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Suggest treatment for fungal toenail infection

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Posted on Thu, 7 Apr 2016
Question: I am currently taking terbinafine cream for fungal toenail infection but this doesn't seem to have much effect. I have been taking this for 5 years. All toenails are affected particularly the large toenails. What is the best treatment for this condition? Is this medication available in tablet form?Is there some reason why my GP may not prescribe this? Maybe because of other medication I am taking?
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Answered by Dr. Albana Sejdini (2 hours later)
Brief Answer:
Oral antifungal medications to start after examination of nail scrapping...

Detailed Answer:
Hi,

I have gone through your medical history carefully and understood your concerns.

It is difficult to treat fungal toenail infection. This is because the cream you use cannot be absorbed by the nail. It can only affect the nail bed where the nail takes the nutrients for its functioning.

It will take more than 1 year from the day you started to use topical medications for the improvement to take place.

Terbinafin can be used orally but will not have much effect and it carries alot of side effects especially when it comes to liver damages. I always recommend my patients to check their liver function test first before starting terbinafin orally.

Next, is the infection cannot be dominated for long time, then, examination of nail scrapping is advised to rule out psoriasis that can mimic fungal infection.

Furthermore, the way you use anti-fungal medications matters:
- I advise my patients to thin their nail first before applying anti-fungal cream; this is the best way the cream can penetrate and kill the fungus. Can use urea lotion on the nail for this purpose
- After that, can apply terbinafin or itraconazole cream
If no success with terbinafin cream, antifungal nail polish is advised to apply on the surface of the nail and surrounding skin once a day for one year. This antifungal nail polish contains ciclopirox.
Can discuss this further with your doctor.

Hope it was of help!
Dr.Albana
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Albana Sejdini

General & Family Physician

Practicing since :2006

Answered : 7070 Questions

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Suggest treatment for fungal toenail infection

Brief Answer: Oral antifungal medications to start after examination of nail scrapping... Detailed Answer: Hi, I have gone through your medical history carefully and understood your concerns. It is difficult to treat fungal toenail infection. This is because the cream you use cannot be absorbed by the nail. It can only affect the nail bed where the nail takes the nutrients for its functioning. It will take more than 1 year from the day you started to use topical medications for the improvement to take place. Terbinafin can be used orally but will not have much effect and it carries alot of side effects especially when it comes to liver damages. I always recommend my patients to check their liver function test first before starting terbinafin orally. Next, is the infection cannot be dominated for long time, then, examination of nail scrapping is advised to rule out psoriasis that can mimic fungal infection. Furthermore, the way you use anti-fungal medications matters: - I advise my patients to thin their nail first before applying anti-fungal cream; this is the best way the cream can penetrate and kill the fungus. Can use urea lotion on the nail for this purpose - After that, can apply terbinafin or itraconazole cream If no success with terbinafin cream, antifungal nail polish is advised to apply on the surface of the nail and surrounding skin once a day for one year. This antifungal nail polish contains ciclopirox. Can discuss this further with your doctor. Hope it was of help! Dr.Albana