Oral Medications for Toenail Fungus and Thick Skin Treatment Explained

Oral medication treatment for onychomycosis (fungal nail infection) and thickened skin associated with athlete's foot (tinea pedis)?

Hello doctor, I have had athlete's foot for about 15 years and onychomycosis for about 7 to 8 years, affecting around 6 of my toenails.
I have the hyperkeratotic type of athlete's foot, and my hands are also affected due to scratching my feet.
I am considering taking oral medication for onychomycosis, but will this also help eliminate the hyperkeratotic athlete's foot? I have tried various topical treatments without success.
If I take antifungal medication, will I need to physically remove the thick skin as well? Would using a foot soak powder or foot mask containing salicylic acid help in treating the thick skin? Are there any new oral medications available now? Each hospital offers different medications; how should I choose? Which medication is more effective?
Regarding liver function tests, should I also check kidney function just to be safe? Do these medications affect liver function, and do they also impact the kidneys? Additionally, do hospitals conduct detailed fungal testing now, or do they just prescribe medication without further investigation?
Also, could you recommend any doctors at National Cheng Kung University, Chi Mei Medical Center, or Tainan City Hospital? Is it better to go to a hospital or a clinic? Are there any authoritative doctors in other regions who specialize in this treatment, or does it not make a difference? I apologize for the many questions.
Thank you for your advice, and I wish you good health and happiness.

xun, 30~39 year old female. Ask Date: 2012/08/29

Dr. Yang Zhiya reply Dermatology

Hello, oral antifungal medications for nail fungus can also be helpful for athlete's foot.
As for whether the thickened skin is caused by athlete's foot or other factors, a physician needs to examine the lesions in person to provide a diagnosis.
Currently, the National Health Insurance in Taiwan covers only two medications for nail fungus: Terbinafine and Itraconazole.
Both have similar efficacy and are metabolized by the liver, which is why the insurance only covers liver function tests and not kidney function tests.
I recommend that you consult a dermatologist for examination and treatment.
Thank you!

Reply Date: 2012/08/29

More Info

When it comes to treating toenail fungus (onychomycosis) and thick skin associated with athlete's foot (tinea pedis), oral medications can be an effective option, especially for chronic cases like yours. Given that you have been dealing with athlete's foot for about 15 years and toenail fungus for 7-8 years, it is understandable that you are seeking a more aggressive treatment approach.

Oral Medications for Fungal Infections
The most commonly prescribed oral antifungal medications for toenail fungus include terbinafine (Lamisil) and itraconazole (Sporanox). These medications work by inhibiting the growth of fungi, allowing the body to clear the infection. Terbinafine is often preferred due to its efficacy and shorter treatment duration, typically lasting about 6 weeks for toenail fungus. Itraconazole may require a longer treatment period and is sometimes used in a pulse dosing regimen.

Thick Skin Treatment
Regarding the thick skin associated with your athlete's foot, oral antifungals can help address the underlying fungal infection, which may subsequently improve the condition of the skin. However, thickened skin often requires additional treatment. Topical treatments containing salicylic acid can be beneficial as they help to exfoliate and soften the thickened skin. Using foot soaks with salicylic acid or specialized foot masks can assist in removing the thick skin, making it easier for topical antifungals to penetrate and work effectively.

New Medications and Treatment Options
As for new medications, the field of dermatology is always evolving, and new antifungal agents may become available. It is essential to consult with a healthcare provider who can provide the latest information on available treatments. Your choice of medication may depend on various factors, including the severity of your condition, any underlying health issues, and potential drug interactions.

Monitoring Liver and Kidney Function
You raised an important point about monitoring liver and kidney function when taking oral antifungals. Both terbinafine and itraconazole can affect liver function, so it is crucial to have liver function tests (LFTs) done before starting treatment and periodically during therapy. Kidney function is also important to monitor, especially if you have any pre-existing kidney issues or are taking other medications that may affect renal function.

Diagnostic Testing for Fungal Infections
Regarding the testing for fungi, most dermatology clinics and hospitals can perform fungal cultures or KOH (potassium hydroxide) preparations to confirm the presence of fungal infections. This testing can help ensure that the correct treatment is prescribed. If you feel that your healthcare provider is not adequately addressing your concerns, it is reasonable to seek a second opinion.

Choosing the Right Healthcare Provider
In terms of choosing a healthcare provider, both hospitals and specialized dermatology clinics can offer effective treatment. Larger hospitals may have access to more resources and specialists, while clinics might provide more personalized care. It is advisable to look for a dermatologist with experience in treating fungal infections, particularly if they have a good reputation in your area.

Recommendations for Doctors
While I cannot provide specific recommendations for doctors in Tainan, I suggest looking for dermatologists affiliated with reputable hospitals like National Cheng Kung University Hospital or Chi Mei Medical Center. You can also check online reviews or ask for referrals from friends or family.

Conclusion
In summary, oral antifungal medications can be effective for treating toenail fungus and may indirectly help with thick skin associated with athlete's foot. Combining oral treatment with topical therapies that exfoliate thickened skin can enhance your results. Regular monitoring of liver and kidney function is essential during treatment, and diagnostic testing can confirm the presence of fungal infections. Finally, choosing the right healthcare provider is crucial for effective management of your condition. Always feel free to ask questions and seek second opinions to ensure you receive the best care possible.

Similar Q&A

Understanding Toenail Fungus: Oral Medications, Side Effects, and Treatment Options

A 12-year-old girl has been diagnosed with onychomycosis (fungal nail infection). If she takes oral medication, could there be side effects? Besides oral medication, are there other treatment options? Is onychomycosis easily transmissible? What precautions should be taken?

Dr. Jiang Zheen reply Dermatology
If it is confirmed to be a fungal nail infection, and if it is not too severe, topical antifungal medication such as Laceryl can be used for treatment. If it is more severe, oral medication may be necessary, but liver function must be assessed and confirmed to be normal before st...

Understanding Toenail Fungus Treatment: Oral vs. Topical Options

Hello Dr. Wu, Recently, I discovered a black object resembling a fungus on the outer side of my left big toe nail (next to the toe web). After examination at the hospital, I was diagnosed with onychomycosis. The clinic physician mentioned that while topical medications have low...

Dr. Wu Yuxin reply Dermatology
1. That's correct, so we need to eliminate the fungus at the nail matrix and prevent the spread of the fungus on the toenails. Removing the nail is quite drastic and is generally not performed casually; it is even less likely to be done if there are multiple roots involved. ...

Effective Treatments for Nail Fungus: Oral and Topical Options Explained

Hello, could you please tell me what other effective oral medications are available for onychomycosis besides the oral medications that require six weeks for fingers and three months for toes? Additionally, besides Lamisil, are there any other effective topical treatments? What h...

Dr. Jiang Zheen reply Dermatology
The most commonly used oral medications for onychomycosis are two types: Lamisil (terbinafine) and Sporanox (itraconazole). Additionally, there is another medication called fluconazole, which is used less frequently due to its potentially greater side effects. As for topical medi...

Understanding Toenail Fungus: Causes, Symptoms, and Treatment Options

Hello Dr. Cheng: I previously developed onychomycosis after having a nail removed, but it seems to have improved somewhat over time. The nail has become harder and has not changed shape, but there is a slight yellow discoloration. Is it possible to buy an oral medication at the p...

Dr. Zheng Lizhen reply Dermatology
Onychomycosis, commonly known as nail fungus, occurs when fungi infect the nails, causing them to appear gray or yellow. The most common cause is often the spread of athlete's foot (tinea pedis). Once onychomycosis develops, topical treatments are often ineffective because t...