Footnotes / Blog

What Are Toenail Fungus Treatment Options and Challenges?

Toenail fungus is a persistent and often difficult condition to treat, with no treatment modality achieving success rates consistently above 80%. This makes it one of the more challenging podiatric problems to address. The most common culprit behind toenail fungus is the organism Trichophyton rubrum, which thrives in environments that are warm, dark, and moist. While toenail fungus can affect anyone, certain populations, such as the elderly or those with compromised immune systems (e.g., diabetes, HIV, chemotherapy patients), are particularly susceptible.

Causes and Symptoms

Toenail fungus typically begins with mild symptoms, such as slight yellowing at the corners of the toenail. As the infection progresses, the nail may become thicker, discolored, flaky, malformed, and even painful. The more severe the case, the more difficult it is to treat. In some extreme cases, surgical removal of the nail may be necessary.

Treatment Modalities

Treatment for toenail fungus varies based on the severity of the infection and the individual patient’s needs. Here’s a breakdown of the most common treatment options.

Lamisel (Oral Antifungal)

Currently, Lamisel is the most widely accepted treatment for toenail fungus. This oral medication is taken once daily for three months, with a success rate of around 70-80%. While effective, Lamisel comes with a minimal risk to the liver, similar to other medications like Lipitor. For this reason, patients undergoing treatment with Lamisel are monitored for liver function through lab work.

Another oral antifungal is Gris-Peg, though it is generally less effective than Lamisel. However, Gris-Peg is more likely to be covered by insurance.

Topical Treatments

For patients unable or unwilling to take oral medication, topical treatments become the primary option.

• Penlac: Penlac is a nail lacquer that is applied daily. While it is now available in a generic form, making it more affordable, it has a low success rate (10-15%) and requires a commitment of 48 weeks. Patients must apply the lacquer every morning and remove it with alcohol every night.
• Formula 3: This is a non-prescription, oil-based nail lacquer sold in our office. It requires application 1-2 times a day and costs around $40. Formula 3 offers a money-back guarantee if there are no results, providing reassurance to patients.
• Fungisel: A new product we are marketing, Fungisel is a topical version of Lamisel. It is expected to be priced similarly to Formula 3, and also comes with a money-back guarantee.

Laser Therapy

Laser therapy is a relatively new option for treating toenail fungus. While no conclusive scientific studies have proven its efficacy, it is a growing treatment modality. Unfortunately, due to the lack of scientific validation, insurance companies typically do not cover the cost, which can be as high as $800 per foot. Until more evidence is available, most providers, including our office, continue to recommend the aforementioned therapies.

Home Remedies

Several home remedies have been suggested for treating toenail fungus, often with mixed results. Fungus thrives in moist, dark environments, so the goal is to dry out the nail and keep the feet clean. Here are a few home remedies:

• Rubbing Alcohol or Apple Cider Vinegar: After showering, apply rubbing alcohol or apple cider vinegar to the affected nail.
• Lysol Spray: Spraying the inside of shoes with Lysol disinfects the area and kills fungus.
• Foot Powder: Regular use of foot powder can help reduce moisture buildup.
• Other Remedies: Some patients have reported success with products like Vicks Vapor Rub, Listerine (old school kind), or even bleach. However, these remedies often require strict daily use for up to a year to see results.

Conclusion

Toenail fungus is a stubborn condition that requires a tailored approach depending on the severity of the infection and the patient’s individual circumstances. While there are several effective treatments, including oral antifungals like Lamisel and topical lacquers like Penlac and Formula 3, none of these options are foolproof. Laser therapy offers promise but lacks scientific backing, while home remedies can offer a low-cost alternative but may take longer to show results.