From the Guidelines
The most effective treatment for toe onychomycosis is oral terbinafine (250 mg daily for 12 weeks), as it has been shown to be superior to itraconazole in terms of cure rates and risk of drug interactions 1.
Treatment Options
The treatment for toe onychomycosis typically involves:
- Oral antifungal medications, such as terbinafine, itraconazole, or fluconazole
- Topical treatments, such as ciclopirox 8% nail lacquer, efinaconazole 10% solution, or tavaborole 5% solution
- Combination of both oral and topical treatments
Oral Medications
- Terbinafine: 250 mg daily for 12 weeks, with a cure rate of 70-80% 1
- Itraconazole: 200 mg twice daily for 1 week per month, for 3 months, with a cure rate of 60-70% 1
- Fluconazole: 150-300 mg once weekly for 6-12 months, with a cure rate of 50-60% 1
Topical Treatments
- Ciclopirox 8% nail lacquer: applied daily for up to 48 weeks
- Efinaconazole 10% solution: applied daily for 48 weeks
- Tavaborole 5% solution: applied daily for 48 weeks
Prevention of Reinfection
To prevent reinfection, it is essential to:
- Keep feet dry and wear breathable footwear
- Change socks daily
- Avoid walking barefoot in public areas
- Use antifungal powders or sprays in shoes
- Discard old and moldy footwear
Treatment Success
Treatment success depends on consistent application and completing the full course of therapy, even if visual improvement occurs earlier. Recurrence is common, occurring in 10-50% of cases, so maintaining good foot hygiene is essential 1.
From the FDA Drug Label
Terbinafine tablets, USP are indicated for the treatment of onychomycosis of the toenail or fingernail due to dermatophytes (tinea unguium). INDICATIONS AND USAGE Terbinafine tablets are an allylamine antifungal indicated for the treatment of onychomycosis of the toenail or fingernail due to dermatophytes (tinea unguium)
The treatment for toe onychomycosis is terbinafine (PO), an antifungal medication.
- Key points:
From the Research
Treatment Options for Toe Onychomycosis
The treatment for toe onychomycosis, a fungal infection of the toenail, has improved significantly with the introduction of new oral antifungal agents. Some of the effective treatment options include:
- Itraconazole: This medication has been shown to be effective against various types of fungi, including dermatophytes and non-dermatophyte molds 3, 4, 5.
- Terbinafine: This medication is also effective against dermatophytes and has been shown to have a high cure rate for toe onychomycosis 3, 6, 4, 5.
- Fluconazole: Although not labeled for the treatment of onychomycosis by the U.S. Food and Drug Administration, early efficacy data are promising 3, 7.
Treatment Regimens
The treatment regimens for toe onychomycosis vary depending on the medication and the severity of the infection. Some common treatment regimens include:
- Itraconazole pulse therapy: This involves taking the medication for 1 week, followed by a 3-week break, and repeating the cycle for a total of 3-4 pulses 4, 5.
- Terbinafine continuous therapy: This involves taking the medication daily for 12 weeks 6, 4.
- Fluconazole continuous therapy: This involves taking the medication daily for 12 weeks 4.
Efficacy and Safety
The efficacy and safety of these treatment options have been evaluated in several studies. The results show that:
- Itraconazole and terbinafine have a high cure rate for toe onychomycosis, with minimal adverse effects 3, 6, 4, 5.
- Fluconazole has also shown promise in treating toe onychomycosis, although more data are needed to confirm its efficacy 7.
- The new oral antifungal agents have a favorable adverse-effects profile, with predictable and manageable drug interactions 3.