Toenail Fungus: Treatment Options and Liver Health Concerns

Onychomycosis

Hello Dr.
Liao, I have been experiencing a problem with onychomycosis in my big toes.
Three years ago, I received treatment with an oral medication that I believe was called "Sporanox" (I'm not quite sure, but after six months there was no improvement).
I am a carrier of hepatitis B, and during the previous treatment period, I regularly monitored my liver function, which fortunately did not show any abnormalities.
Additionally, blood tests and ultrasounds conducted in March of this year were normal.
However, the onychomycosis has been a long-standing issue for me, causing psychological distress and inconvenience in my daily life.
I would like to ask the doctor: 1) What is the success rate of re-initiating oral medication treatment, considering my previous treatment was unsuccessful? 2) If I were to undergo oral medication treatment again, what is the likelihood of causing liver damage? Is it possible to attempt treatment once more? I would greatly appreciate your detailed response! Sincerely, Mr.
Yang, a patient troubled by onychomycosis.

Mr. Yang, 20~29 year old female. Ask Date: 2001/06/23

Dr. Liao Wenyu reply Dermatology

1.
If the medication is ineffective, it is recommended to switch to another drug.
2.
The likelihood of developing liver abnormalities is actually low (the abnormal liver enzyme levels occur in about 3-4%, but the incidence of significant hepatitis is approximately one in a hundred thousand).

Reply Date: 2001/06/23

More Info

Dear Mr. Yang,
Thank you for reaching out with your concerns regarding toenail fungus and the implications of treatment given your status as a carrier of Hepatitis B. It’s understandable that living with toenail fungus (onychomycosis) can be distressing, especially when it affects your quality of life. Let’s address your questions regarding treatment options and liver health.

1. Success Rate of Oral Antifungal Treatment: The success rate of oral antifungal medications, such as Itraconazole (Sporanox) and Terbinafine (Lamisil), can vary based on several factors, including the specific type of fungus causing the infection, the duration of treatment, and the patient’s overall health. Generally, studies suggest that Terbinafine has a higher success rate (around 70-90%) compared to Itraconazole, especially for dermatophyte infections. However, since you mentioned that your previous treatment with an oral antifungal was unsuccessful, it’s crucial to confirm the diagnosis and the specific type of fungus involved. A mycological culture or a nail biopsy may be necessary to identify the organism accurately. This information can guide the choice of the most effective treatment.

2. Liver Health Concerns with Oral Antifungal Medications: Given your status as a Hepatitis B carrier, it’s wise to be cautious about medications that can affect liver function. Both Itraconazole and Terbinafine have been associated with liver enzyme elevations in some patients, although this is relatively rare. Since you have a history of normal liver function tests and have been monitored regularly, the risk of significant liver damage remains low, but it is not negligible. Before starting any oral antifungal treatment, it’s essential to have a thorough discussion with your healthcare provider about the potential risks and benefits. They may recommend baseline liver function tests and regular monitoring during treatment to ensure your liver remains healthy.

In your case, if you decide to pursue oral antifungal therapy again, your doctor may consider a few strategies to mitigate risks. These could include:
- Choosing the Right Medication: Depending on the specific fungus identified, your doctor may opt for a medication with a better safety profile for patients with liver concerns.

- Monitoring: Regular liver function tests during treatment can help catch any potential issues early.

- Alternative Treatments: If oral medications pose too much risk, topical antifungal treatments might be an option, although they are generally less effective for extensive infections.

Additionally, lifestyle modifications can support your treatment. Keeping your feet dry and clean, using antifungal powders, and avoiding tight footwear can help reduce fungal growth.

In conclusion, while there are effective treatment options available for toenail fungus, your unique health situation necessitates a careful approach. I strongly recommend consulting with a dermatologist who can assess your condition and provide a tailored treatment plan that considers both the fungal infection and your liver health.
Thank you for your inquiry, and I wish you the best in your treatment journey.

Sincerely,
Doctor Q&A Teams

Similar Q&A

Managing Toenail Fungus: Safe Treatment Options for Future Mothers

I have had toenail fungus on eight toes for many years. I know there are oral medications available for treatment, but I have been hesitant to take them because I plan to have children and I'm concerned about potential effects. I've also heard that these medications can...

Dr. Zheng Lizhen reply Dermatology
1. New oral antifungal medications may cause a slight increase in liver transaminase levels in a small number of patients (not indicative of liver damage), but this is usually temporary and will return to normal after discontinuation of the medication. There have been very rare r...

Managing Toenail Fungus: Safe Medication Options and Liver Health

Hello Doctor, I have been troubled by a toenail fungus issue affecting all ten of my toes for the past few years. Last year, I visited a dermatologist from June 11, 2022, to September 1, 2022, and was prescribed 100 mg of Itraconazole capsules. I took it for three months, and the...

Dr. Wu Yuxin reply Dermatology
If you feel that taking medication is a burden, you need to carefully consider it. After all, the decision to take medication or not is ultimately yours; the doctor cannot make the final decision for you, and you must weigh your options.

Effective Treatments for Nail Fungus: A Guide to Managing Onychomycosis

How is nail fungus treated?

Dr. Jiang Yujiao reply Dermatology
Hello: The treatment options for onychomycosis include topical antifungal medications or oral antifungal medications. However, oral antifungal medications should only be used in individuals with normal liver function. Response from Jiang Yujiao.

Understanding Treatment for Athlete's Foot and Nail Fungus

I went to see a doctor because my feet have been peeling, and there is no pain or itching. The doctor diagnosed me with athlete's foot and onychomycosis (fungal nail infection). The doctor prescribed Sporanox (itraconazole) for me. Is it harmful to the liver? There is also a...

Dr. Wu Huiling reply Pharmacology
Hello! "Athlete's foot" is a superficial fungal infection that occurs on the feet, often leading to thickening of the plantar keratin (which can be treated with exfoliants like salicylic acid) and even fissures. It is commonly associated with nail involvement, resu...