Ask The Experts

Why do all podiatrist and dermatologist not know about toe nail fungus? I have been to 5 doctors for 10 years, but no one can treat me for the toenail fungus. What is so hard about this?

Thank you for contacting IPFH. We do not diagnose or provide treatment recommendations on line. Toenail fungus can be very difficult to cure: the toenail grows relatively slowly, and the warm and often damp environment of a shoe or boot tends to encourage fungal growth. In fact, some of the best medications on the market today have cure rates only slightly better than 50%. Treatments include topical creams, gels, nail lacquers, and oral medication. In some rare cases, surgery may be necessary to resolve the infection.

New topical medications have just come into the market in the last few years. Two of the new nail lacquers, tavaborole (brand name 'Kerydin') and efinaconazole (brand name 'Jublia'), have been shown to be effective in between 7% to 18% of cases. They can cost around $600 per bottle, and the medication has to be applied every day for nearly a year to be effective. Older paint-on drugs such as ciclopirox (Penlac nail lacquer and the generic version) have shown success in about 6 to 9% of cases. Oral prescription anti-fungals such as terbinafine (Lamisil and the generic version) are more effective, resolving up to 66% of cases after twelve weeks. But oral medications can pose potential risks that include rash, digestive discomfort, headache, loss of sense of smell, and in some cases, liver problems. There is some evidence to suggest that laser treatments can be effective against toenail fungus. This is an expensive option and more research needs to be done; but it can be an alternative for people who don’t want to risk the potential side effects of oral medications. None of this information is meant to alarm you, but rather we note it to help make you aware of the complexities of treating toenail fungal infections.

We should also mention that some home remedies may also work. For example, a recent small study suggested that mentholated ointments such as Vicks VapoRub might be effective in treating toenail fungus, depending on the particular microbe that is causing the infection. However, more studies are needed to confirm this remedy's efficacy.

Our best advice to you is to start back at "square one:" Consult with your primary care physician and have him or her help you determine the best course of action for treatment. He or she knows your medical history and can recommend and work with a specialist such as a podiatrist or dermatologist to help determine your next step. Two important things to remember: Treating a toenail fungal infection is a long process, and not all remedies may be advisable for you based on your overall medical condition. While toenail fungus can be annoying and unsightly, unless you have diabetes, it does not pose a significant risk to your overall health (people with diabetes should always seek treatment for fungal infections, since they can produce irritations and lesions in the skin that might develop into sores that can lead to ulceration).

We hope you will continue to seek medical advice and treatment, and that it will lead to the resolution of your condition.

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