There are several different ways to treat nail fungus. You can use topical anti-fungals, take prescription medication, have your nails surgically removed, use laser therapy or any combination of these treatments. While there may be different ways to treat your toenails, doctors agree that it is best to treat the fungus as soon as it is noticed.

In early cases, over the counter or topical medications may be sufficient. However, studies have shown that once the fungus has significantly invaded the nail, topical anti-fungals creams and lacquers are only about 15% effective on their best day. The nail lacquers, or polishes, most commonly used are prescription Penlac, doctor recommended Formula 3, or Tea Tree oil found in most pharmacies. If you decide to use a nail lacquer, you must use it daily and remove it with an emory board once per week to prevent build up on the nail. Some patients decide to take oral medication for nail fungus treatment. This is, BY FAR, the LEAST effective way to treat nail fungus.

Lamisil is the most commonly prescribed pill to treat nail fungus. Until recently, oral medication was considered the “gold standard” treatment for this condition. Studies have proven that Lamisil is 81% effective and is a very safe medication. In order to receive a prescription, you need to have a nail biopsy confirm that the toenail is fungal. Additionally, a liver function blood test needs to be performed to make sure that your liver is functioning normally. Lamisil is filtered through the liver. If there is a problem with your liver, the medication can make the problems worse. If your liver is functioning normally, studies have shown that Lamisil will not cause any damage to your healthy liver. The most effective way to take this medication is one pill daily for 90 days.

Laser therapy is fast replacing prescription medication as the “go to” treatment for nail fungus. There are no pills to take, no side effects, and no interactions with medications. Laser treatment can be tolerated by anyone. Most importantly, laser treatment has been found to be up to 85% effective in test patients. The only downside to laser treatment is that it is not covered by most insurance carriers, so it is an out of pocket expense. Most patients require only one to two sessions, although there are studies that track up to 4 sessions in test patients. Most patients will notice some clearing in the nail at about 2 to 3 months with full clearing seen at about 8 months to 1 year.

The most extreme form of treatment for nail fungus is to surgically remove the nail. This is usually reserved for patients with very thick toenails who just “do not want to have to deal with it anymore.” These patients usually have pain associated with the extreme thickness of their toenail. It is typical for these patients to deal with these nail problems for decades. In our office, when we perform the procedure, we remove the nail permanently. We do this because a temporary procedure that allows the nail to grow back does not insure a “clear” nail will grow in the old nail's place. When you remove a nail, you disrupt the root of the nail, and in essence, cause injury to the root and the nail bed. If you have read the previous articles I've written about nail fungus, you will know that nail injury can mimic the look of nail fungus. So, if we temporarily remove the nail, but damage the nail bed and the root in the process, the new nail that grows back (while it may not be fungal) may be injured and thus “look” fungal. If that is the case you just went through a nail procedure for nothing. Why? Because you still have a fungal looking nail. So, if you choose to go the surgical route, my advice is permanent nail removal.

* Our next article deals with what to do AFTER your nails are cleared of fungus.