Treatment Guide - Patient guidelines for treatment of toe nail fungus (onychomycosis)

What can you do to treat fungal infections of the toenail?  There's a number of different methods of treatment based upon the severity of your fungal nail infection.  Use these treatment guidelines to help make treatment decisions.  

Topical natural medications

• Pros – Safe, inexpensive
• Cons – Marginally effective
• Indications – Superficial fungal infection that affect less than 10% of the nail.

Topical pharmaceuticals medications

• Pros – Safe, inexpensive
• Cons – Marginally effective
• Indications – Superficial fungal infection that affect less than 10% of the nail.

Fungal toe nail removal

Chemical

• Pros – easy, home treatment, painless and effective, nail will grow back again
• Cons – none
• Indications – thick, very infected fungal nails

Surgical

• Pros – nail will be removed permanently
• Cons – nail will be removed permanently
• Indications – very thick, painful fungal toe nails

Oral antifungal medication

Lamisil (terbinafine) is the most common oral antifungal used to treat infected toe nails and finger nails. The course of treatment for onychomycosis of the toe nail is 250mg daily (one pill per day) for 90 days.

• Pros – effective coverage for many species of fungus, convenient, compliance with prescription is easy
• Cons – Recurrence of fungus common with need to use Lamisil every 18-24 months to maintain clear nails, competes with other medications in the liver, may contribute to loss of taste
• Indications – fungal infections of the nail

Tips for treating fungal toe nails

1. Most fungal infections occur following an injury to the nail. If your nail is injured, be sure to start on a topical antifungal to prevent infection of the nail.
2. Fungus is a plant and requires moisture to grow. Perspiration is key to the growth and persistence of fungus infections of the skin or nail. Be sure to:

   • Rotate shoes to allow them to dry

   •  Use socks to wick away moisture

   •  Use a topical drying agent like Onox to decrease perspiration (https://www.myfootshop.com/onox-foot-drying-solution-1)

3. Fungal infections of the nail cause discoloration, thickening, and separation of the nail from the underlying nail bed. Antifungal medications, whether topical or oral, can help with discoloration and thickening but they correct separation of the nail from the underlying nail bed.
4. Treatment of fungal infections of the skin and nail of the foot need to be recognized as ongoing daily hygiene issues. Just as you brush your teeth twice a day, you’ll also need to treat fungal infections of the skin and nail twice a day, forever.
5. Dry skin on the foot is often a low-grade fungal infection of the skin. These fungal infections, called tinea rubrum, will act to seed the infection of the toe nail upon injury to the nail.

This article was written by Jeffrey Oster, DPM.  Dr. Oster is a board certified podiatrist and medical advisor to Myfootshop.com.  This article was most recently updated on 1/20/2021.