By Gary D. Prant DPM
There’s much hype lately about treating the humdrum problem of toenail fungus with a high tech laser. Many forget the less glamorous but inexpensive and effective treatments for this problem. Combining one ancient treatment with a new topical drug is proving extremely effective for my patients without the use of far more expensive laser treatment.
Ten percent of the U.S. population – some 35 million Americans – suffer from toenail fungus, or onychomycosis. Before they head out for the “latest and greatest” treatment of toenail fungus, they might want to try longtime remedies and new medications.
The mainstay of fungus nail treatment for podiatrists going back maybe hundreds of years – maybe thousands – has been debridement of the toenails. Debridement is an ugly, yet fancy, medical word for grinding down the toenail so it is thin and then using an instrument to clean out the debris underneath the toenail. This reduces the fungus in the toenail by removing some of the fungus underneath the nail. Also, thinning the toenail allows topical medicine to penetrate the nail and kill the fungus within it. An important side benefit of debridement is that the toenail immediately looks much better. I have seen fungus toenails almost an inch thick. A toenail that thick can be painful in a shoe and is nearly impossible to cure with a topical medicine because nothing can penetrate that thick toenail.
Combined with the age-old treatment of debridement, there are several new topical medications which are remarkably more effective then medications available just a few years ago. We have been getting excellent results with a new form of topical terbinafine. Terbinafine is the exact same medicine which was used in oral Lamisil. Oral Lamisil is the most effective medication for fungus toenails but there is a concern about side effects. The new topical version of terbinafine avoids the systemic side effects. There are several other effective new topical medications which we use for fungus toenail problems in specific patients.
It takes about nine months to one year for a new toenail to completely grow in. Whether you spend $750 or more for a laser procedure, or pay your co-pay for an office visit and buy the new topical fungus toenail treatments, you will need to be patient for a clear toenail.
Read my opinions of currently offered laser treatment for toenail fungus here and my thoughts of the procedure in general here. While I DO support the use of lasers for certain podiatry complaints and have had great success in my office with conditions like ingrown toenails, I recommend my patients wait a bit longer to treat toenail fungus until the next generation of lasers is released — and that may be in just a few months.