Athlete’s Foot
prescribe products containing terbinafine such as lamisail AT
Toenail Fungal Infections
What’s the best treatment for toenail fungus? There’s no magic bullet. Lamisil (terbinafine) taken daily for 12 weeks works best. But, long-term success hovers only around 50%. It can cost upwards of $240 per month. It costs less if given in pulse dosing…one week a month for 4 months. But it’s too soon to tell if pulse doses work as well as daily therapy. Sporanox (itraconazole) is the next best option. For Sporanox, pulse dosing works as well as daily dosing. Griseofulvin doesn’t work as well…Nizoral may cause more hepatotoxicity…it’s too soon to tell if Diflucan is effective. Don’t use these three. Explain to patients that you’ll need to do regular liver function tests while they take an ORAL antifungal. TOPICAL antifungals are less effective than oral therapy. Penlac (ciclopirox) is an option for mild cases…and for patients who can’t take oral antifungals. But less than 12% of patients achieve a clear nail even after a year of daily use and regular nail trimming. Antifungal solutions (Lotrimin AF, Loprox) or tea tree oil are sometimes used…but there’s only sketchy evidence they’re effective. Vicks VapoRub and bleach are touted on many internet sites. But tell patients there’s no proof that they work. Explain that treatment is expensive…causes side effects… and often isn’t that effective. Recurrence rates can be over 50%. Despite the downsides, many patients will still want to try something. Document that you explained the pros and cons. (Prescriber’s Letter)