877-944-6131 Email Us

Clinician’s Corner: Toenail Fungus

Your fingernails and toenails are composed of keratin and adherent connective tissue, the same stuff that your hair is made of. Nail grows at an average rate of 0.1 mm/day (1/2 inch every 100 days). Finger nails require 3 to 6 months to re-grow completely while toe nails require 12 to 18 months.  Onychomycosis is a fungal infection of the nails, 80% of the infections are caused by dermatophytes (Trichophyton rubrum), that causes lots of other skin fungal infections.

Diagnosis is based on clinical exam and history, microscopy, and culture.

  • OTC nail lacquers (Fungi-Nail®) treat fungus around the nail, they don’t penetrate the nail plate. Don’t recommend them due to minimal efficacy; is only for athlete’s feet.
  • Rx products provide best treatment option.
  • Advise patients about possible recurrence.

Treat for 6 weeks for fingernails and 12 weeks for toenails.

  • Terbinafine (Lamisil®) (Rx) – fewest drug interactions; most efficacy: cure rate: (46%). Side effects include headache, gastrointestinal disturbance (diarrhea and/or dyspepsia), rash and elevated liver enzymes
  • Itraconazole (Sporanox®)(Rx) –drug:drug interactions. cure rate (23%pulse). Side effects, skin rash, high triglycerides, cardiac side effects and gastrointestinal effects (nausea, bloating, and diarrhea)
  • Fluconazole (Diflucan®) (Rx) cure rate:28% dosed at 150mg once a week, less drug interactions than itraconazole. Frequent relapse, due to poor retention in the nail.
  • Ciclopirox (Penlac®) (Rx) nail lacquer complete cure rate (7%)
  • Efinaconazole (Jublia®) (Rx) nail lacquercomplete cure rate (17%)
  • Tavaborole (Kerydin®) (Rx)nail lacquer cure rate (<10%)

Vicks Vap-o-rub?

  • Small study of 18 participants, where fifteen of the 18 participants (83%) showed a positive treatment effect. Source: J Am Board Fam Med. 2011 Jan-Feb;24(1):69-74. doi: 10.3122/jabfm.2011.01.100124
  • 5 of 18 (27.8%) had a clinical cure at 48 weeks;
  • 10 of 18 (55.6%) had partial clearance
  • 3 of 18 (16.7%) showed no change.

Since our enemy Trychophyton rurum is everywhere, re-infection is a possibility if measures are not taken to make the feet an inhospitable environment for this fungus.  Fungus breed where it is warm, dark and moist.  Here are some points:

  • 1 in 5 “cures” will relapse (20%) within 2 years
  • Keep feet clean and dry
  • Change socks often
  • Antifungal product for feet and shoes.
  • Sports shoes that fit well will reduce microtrauma to the nail plate. Wear sandals when possible.
  • Using communal showers leads to fungal infection, so these should be avoided
  • Care with hygiene is needed to reduce cross-infection between family members
  • Throw out old “creek shoes”.
  • Emollients can be used to avoid cracks in the skin that allow fungus to enter.

Certain-Dri®—Prevention of nail fungus

  • Contains aluminum chloride-12%. This product stops the feet from sweating, creating the moist environment for the fungus to grow.
  • Water-based and unscented which makes it gentler on skin
  • Should not wash off after bathing or showering, if application instructions are followed. Use twice a week.

Your Thompson Pharmacist is the best source for foot care products both in the front of the store and in the prescription department.

Go Ahead and ASK! At Thompson Pharmacy its all for YOU!