From the Guidelines
Toenail fungus infections are most effectively treated with oral antifungals, specifically terbinafine, which has been shown to have higher efficacy and tolerability compared to itraconazole 1. Toenail fungus infections can be treated with various options, including topical antifungals, oral medications, and home remedies, with varying degrees of effectiveness. For mild to moderate infections, over-the-counter topical treatments like clotrimazole, terbinafine (Lamisil), or ciclopirox (Penlac) can be applied directly to the affected nail daily for several months, though they have modest success rates of 20-50%. Some key points to consider when treating toenail fungus infections include:
- Oral antifungals such as terbinafine (250mg daily for 12–16 weeks) and itraconazole (200mg per day for 12 weeks continuously, or alternatively as pulse therapy at a dose of 400mg per day for 1 week per month) are more effective, with cure rates of 50-80%, but may cause side effects including liver damage 1.
- Terbinafine has been shown to be more effective than itraconazole, with complete cure rates of 55% compared to 26% for pulsed itraconazole at follow-up at 72 weeks 1.
- Regarding Listerine, there is limited scientific evidence supporting its effectiveness against toenail fungus, and it should not be considered a primary treatment option.
- For best results, keep nails trimmed, dry, and clean; wear breathable footwear; and seek medical advice for persistent infections, especially if you have diabetes or circulation problems. It is essential to note that several large studies demonstrate higher efficacy rates for terbinafine in comparison with itraconazole, making it the preferred choice for treating toenail fungus infections 1.
From the FDA Drug Label
The results of use of Ciclopirox Topical Solution, 8%, (Nail Lacquer), in treatment of onychomycosis of the toenail without lunula involvement were obtained from two double-blind, placebo-controlled studies conducted in the US Terbinafine tablets, USP are indicated for the treatment of onychomycosis of the toenail or fingernail due to dermatophytes (tinea unguium)
The various options for toenail fungus infections include:
- Ciclopirox Topical Solution, 8%, (Nail Lacquer): indicated for mild to moderate onychomycosis of fingernails and toenails without lunula involvement, due to Trichophyton rubrum
- Terbinafine tablets: indicated for the treatment of onychomycosis of the toenail or fingernail due to dermatophytes (tinea unguium) Their comparative efficacies are:
- Ciclopirox Topical Solution, 8%, (Nail Lacquer):
- Complete cure: 5.5% and 8.5% in two studies
- Almost clear: 6.5% and 12% in two studies
- Terbinafine tablets: no efficacy data provided in the given drug labels There is no information in the provided drug labels about the use of Listerine for toenail fungus treatment 2, 3, 3.
From the Research
Treatment Options for Toenail Fungus Infections
- Oral antifungal medications such as terbinafine, itraconazole, and fluconazole are effective treatments for toenail onychomycosis 4, 5, 6
- Terbinafine has been shown to be more effective than itraconazole and fluconazole in achieving clinical and mycological cure 4, 5, 6
- Topical antifungal agents such as efinaconazole and tavaborole are also available for the treatment of onychomycosis 7
- Pulse and continuous dose terbinafine regimens have been compared, with continuous dose regimens showing superior efficacy 8
Comparative Efficacies of Treatment Options
- Terbinafine has been shown to have a higher clinical cure rate (76.67%) compared to pulse dose terbinafine regimens (26.67%) 8
- Terbinafine has also been shown to have a higher mycological cure rate compared to itraconazole and fluconazole 4, 5, 6
- Azoles have been shown to be effective in achieving clinical and mycological cure, but may have a higher risk of adverse events compared to terbinafine 5
- Griseofulvin has been shown to have a lower efficacy compared to terbinafine and azoles, and a higher risk of adverse events 5