The medical treatment of nail fungus is divided into topical and systemic. Topical treatments include special creams and nail varnishes containing antifungal drugs. Systemic treatment consists of oral antifungal drugs in the form of capsules or tablets. Antifungal drug therapy is the cornerstone of nail fungus treatment.
However, even the most up-to-date, state-of-the-art drugs do not prevent re-infection and do not ensure a rapid recovery if disinfection of shoes and feet is not carried out.
Topical antifungal drugs
As already mentioned, these are various creams, solutions and nail polishes that contain antifungal agents and act on the surface of the skin. The effectiveness of topical agents is very limited. The nail plate is quite thick, so the drugs do not penetrate deeply enough to produce the necessary concentration of the drug in the nail to kill the fungus that has grown. Thus, in most cases, topical treatments cannot cure nail fungus. However, these preparations have fewer side-effects than treatment with systemic drugs. Topical treatment of nail fungus is recommended in the following cases:
- In superficial white onychomycosis
- Less than 50% of the nail plate is affected
- Few nails are affected (i.e. no more than 2-3)
- In children with thin and fast growing nails
- Patients intolerant to systemic therapy or with contraindications to oral medications
- For maintenance of the treatment effect after systemic therapy
- In combination with other treatment modalities (e.g. laser therapy or oral medications)
The most common antifungal nail lacquers include amorolfine, ciclopirox. These are used for a long period of time, about 6-12 months, until a healthy nail grows back.
Antifungal creams contain terbinafine, naftifine, ketoconazole and other active ingredients. These also have to be used for a long time.
To increase the effectiveness of topical medication, it is recommended to reduce the mass of the infected nail, e.g. by milling. When the nail plate is flattened, more of the active substance penetrates into the nail, resulting in a higher concentration of the drug in the nail.
Systemic antifungal treatment
Oral antifungal agents are more effective in treating nail fungus than topical agents. The main advantage of oral medication is that sufficient concentrations of the drug reach the nail, and the drug remains in the nail plate for some time, even after the medication has been stopped. However, they also have a higher chance of adverse reactions and may interact with other medicines the patient is taking. The main oral antifungals are terbinafine, itraconazole, fluconazole. Systemic therapy is recommended in the following cases:
- Multiple nails affected, usually more than 2-3
- Damaged nail sucker
- More than 50% of the nail plate affected
- No improvement after 6 months of topical treatment
- Deep white onychomycosis
- Proximal subcutaneous onychomycosis
Before prescribing a systemic antifungal treatment, it is necessary to assess the general condition of the organism and to perform certain laboratory tests. It is particularly important to investigate liver function and to carry out a complete blood and urinalysis. Treatment with oral antifungal drugs should only be started after assessment of the internal organs.
Systemic antifungal therapy is not indicated in the presence of hepatic or renal impairment, cardiac insufficiency, pregnancy and lactation. In addition, it is important to assess drug-drug interactions, e.g. terbinafine may interact with antidepressants, beta-blockers.
Regular blood tests, at least every 6 weeks, are recommended when taking oral antifungals, and liver function tests should be performed. The most common adverse effects of these drugs are indigestion, nausea, bloating, diarrhoea, headache, and elevated liver enzymes in the blood.
Medical treatment for nail fungus can take several months.
Medication is given until a healthy, beautiful nail grows back and no fungus is detected on examination (nail microscopy, culture).
Medical treatment of nail fungus can be combined with other treatment methods such as surgical removal of nail plates or laser therapy.
The nail fungus photos in our gallery can also help you to recognise if you have nail fungus.
