Toenail fungus FAQ (Onychomycosis)

Did you know:

• Over 35 million people in the US have toenail fungus.
• The Oral antifungals (terbinafine (Lamisil) and itraconazole) have a clearance rate around 50% (lower rates in patients over 65y) and require liver testing due to liver toxicity.
• New topical antifungals (like Kerydine or Jublia) are expensive and need to be used for 11 months but have a clearance rate over 50%.
• Older antifungals have much lower clearance rates Efinaconazole (only 18%) and Tavaborole (6-9%).
• The most common complications of topicals were skin peeling, redness, or itching at the site, or ingrown toenail.
• In the health food literature patients have tried tea tree oil or grapefruit seed extract or eating garlic tablets.  There are no statistics on the clearance rates of these home remedies and, of course, there is no standardization of health food products with respect to active ingredients.
• Lasers have been used successfully for treatment of nail fungus.  The right laser with the right treatment parameters and good patient compliance are important contributing factors to higher clearance rates.

Typical Onychomycosis

• Part of the difficulty in evaluating any therapy for onychomycosis is in distinguishing between reinfection and treatment failure.  Factors such as repetitive nail trauma, dystrophic nails, poor nail hygiene, and diabetes predispose patients to multiple episodes of infection.
• Some clinicians / researchers have suggested that perhaps it would be more appropriate to approach onychomycosis as a chronic disease necessitating regular episodes of therapy to prevent nail dystrophy, rather than a discrete episode of infection that can be guaranteed to be cured outright.