What is the treatment for my toe fungus, considering my recent bloodwork results, including elevated LDL (Low-Density Lipoprotein) cholesterol?

Treatment for Toenail Fungus Based on Bloodwork Results

Oral terbinafine 250 mg daily for 12 weeks is the recommended first-line treatment for your toenail fungus, as it has superior efficacy with 70-80% mycological cure rates for toenail infections. 1

Assessment of Your Bloodwork

Your bloodwork results are generally within normal ranges with only minor abnormalities:

• LDL cholesterol is slightly elevated at 120 mg/dL (reference range <100 mg/dL)
• MCV and MCH are marginally elevated, which may indicate macrocytosis

These results do not contraindicate antifungal therapy, and your kidney and liver function tests are normal, which is important when considering oral antifungal medications.

Treatment Options

First-Line Treatment:

• Oral terbinafine (250 mg daily for 12 weeks)
  • Most effective for dermatophyte infections (most common cause of toenail fungus)
  • Superior efficacy compared to other antifungals with 70-80% mycological cure rates 1
  • Well-tolerated with fewer drug interactions than azoles 2
  • A 12-week course is sufficient for toenail onychomycosis 3

Alternative Options:

1. Oral itraconazole

   • Option for those who cannot tolerate terbinafine
   • Can be given as continuous therapy (200 mg daily for 12 weeks) or pulse therapy (400 mg daily for 1 week per month for 3-4 months) 1
   • First choice for Candida infections, but less effective than terbinafine for dermatophytes 4

2. Topical therapy (for mild cases or when oral therapy is contraindicated)

   • Amorolfine 5% nail lacquer (once or twice weekly for 6-12 months) 4, 1
   • Ciclopirox 8% lacquer (once daily for up to 48 weeks) 4
   • Less effective than oral therapy, with cure rates around 50% 4

Why Oral Therapy is Recommended

Systemic therapy is almost always more successful than topical treatment for toenail fungus 4. Topical treatments should only be used in:

• Superficial white onychomycosis
• Very early distal lateral subungual onychomycosis
• When systemic therapy is contraindicated

Monitoring During Treatment

1. Baseline liver function tests before starting oral terbinafine
2. Follow-up at 3-6 months after starting treatment
3. Continue monitoring for at least 48 weeks from treatment initiation 1

Prevention of Recurrence

To prevent recurrence of toenail fungus:

• Keep nails short and clean
• Wear breathable footwear
• Use antifungal powders in shoes
• Wear cotton, absorbent socks
• Avoid sharing nail clippers or other personal items
• Treat any concomitant fungal infections (like athlete's foot) 1

Important Considerations

• Clinical improvement may not equate to mycological cure, with cure rates often 30% lower than clinical improvement 1
• Treatment failure can occur due to poor compliance, poor absorption, immunosuppression, or resistant organisms 1
• Your slightly elevated LDL cholesterol should be addressed separately through diet, exercise, and possibly medication if recommended by your physician

Remember that toenail fungus treatment requires patience, as visible improvement may take several months even with effective therapy.