescribed. These systemic treatments work from within the body to combat the infection. What are the most commonly prescribed oral antifungal medications?

• Terbinafine
• Itraconazole

These medications require a prescription and are typically recommended for more extensive infections or when topical treatments have failed. How do oral antifungals compare to topical treatments in terms of effectiveness?

Effectiveness of Oral Antifungal Medications

Studies have shown that oral antifungal medications are generally more effective than topical treatments. For instance:

• Terbinafine has demonstrated cure rates of up to 70% in clinical trials
• Itraconazole has shown effectiveness rates ranging from 50% to 70%

However, it’s crucial to consider that oral medications may come with a higher risk of side effects compared to topical treatments.

Comparing Topical and Oral Toenail Fungus Treatments

When deciding between topical and oral treatments for toenail fungus, several factors come into play. How do these treatment options compare in terms of key aspects?

Treatment Duration

Topical treatments often require longer treatment periods:

• Nail polishes may need to be applied for up to a year
• Cream treatments typically last 6-8 weeks

Oral medications generally have shorter treatment durations:

• Terbinafine is usually prescribed for 6-12 weeks
• Itraconazole may be taken for 3-4 months

Ease of Use

Topical treatments require consistent application and may be messy or time-consuming. Oral medications are typically taken once daily, making them more convenient for many patients.

Side Effects

Topical treatments generally have fewer systemic side effects but may cause local irritation. Oral medications can have more significant side effects, including:

• Gastrointestinal disturbances
• Headaches
• Skin rashes
• Potential liver toxicity (rare but serious)

Combination Therapies: Enhancing Toenail Fungus Treatment Efficacy

In some cases, healthcare providers may recommend combining different treatment approaches to maximize effectiveness. What are some common combination therapies for toenail fungus?

Topical + Oral Medications

Combining a topical antifungal with an oral medication may provide a dual-action approach, targeting the infection both externally and internally. This combination can potentially increase the overall success rate and reduce treatment duration.

Mechanical Removal + Antifungal Treatment

In cases where the nail is significantly affected, partial or complete removal of the infected nail (either surgically or chemically) may be combined with antifungal therapy. This approach can help the medication reach the infection more effectively.

Laser Therapy + Antifungal Treatment

Some clinics offer laser treatments for toenail fungus, which may be combined with traditional antifungal medications. While more research is needed to confirm the efficacy of laser therapy, early studies suggest it may enhance overall treatment outcomes when used in conjunction with other methods.

Prevention and Lifestyle Changes for Managing Toenail Fungus

While treating an active toenail fungus infection is crucial, preventing recurrence and managing risk factors is equally important. What steps can individuals take to reduce their risk of developing or redeveloping toenail fungus?

Proper Foot Hygiene

• Wash feet daily with soap and water
• Dry feet thoroughly, especially between toes
• Use antifungal foot powder or spray

Footwear Considerations

• Wear breathable shoes and socks
• Avoid walking barefoot in public areas (e.g., locker rooms, swimming pools)
• Rotate shoes to allow them to dry completely between uses

Nail Care

• Keep nails trimmed and clean
• Avoid sharing nail care tools
• Sterilize nail care tools regularly

Managing Underlying Conditions

Certain health conditions can increase the risk of toenail fungus. Managing these conditions effectively can help prevent fungal infections:

• Diabetes
• Circulatory problems
• Immune system disorders

Emerging Treatments and Future Directions in Toenail Fungus Management

As research in the field of dermatology and mycology continues to advance, new treatments for toenail fungus are being developed and tested. What are some promising emerging therapies and areas of research?

Photodynamic Therapy

This treatment involves applying a photosensitizing agent to the affected nail and then exposing it to a specific wavelength of light. The light activates the agent, which then destroys the fungal cells. Early studies show promising results, but more research is needed to determine its long-term efficacy and safety.

Nanoparticle-Based Treatments

Researchers are exploring the use of nanoparticles to deliver antifungal agents more effectively. These tiny particles may be able to penetrate the nail more easily and provide sustained release of medication, potentially improving treatment outcomes.

Novel Antifungal Compounds

Pharmaceutical companies are continually working to develop new antifungal medications with improved efficacy and safety profiles. Some areas of focus include:

• Drugs with broader spectrum activity against various fungal species
• Medications with fewer side effects and drug interactions
• Formulations that provide better nail penetration

Gene Therapy and Immunomodulation

Future treatments may target the genetic factors that make some individuals more susceptible to fungal infections or aim to boost the body’s natural immune response against fungal pathogens.

As research progresses, it’s likely that we’ll see more personalized treatment approaches based on factors such as the specific fungal species involved, the extent of the infection, and individual patient characteristics.

When to Seek Professional Help for Toenail Fungus

While many cases of toenail fungus can be managed with over-the-counter treatments, there are situations where professional medical advice is necessary. When should you consult a healthcare provider about your toenail fungus?

Persistent or Worsening Symptoms

If you’ve been using over-the-counter treatments for several weeks without improvement, or if the infection appears to be spreading, it’s time to seek professional help.

Severe Pain or Discomfort

While toenail fungus is often painless, severe cases can cause discomfort or pain. If you’re experiencing significant pain associated with the infected nail, consult a doctor.

Underlying Health Conditions

Individuals with diabetes, circulatory problems, or compromised immune systems should seek professional advice at the first sign of toenail fungus, as they may be at higher risk for complications.

Difficulty with Self-Care

If you have trouble reaching your feet or maintaining proper foot hygiene due to age or physical limitations, a healthcare provider can offer treatment options and management strategies.

Recurrent Infections

If you’ve successfully treated toenail fungus in the past but experience frequent recurrences, a healthcare professional can help identify underlying causes and develop a more effective long-term management plan.

Remember, early intervention can lead to more successful treatment outcomes and prevent the spread of infection to other nails or individuals.

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

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

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

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

What topical (external) treatments are there?

Nail polishes

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

• Amorolfine is applied one to two times a week.

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

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

Sets with creams and a nail scraper

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

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

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

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

How effective are topical treatments?

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

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

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

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

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

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

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

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

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

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

What oral medications are available?

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

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

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

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

Terbinafine

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

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

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

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

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

Itraconazole

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

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

Fluconazole

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

How effective are tablets in treating nail fungus?

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

One year after a three-month treatment with terbinafine:

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

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

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

Itraconazole also proved to be effective. After one year,

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

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

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

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

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

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

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

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

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

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

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

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

When are the different treatments considered?

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

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

• the base of the nail is not infected, and

• only some nails are affected.

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

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

Additional treatments

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

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

Which treatment is right for me?

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

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

Sources

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

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

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

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

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

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

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

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

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

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

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

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

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

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

What topical (external) treatments are there?

Nail polishes

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

• Amorolfine is applied one to two times a week.

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

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

Sets with creams and a nail scraper

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

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

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

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

How effective are topical treatments?

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

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

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

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

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

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

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

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

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

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

What oral medications are available?

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

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

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

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

Terbinafine

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

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

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

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

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

Itraconazole

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

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

Fluconazole

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

How effective are tablets in treating nail fungus?

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

One year after a three-month treatment with terbinafine:

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

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

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

Itraconazole also proved to be effective. After one year,

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

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

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

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

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

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

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

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

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

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

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

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

When are the different treatments considered?

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

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

• the base of the nail is not infected, and

• only some nails are affected.

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

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

Additional treatments

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

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

Which treatment is right for me?

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

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

Sources

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

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

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

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

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

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

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

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

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

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

Terbinafine customer reviews and experience

Terbinafine reviews

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Thinks great 900 03

from 215  ₽

My husband and I picked up a fungus somewhere. On my feet, and on his nails. We went to the hospital together. We were prescribed Terbinafine. Both were used in the same way. The drug helped me. Tenrbinafine coped with the fungus on the feet perfectly. But my husband is not. Apparently, nail fungus is a more serious disease, and it turned out to be too tough for Terbinafine. He had to be treated by another means. And so we have no complaints about the drug. Cheap and no side effects.

Thinks the product is excellent

from 192  ₽

I recently discovered a fungus on my foot. How and where could I even pick it up?! In a state of shock, I heard the first thing that was advertised on TV from the fungus, and ran to the pharmacy. The necessary funds were not there. The pharmacist suggested Terbinafine as an alternative. The ointment is inexpensive, I decided to try it. Used it for a week and it went away. And the moral is this: there is nothing to listen to what they say on TV. There are tools that are just as effective, but they are much cheaper.

Thinks the product is excellent

from 215  ₽

Fungus on the feet is half the trouble. But the fingers affected by the fungus – this is a disaster. And most disgusting, and others look askance. Even if you always wear gloves. Fortunately, there is such a drug as Terbinafine. I was treated for a long time, 6 months, but the main thing is that it is effective. Hands are now healthy and clean. It even made me more confident. A very good tool. I recommend it to anyone who suffers from fungus.

Thinks the product is excellent

from 215  ₽

For several months I tried to cure my foot fungus. Passed several “unfortunate specialists”. Why didn’t they tell me! In the end, it all came down to the fact that in addition to the fungus, I also had to treat allergies, which were caused by drugs prescribed by these “unfortunate specialists”. But I still managed to overcome the fungus. I got an appointment with a good doctor, and he prescribed Terbinafine for me. I took pills and applied ointment to the affected area. I don’t remember this infection anymore. I hope this will continue.

Thinks the product is excellent

from 215  ₽

I have been trying to cure the fungus for so many years! A beautiful pedicure for me was a distant and pipe dream. I’ve tried everything, I think. And Terbinafine helped me in the end. The doctor prescribed me a complex: ointment + tablets. For 2 months, there was no trace of this infection on the nails. Now I go admiring a beautiful pedicure and still can’t believe it. Who has the same problem, I recommend!

Thinks the product is excellent

from 215  ₽

I couldn’t get rid of the fungus for more than 10 years. At one fine moment, I just gave up any attempts to cure him and resigned myself. But one day, by a lucky chance, a very good specialist advised me Terbinafine. With the idea that in principle I have nothing to lose, I decided to try. I drank strictly according to the instructions. And about a miracle! The fungus is gone. So many years of suffering and spending a lot of money! And the usual remedy from the nearest pharmacy helped. I recommend!

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

What is the purpose of this article?

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

What is a fungal nail infection?

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

What causes fungal infections?

Fungi spreading from the foot (known as “dermatophyte fungi” ) cause most fungal nail infections. Less commonly, nail infections are caused by other types of fungi, usually yeast (eg Candida ) and mold .

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

Are they hereditary?

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

What are the symptoms of fungal nail infections?

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

What do fungal nail infections look like?

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

How are fungal nail infections diagnosed?

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

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

Can fungal nail infections be cured?

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

How can fungal nail infections be treated?

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

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

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

Treatment options include:

• Nail treatments (topical treatments)

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

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

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

• Preparations taken by mouth (oral treatment)

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

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

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

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

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

Are there any side effects of the treatment?

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

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

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

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

How do I know if the treatment is working?

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

Surgical nail removal

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

Self Care

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

For toe fungus:

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