and Treating Toenail Fungus: Expert Insights and Safety Concerns

Questions about toenail fungus?

Dear Dr.
Jiang,
I am currently residing in Germany and have been struggling with onychomycosis (fungal nail infection).
I have previously undergone treatment in Taiwan twice, the most recent being two years ago.
German doctors are quite resistant to using oral medications for this condition.
I would greatly appreciate your insights to help me decide whether to pursue treatment here.
1.
Is it possible to take Flucoderm capsules (50mg) once daily for two weeks, followed by a one-week break, continuing this cycle until healthy new nails grow, and then switch to topical treatments? What is the likelihood of recurrence with this approach? Are there concerns regarding drug resistance?
2.
I underwent a 12-week course of oral medication two years ago.
Is it safe to initiate another course of oral medication now? Additionally, if this would be my third course of oral medication in ten years, is there a risk of harm to my liver or kidneys?
3.
Once diagnosed with onychomycosis, is it a lifelong condition that cannot be eradicated, even with careful preventive measures?
Thank you very much, and I wish you peace and health!

Taiwanese, 40~49 year old female. Ask Date: 2006/07/14

Dr. Jiang Zheen reply Dermatology

The ingredient in Flucoderm is not fluconazole.
This medication is less commonly used in Taiwan for treating onychomycosis (fungal nail infection), and personal experience with it is limited.
In Taiwan, we commonly use two classes of medications: Sporanox (itraconazole) and Lamisil (terbinafine), which are generally considered safe as long as liver function is normal.
Reports indicate that abnormal liver function typically occurs within 2 to 4 weeks of medication use.
Based on your previous experience with these medications without side effects, you should be able to use them again with confidence.
Fluconazole is considered a second-line treatment in Taiwan, possibly due to its higher side effect profile.
Onychomycosis is an infectious disease, and recurrence can occur for two reasons: 1) the previous treatment was not fully effective, or 2) reinfection occurred.
If the treatment is fully effective, maintaining cleanliness and dryness of the affected area, avoiding wearing others' shoes, and using your own flip-flops in bathrooms, pools, and public places can help prevent recurrence.
Wishing you peace, and Jesus loves you.

Reply Date: 2006/07/14

More Info

Toenail fungus, medically known as onychomycosis, is a common condition that can lead to discomfort, pain, and cosmetic concerns. It is caused by various types of fungi, including dermatophytes, yeasts, and non-dermatophyte molds. Understanding the treatment options and safety concerns associated with toenail fungus is crucial for effective management.

1. Oral Treatment with Flucoderm (Fluconazole): The proposed regimen of taking Flucoderm capsules (50mg) once daily for two weeks, followed by a week off, is a common approach in antifungal therapy. This method is often referred to as pulse therapy. The goal is to allow the medication to build up in the body and target the fungal infection effectively. However, the recurrence rate of toenail fungus can be high, even after successful treatment. Factors such as underlying health conditions, hygiene practices, and environmental exposure can contribute to the likelihood of reinfection. Regarding drug resistance, while it is a concern with any antifungal treatment, fluconazole is generally effective against most strains of fungi that cause toenail infections. However, if the fungus is resistant, alternative treatments may be necessary.

2. Safety of Repeated Oral Treatment: If you previously underwent a 12-week course of oral antifungal medication two years ago, it is generally safe to consider another course of treatment, provided that your liver and kidney functions are normal. Regular monitoring of liver enzymes is recommended, especially if you have a history of liver issues or are taking other medications that may affect liver function. The risk of liver or kidney damage increases with prolonged use of antifungal medications, so it is essential to have a thorough discussion with your healthcare provider about your medical history and any potential risks involved in repeated treatments.

3. Long-term Management of Toenail Fungus: Once a person has contracted toenail fungus, it does not necessarily mean they will have it for life. With appropriate treatment, many individuals can successfully clear the infection. However, the risk of recurrence is significant, especially if preventive measures are not taken. Maintaining good foot hygiene, keeping feet dry, wearing breathable footwear, and avoiding walking barefoot in communal areas can help reduce the risk of reinfection. Additionally, using antifungal powders or sprays in shoes and regularly changing socks can further minimize the chances of recurrence.

In conclusion, toenail fungus can be effectively treated with oral antifungal medications, but careful consideration of the treatment regimen, potential side effects, and the risk of recurrence is essential. It is advisable to consult with a healthcare professional who can provide personalized recommendations based on your medical history and current health status. Regular follow-ups and monitoring can help ensure that any potential complications are addressed promptly, allowing for a more successful outcome in managing toenail fungus.

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