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May 30, 2020

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

That was the query posed in a New York Times Science Q & A.

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."

May 30, 2020 at 02:01 PM | Permalink


My father had a horrific case of Army toenails that dated back to D-Day, at least, and growing up in a one-bathroom house with a tub shower, my mother, brother, and I all got to share the mycotic nightmare and there's no oil or acid or radiation or Nobel prize-winning dermatologist on earth that could put a dent in it.

Posted by: Flautist | Jun 2, 2020 9:10:32 AM

I just use tea tree oil! Cheap and effective. And antifungal.

Posted by: clif marsiglio | Jun 1, 2020 8:03:46 PM

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