Fighting the fungus among us: Treatment options for toenail fungus

The Bottom Line

  • Fungal toenail infections are unpleasant to look at and can cause pain and loss of function in the affected toe. They can impact both the physical and emotional health of an affected individual.
  • The best way to avoid fungal toenail infections is keeping: feet cool and dry, nails short, and wearing footwear in public places.
  • Research shows oral medications can cure fungal nail infections. Success rates and adverse events may differ slightly across medications, so be sure to discuss with your doctor which option is best for you.

If you don’t have it, it may seem like a joke. But if you do, you’re probably not laughing – in fact, you may be doing anything to avoid exposing your toes. This is because onychomycosis, or toenail fungus, can wreak havoc on the appearance of your nails, leaving you feeling frustrated and self-conscious.

Fungal toenail infections are common, affecting 2 to 14% of the general population (4;5) and one-third of people with diabetes (2). Although toenail fungus is relatively harmless, people with diabetes are at increased risk of serious complications from an infection, such as the loss of a limb (3).

Clearly, nail fungus is not just a cosmetic problem. At first, toenail fungus does not cause physical symptoms, but may make an infected nail appear different from the others. As the condition worsens, however, the fungus can cause pain and discomfort; in some cases, it can even cause numbness and loss of function in the affected toe. As the physical appearance of the toenail worsens, some people also experience loss of self-esteem or opt out of social activities, and this can harm their sense of well-being (1).

You may be familiar with the adage “prevention is the best medicine”. This certainly applies to toenail fungus, which is notoriously difficult to treat and rarely goes away on its own. Prevention strategies include keeping feet cool and dry, clipping nails short, and wearing footwear in public places (7).

If this pesky fungus has already made an appearance, numerous antifungal agents – both topical and oral – are available to help you mount an attack. Topical treatments tend to have a lower success rates (6), so many turn to oral medications to try to cure the problem.

Whether it is sandal season or not, toenail fungus sufferers everywhere want to know – which treatment option is most likely to provide a cure so that they can proudly bare their toes?

What the research tells us

Research shows a similar effect among three widely used oral antifungal medications – terbinafine, griseofulvin, and azoles, although all produce side effects. Overall, terbinafine appears to have a slightly better cure rate than either the azoles and griseofulvin, and slightly fewer side effects which commonly include headaches, viral infections and nausea (6). Both terbinafine and the azoles have a similar ability to prevent the recurrence of infection (6). Griseofulvin – has a similar cure rate to the azoles, but produces more side effects, including headaches, stomach disturbances, loss of taste, nausea, and allergic reactions (6).

If you have a fungal nail infection there are oral antifungal medications available that may help cure the fungus and get you back to enjoying open toed shoes again!

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  1. Tosti A. Onychomycosis. [Internet] 2017. [cited November 2017]. Available from https://emedicine.medscape.com/article/1105828-overview#showall 
  2. Gupta AK, Konnikov N, MacDonald P, et al. Prevalence and epidemiology of toenail onychomycosis in diabetic subjects: A multicenter survey. Br J Dermatol. 1998; 139(4):665-671. 
  3. Cathcart S, Cantrell W, Elewski BE. Onychomycosis and diabetes. J Eur Acad Dermatol Venereol. 2009; 23(10):1119-1122. doi: 10.1111/j.1468-3083.2009.03225.x.
  4. Ghannoum MA, Haijeh RA, Scher R, et al. A large-scale North American study of fungal isolates from nails: The frequency of onychomycosis, fungal distribution, and antifungal susceptibility patterns. J Am Acad Dermatol. 2000; 43(4):641-648. 
  5. Roberts DT. Prevalence of dermatophyte onychomycosis in the United Kingdom: results of an omnibus survey. Br J Dermatol. 1992; 126(Suppl 39):23-27. 
  6. Kreijkamp-Kaspers S, Hawke K, Guo L, et al. Oral antifungal medication for toenail onychomycosis. Cochrane Database Syst Rev. 2017; (7):CD010031. doi: 10.1002/14651858.CD010031.pub2. 
  7. Mayo TT, Cantrell W, Elewski BE. Can we prevent onychomycosis? J Infect Dis Ther. 2014; 2(148). doi: 10.4172/2332-0877.1000148.

DISCLAIMER: The blogs are provided for informational purposes only. They are not a substitute for advice from your own healthcare professionals.

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