Dr. Jo Herzog discusses how to treat and prevent nail fungus. Her advice is in response to the following question by a Family Savvy reader.
Dr. Herzog, can you tell me if there are any new treatments for toenail fungus? Every time I think mine has gone away, it always comes back. I am so frustrated that I don’t know what to do.
Dr. Jo Herzog
Toenail fungus is a common problem. What is most frustrating about trying to “cure” this affliction is the rate of recurrence. A return of the fungus is common–the chances being greater as we get older and in men.
This problem is rarely dangerous to your health (although for diabetics, it could occasionally cause the feet to be a route of infection). Since it is usually benign, my main goal in this treatment is to do no harm.
Most patients want their toenail fungus treated for cosmetic reasons (toenail fungus is unsightly) and are not as concerned about health issues stemming from it. Occasionally, very thick toenails can be uncomfortable. Very few patients come to me concerned about a future lower leg infection from their fungus. Therefore, I try to explain how long treatment takes and what their chances are of a permanent “cure.”
Older men seem to have the highest rate of recurrence. A new toenail takes about a year to grow in, so a fully new nail should not be expected until the old one grows out. Since treatment can take a long time, results are not immediate, and there can be a high recurrence rate, I explain to my patients the different treatment methods in terms of “tiers” or “levels” of treatment that can be pursued, depending on how bothersome the nail is to the patient and how much risk he or she is willing to take.
Ways to treat toenail fungus:
- The simplest and least invasive method of treatment is a topical nail lacquer that penetrates the nail over time and contains an antifungal drug. Penlac is the most common lacquer used. It is a prescription and is applied daily for the first couple of months and then every other day. It is removed with nail polish remover weekly. It is relatively safe and simple but can take a year to achieve a “cure.” If the nails are severely affected, this probably will not work.
- The next tier of traditional treatment is the use of oral medications. Lamisil is the most common, but others are used. These can be given as daily doses (for a few months) or weekly or one week per month doses (for a longer period). Although rare, there can be drug interactions with some other drugs, as well as a chance of allergic reaction and liver toxicity. We do periodic monitoring of blood with oral medications. Rarely do we resort to dissolving a toenail, killing the infection, and starting a new one.
- A form of laser has been approved as a way to clear the part of the nail that is affected by fungus. There has not been enough good scientific literature out yet for me to know what I think of it. Between one and four sessions are generally needed, and the cost can vary from from $750 to $1500 a session. If this works well, it might become a good alternative for those who can afford it and don’t want to take oral medications. However, don’t forget that when you clear up your nails, you will want to keep them that way~hence the suggestions below
Ways to prevent toenail fungus:
- Do not go barefoot in public places. Even fancy hotels have had fungus cultured from their carpets. Wear flip flops or sandals in public showers and around pools.
- Put antifungal powder in your shoes. Shake the powder around to cover the inside of the shoes, and keep it there for 24 hours. Wear a different pair of shoes the next day.
- Change socks daily. Washing socks in hot water and bleach is a good idea.
- Try to keep feet dry. Athletes get fungus more often because they walk around bare foot in locker rooms, go in showers, and have moist feet.