Effective Treatments for Severe Nail Fungus: Options Beyond Nail Removal

Q: Effective Treatments for Severe Nail Fungus: Options Beyond Nail Removal

Hello： For a detailed introduction to onychomycosis (fungal nail infection), you can refer to the article on the Dermatology Expert Health website http：//www.drskincare.com.tw/Qa/Index.aspx?CID=12. <br>Generally, for older adults, it is still recommended to use topical medication

Severe onychomycosis

Hello, doctor.
My grandmother has a very severe case of onychomycosis.
After researching online, I found that most topical treatments are suitable for mild to moderate cases, but oral medications may have side effects such as vomiting.
So I would like to ask if the only treatment option in this situation is to remove the nail? Since my grandmother works in the fields every day, removing the nail would be very inconvenient.
Are there any other topical medications that are suitable for severe onychomycosis patients? Thank you for your response.

P, 20~29 year old female. Ask Date: 2016/05/07

Dr. Li Yufen reply Dermatology

Hello: For a detailed introduction to onychomycosis (fungal nail infection), you can refer to the article on the Dermatology Expert Health website http://www.drskincare.com.tw/Qa/Index.aspx?CID=12.
Generally, for older adults, it is still recommended to use topical medications for treatment, although the course may take six months to over a year.
Before applying the medication, you can use a nail file to slightly thin the thickened nails to facilitate better absorption of the medication.
Thank you!

Reply Date: 2016/05/07

More Info

When it comes to treating severe nail fungus, particularly in elderly patients like your grandmother, there are several options to consider beyond simply removing the nail. Nail fungus, or onychomycosis, can be quite challenging to treat, especially in severe cases, but there are effective treatments available that can help manage the condition without resorting to nail removal.

Oral Antifungal Medications
Oral antifungal medications are often the first line of treatment for severe nail fungus. Two commonly prescribed medications are Terbinafine (Lamisil) and Itraconazole (Sporanox). These medications work systemically to eliminate the fungal infection from within, and they are generally more effective than topical treatments for severe cases.
- Terbinafine is particularly effective against dermatophyte infections, which are the most common cause of nail fungus. It is usually taken for 6 to 12 weeks, depending on the severity of the infection.

- Itraconazole has a broader spectrum of activity and can be effective against both dermatophytes and non-dermatophyte fungi. It can be administered in a pulse therapy regimen, which may be more convenient for some patients.

While these medications can have side effects, including gastrointestinal issues like nausea or vomiting, they are typically well-tolerated. It's important for your grandmother to discuss her medical history with her healthcare provider to ensure that these medications are safe for her, especially if she has any underlying health conditions.

Topical Antifungal Treatments
For patients who may not tolerate oral medications well, or for those who prefer to avoid them, there are topical antifungal treatments available. However, it’s crucial to note that topical treatments are generally more effective for mild to moderate cases. In severe cases, they may need to be used in conjunction with oral medications.

- Ciclopirox (Penlac) and Efinaconazole (Jublia) are examples of topical treatments that can be applied directly to the affected nails. They may require consistent application over several months to see significant improvement.

Combination Therapy
In some cases, a combination of oral and topical treatments may be recommended. This approach can enhance the effectiveness of treatment, especially in severe cases where the infection is extensive.

Non-Pharmacological Options
In addition to medication, there are non-pharmacological approaches that can help manage nail fungus:
1. Nail Care: Keeping the nails trimmed and filed can help reduce the amount of infected nail material and improve the penetration of topical treatments.

2. Foot Hygiene: Regularly washing and thoroughly drying the feet, especially between the toes, can help prevent further fungal growth.

3. Footwear Choices: Wearing breathable shoes and moisture-wicking socks can help keep the feet dry and reduce the risk of fungal infections.

Nail Removal
While nail removal is an option, it should typically be considered a last resort, especially for someone who is active and works outdoors, like your grandmother. The recovery time and potential complications from nail removal may not be worth it if effective treatments are available.

Conclusion
In summary, while severe nail fungus can be difficult to treat, there are multiple options available that do not involve nail removal. Oral antifungal medications are often the most effective, but topical treatments and combination therapies can also be beneficial. It’s essential for your grandmother to consult with her healthcare provider to determine the best treatment plan tailored to her specific situation. With the right approach, it is possible to manage and potentially cure severe nail fungus effectively.

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