A New Toe Hold In the Fight Against Toenail Fungus

February 20, 2015

Drs. Michael Zapf, Darren Payne & Steve Benson

Dreading wearing sandals or flip-flops because of unsightly toenails? You are not alone. An estimated 35 million people in the United States suffer from toenail fungus, a disease that discolors, cracks and thickens toenails.

Toenail fungus is caused by damage to the nail, which leads to fungal infection. Causes include physical activities, genetics, poor circulation and certain medical conditions. Almost half of those aged 70 and older are affected. Fungus can spread through common use of wet towels, improper foot hygiene or walking on contaminated floor surfaces and even from pedicures.

Your Options
Until the introduction of laser technology six years ago, the only approved treatment for fungal nails was a course of pills, usually Lamisil, or the daily use of Penlac, a topical lacquer that produced poor results. The pills are still used today and are remarkably effective with a 70 to 80 percent chance of clearing up nails. Unfortunately, the recurrence rate is quite high, and because of a small but real chance of liver and blood damage, doctors need to check liver and blood function with laboratory tests.

Laser treatment can help the 20 percent that are not helped by oral medicine or those with preexisting liver or blood problems. The treatment is not a one-time event. A little over half of the patients who use only laser reach a satisfactory endpoint after 12 to 18 months of treatments. It is still not as effective as the full dose of oral therapy.

A new topical antifungal medication, Jublia, has been on the market for a few months and is showing as much as a 50 percent success rate. If your goal is to get rid of the fungus as soon as possible without risk, consider combining laser treatment with Jublia. The combination is likely to be as successful as oral medication but without blood tests and the possible side effects. Check with your podiatrist for the best options for you.