| Medications for onychomycosis fall into two categories; topical and oral. There are any number of effective topical medications available over the counter. Topical medications are most helpful in treating early, small infections and for maintaining clear nails. Topical medications do have a limited ability to penetrate the nail to reach all of the fungal elements. Topical medication inhibit the growth of the fungus allowing for faster growth of the nail. Remember, the fungus doesn't take a day off. Compliance is a big issue when using topical antifungals. The FDA approved a new prescription strength topical medication for treating onychomycosis in 1999 called Penlac. (Dermik Laboratories, Collegeville, PA). Penlac is manufactured in Frankfurt, Germany by Aventis Pharma Deutschland GmbH. Penlac doesn't carry the side effects of the oral medications but the jury is still out on the efficacy of this medication. The older generations of oral antifungal medications, such as Fulvicin or Griseofulvin, have been used successfully for years and are making a comeback due to their economic value. The newer generation of oral antifungals, including Sporanox and Lamisil have been received very well by the medical community. Care should be taken when using Sporanox due to its' potential liver toxicity. Both Sporanox and Lamisil are expensive medications costing several hundred dollars for the recommended three month course of treatment. When all else fails, the fungal toe nail can be permanently removed. This procedure is not difficult to perform and most patients return to their normal shoes in just a Band-Aid in 24hrs. The removal of the nail is permanent. Which choice is right for you? Consider the following two examples; Case 1. Sandy is a 24 year old hairdresser who has intimate hands on contact with her clients on a daily basis. She has developed a fungal infection in several of her finger nails. She is concerned that the fungal infection will have a direct impact on her livelihood and does not want to spread the infection to others. Case 2. Joe is a 62 year old farmer and has a long history of injuries to his hands and feet. His last visit to the doctor showed signs of an increase in his liver enzyme studies indicating an overall decrease in his liver function. Joe has developed onychomycosis in most of his toe nails. I think the choices for Joe and Sandy are clear but in most cases the criteria to make recommendations for treatment of onychomycosis are not as obvious. In those cases, patients should consult their physician to discuss the pros and cons of oral antifungal treatment. |