From the Guidelines
For topical treatment of anti-fungal toe fungus, I recommend using Amorolfine (Loceryl) nail lacquer, as it has been shown to be effective in around 50% of cases of toenail infection. This is based on a study published in the British Journal of Dermatology 1. When using Amorolfine, it is essential to apply the lacquer to the affected nail area, as directed, to achieve the best results. Some key points to consider when using topical antifungal treatments include:
- Applying the medication to clean, dry affected areas
- Using the medication for an extended period, typically at least 2-4 weeks, and continuing for 1-2 weeks after symptoms disappear
- Wearing clean cotton socks and well-ventilated shoes during treatment to promote a dry environment and prevent fungal growth
- Monitoring for signs of infection, such as increased redness, swelling, or pain, and seeking medical attention if symptoms worsen or do not improve with treatment. It is also important to note that other topical antifungal preparations, such as tioconazole, have shown variable results, ranging from cure rates of around 20% up to 70% 1. However, Amorolfine has demonstrated a more consistent efficacy rate, making it a preferred choice for topical treatment of toe fungus.
From the FDA Drug Label
Directions • adults and children 12 years and older o use the tip of the cap to break the seal and open the tube o wash the affected skin with soap and water and dry completely before applying o for athlete's foot wear well-fitting, ventilated shoes. Change shoes and socks at least once daily. ▪ between the toes only: apply twice a day (morning and night) for 1 week or as directed by a doctor. ▪ on the bottom or sides of the foot: apply twice a day (morning and night) for 2 weeks or as directed by a doctor. Terbinafine (TOP) can be used topically for anti-fungal treatment of toe fungus, specifically athlete's foot.
- Apply twice a day (morning and night) between the toes for 1 week or as directed by a doctor.
- Apply twice a day (morning and night) on the bottom or sides of the foot for 2 weeks or as directed by a doctor 2.
From the Research
Topical Treatments for Anti-Fungal Toe Fungus
- The provided studies primarily focus on oral terbinafine as a treatment for onychomycosis, with limited discussion on topical treatments 3, 4, 5, 6.
- However, one study mentions that topical monotherapy can be considered for mild to moderate onychomycosis and is a therapeutic option when oral antifungal agents are contraindicated or cannot be tolerated 7.
- The same study notes that topical antifungal therapies have minimal adverse events, but are less effective than oral antifungal therapies due to poor nail penetration 7.
Effectiveness of Terbinafine
- Terbinafine has been shown to be highly effective in treating onychomycosis, with mycological cure rates ranging from 62-91% in various studies 3, 4, 6.
- Terbinafine has also been found to be effective in treating nondermatophyte onychomycosis, as well as in high-risk populations such as diabetics and immunocompromised patients 6.
- The drug has a low potential for drug interactions and is generally well tolerated, making it a popular choice for treating onychomycosis 3, 4, 5.
Comparison with Other Treatments
- Terbinafine has been compared to other antifungal agents, such as itraconazole and fluconazole, and has been found to be more effective in treating dermatophyte onychomycosis 3, 4.
- However, the choice of treatment ultimately depends on the individual patient's needs and medical history, as well as the severity of the infection 7.