You have 5 treatment options for your fungal toe nails:
1. Do nothing
- You have 5 treatment options for your fungal toe nails
2. Nail thickness reduction
- Have your thick fungal reduced on a regular basis every 8-10 weeks to prevent pain due to shoes pressing on your thick nails.
Debridement of fungal nail to base of nail
3. Topical anti fungal and nail thickness reduction
- Most people start their treatment with the use of a topical medication or a home remedy. People have tried topical Lamisil™, Lotrimin™, Micatin™, Vicks Vapo-Rub™, tea tree oil, white vinegar, rubbing alcohol, bleach and the prescription product Penlac™ which is effective but expensive. All of these need to be used twice a day for up to a year to see results. Our current favorite is a topical antifungal called Tineacide™ nail formula. Tineacide™ nail formula (1% tolnaftate in an oil base) is available OTC in our office for your convenience. The probable effectiveness rate is less than 30% when used twice a day for a year.
- Tineacide™ OTC antifungal cream can be applied to skin to kill fungus that infects toe nails. Tineacide nail formula and cream is available OTC in our office.
NonyX™-Nail Gel. This product is only moderately helpful in treating fungus nails but it has an excellent bleaching agent to lighten the color of a discolored nail. NonyX nail gel is available OTC in our office for your convenience.
4. Oral medicine, topical medicines and nail thickness reduction
- The gold standard for toe nail fungus treatment is the oral medicine Lamisil™ (terbinafine). This medicine is taken one tablet a day for 90 days and achieves a 75% rate of improvement. There is a rare and slight but very real risk to the liver, kidney and blood cells. The people who have been seriously injured probably already had some organ damage and there is no proof that Lamisil did the damage all by itself. To check on potential damage we recommend a pre-treatment and during-treatment levels of your liver function and your blood cells (liver function tests and complete blood count) via your family doctor. Because of the risks of Lamisil™, we want laboratory proof that you have fungus in your nails before we prescribe this medication. This requires a laboratory examination of a sample of your nails. It takes us about 2 weeks to get results back from the laboratory. Non-generic Lamisil costs more than $125 but generic forms are available.
5. Laser therapy, topical medicines and nail thickness reduction
- This is a new treatment available for fungus nail treatment. The laser treatment is performed during one visit where a laser light is passed over and through your nails to kill the fungus without damage to any of your skin or nails. The light literally passes right through your skin without any damage at all. It has been used thousands of times without any side effects. With the laser there are no injections, no pills, no lab tests and no risks of any kind. The effectiveness is reported to be at 88% (no fungus can be resistant to this wavelength of light). Failures are likely due to damage to the nail plates, either through injury, severe long standing fungus infection, poor circulation or genetics. The laser treatment with 1 year of follow-up exams costs $45-75 per nail depending on how many nails are treated and may not covered by any insurance companies.
