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April 13, 2013

BehindTheMedspeak: "Is there any cure for toenail fungus that doesn't involve a risky drug?"

That was the question posed in Tuesday's New York Times Science question.

Writer Anahad O'Connor's answer:


The germs that cause toenail fungus, or onychomycosis as it is known in the medical world, are tough to avoid. They thrive near pools, in gyms, on clothing and can even hide in carpeting. So it may be no surprise that at some point in their lives, roughly 1 out of 10 adults develop the infection, which can leave nails brittle, discolored and inflamed.

Many treatment options exist, though most have side effects. And no matter what the choice, complete eradication is difficult, and re-infection is common.

One of the most effective treatments is the drug Lamisil, which is taken orally for 90 days and works for about two out of three people. But it has been associated with rare cases of liver damage and may require regular liver function tests, which can scare people away.

"The 'risk' of oral therapy has been largely overstated," said Dr. Bryan C. Markinson, the chief of podiatric medicine and surgery at the Mount Sinai School of Medicine. "The truth is that after tens of millions of uses worldwide, this therapy is unequivocally safe."

Another option is treating the nail and surrounding skin with an antifungal nail polish. Prescription nail lacquers like ciclopirox have been clinically tested and approved by the Food and Drug Administration, and shown to be efficacious when used as directed, though not as effective as oral drugs; over-the-counter topicals are also available but have not been tested.

With the exception of skin allergies, topical antifungals carry little risk of side effects, but they remain unpopular with patients. "It's not because they don’t work," Dr. Markinson said. "It's that they must be used for a minimum of one year on a daily basis to have any chance at a cure. Most patients lose enthusiasm after the first three months."

The F.D.A. has approved laser therapy procedures for toenail fungus as well. One clinical trial involving a type of laser called Noveon found that nine months after treatment, just over a third of patients were cured. The downside? Laser therapy is costly — a single treatment can run $1,000 — and there have been some cases of burns on nails and the surrounding skin.

If you prefer a more natural alternative, there is some evidence that thymol oil, an antiseptic derived from thyme, may help. Proponents of thymol advocate adding the oil to regular footbaths, or coating the affected toenail once or twice a day with Vicks VapoRub. The risks in this case are allergic skin reactions and temporary reddening of the skin.


"Bag those toenails."

April 13, 2013 at 12:01 PM | Permalink


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I keep a spray bottle of undiluted white vinegar in the shower, and spray my feet right before I dry them off every day. I also use a hairdryer to make sure my feet are completely dry before putting on my shoes and sox. The nail fungus I acquired from the gym's hot tub has been eradicated. My nails are 'normal' now, and have been for over a year.

Posted by: fun guy | Apr 14, 2013 3:43:36 AM

Seem to recall Tolnaftate 1%.

Posted by: joepeach | Apr 13, 2013 7:46:41 PM

I use a 5% solution of white vinegar with 1 gallon of water as a foot soak for 5 minute every other day. Then dump the remains in the shower stall to kill spores. The solution also works to clean the grout and drains. I learned this in the US Army. In VN we used to dip equipment in the same solution to kill fungi that grew on everything. good luck

Posted by: John | Apr 13, 2013 1:36:14 PM

I found that keeping my feet bare as much as possible (even slipping off shoes under my desk, so they could stay dryer) and especially exposing them to at least 20 minutes of direct sun every day seemed to help accelerate the cure.

Posted by: MsRadoo | Apr 13, 2013 11:36:05 AM

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