Now this is the million dollar question! If someone had a fool proof treatment plan, then everyone would be following it. Just as nail fungus is opportunistic and difficult to predict how and who gets it, it is important to treat it from all angles.
At our office, we have topical and oral options. Our first line of topical treatment is Tolcylen. It is a topical antifungal with other compounds to treat the thickness of the nail and allow penetration of the medication, with a convenient brush to allow you to apply the medication under the nail as well, because remember, it actually lives on the nail bed. But most importantly, when treating the nail fungus, the environment must be treated as well. If a patient has a nail fungus, he may have a concurrent athlete’s foot infection. The same fungus that causes athlete’s foot also causes nail fungus, so a topical cream may be prescribed to treat the skin as well. Our office carries Tolcylen cream for athlete’s foot.
For recalcitrant nail fungus, an oral medication is also available, oral Lamisil. Before this medication is given, the patient must undergo blood tests to make sure their liver is able to metabolize this medication without causing liver damage. The course for the oral medication is 3 months. We recommend using the topical medication in conjunction with the oral medication, and continue using the topical for maintenance after that because we see a recurrence of the fungus even after the oral medication course is finished. In extreme cases, if there is a specific nail that is particularly thickened or painful, we may suggest removing the nail completely, wait for the nail bed to heal, and then apply the topical with or without the oral medication. In addition, the environment has to be changed, including the shoes. We also carry a shoe spray and recommend using this in conjunction with the topical and oral medications. Believe it or not, the fungus can live in the shoes even when you are not wearing them. If you treat the fungus on your nails and skin, you may get re- infected over and over again when you fail to treat your shoes.
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