Toenail fungus is also known as onychomycosis or tinea unguium. They are mostly caused by fungus affecting the skin such as dermatophytes, yeasts (candida albicans and candida paraphimosis) or molds. It usually starts from one toenail and then spreads to the other if not treated on time. It is more commonly found in males and in elderly people. It is also more prevalent in patients of diabetes mellitus, arterial diseases and people who are on immunosuppressive agents or medicines such as cancer and HIV patients.(1)
The toenail fungus will cause the nail to become brittle, thick with whitish to yellowish discoloration. This often leads to detachment of the nail from the nail bed. In some cases when the infection is severe and bacterial infiltration also takes place in the surrounding area. It leads to fever, swelling, and discharge of pus from the infected site. The mode of treatment depends upon the severity of the infection. Both oral and topical medications are used either alone or in combination for an effective cure.(1)
What Is The Best Medicine For Toenail Fungus?
There are a number of treatment options available for treating toenail fungus. Earlier topical antifungals were widely used to treat nail infections but it was not the best in curing the infection. Later it was found that oral antifungals medicines were more effective on curing the toenail fungus in a short span of time as compared to topical antifungals. The medicines commonly used to treat toenail fungus are terbinafine (especially when then nail fungus is caused by dermatophyte), itraconazole (when the infection is caused by yeast or mold). They are both commonly used oral antifungals that can effectively kill the nail fungus and prevent further infection. They can be given continuously for months or can be taken with breaks between treatments. They take around 3 to 4 months to completely clear up the infection. Fluconazole is another alternative to terbinafine and itraconazole when they are not effective in clearing up the infection.(2)
Although effective they can have a number of side effects that include headache, dizziness, stomach and bowel problems and body rashes. They can also interact with other medicines, so it becomes important to consult a doctor before taking antifungal medications. The patient should tell the whole drug history to the consultant whenever starting the course of antifungals. Anti-fungals should also not be taken in pregnancy and breastfeeding women. People who are on sleeping pills and cholesterol and blood sugar reducing medications should not take itraconazole.(2)
Terbinafine has shown to cause less number of drug interactions but can interfere with anti-depressants and drugs for heart ailments. It can also cause stomach problems along with loss of smell and taste temporarily. In most cases, people can tolerate anti-fungal well. While in others certain side-effects can be seen and alternative methods of treatment need to be started. Some people also resort to home remedies to clear up the infection when the drugs are not effective. A few patients have also shown to respond to topical drugs alone in clearing the infection. The use of topical amorolfine and ciclopirox has shown good results in patients with mild toenail fungus. Certain urea-based creams are also beneficial in clearing up the infection. It involves the use of a scalpel to remove the dead tissue and then application of urea-based cream along with one antifungal cream containing bifonazole followed by bandaging of the nail. It leads to softening of the infected part and then again scraping of the infected layer after 24 hours is done. This procedure is repeated for a month to get effective results.(2)
The additional treatment option is laser treatment that involves the use of UV light on the nail to get rid of the fungus. It is done in cases where all the other methods have failed to clear up the infection. Nail fungus can sometimes recur even after successful treatment in some cases.
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