What’s New for Nail Fungus?

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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Onychomycosis is a fungal infection of the nail and the most common nail disorder. It is more common as we get older and with factors like diabetes, sweating, sports activities, occlusive footwear, and repeated nail trauma. Topical treatments eliminate the need for surveillance blood tests and cause less systemic complications. Two new nail solutions were recently approved.

Why should we care about it? It isn’t just a cosmetic problem because nail fungus can spread to other nails, cause discomfort, and spread to family members.

Why did I get it? The same fungi that cause athlete’s foot also cause toenail fungus. Often toenail onychomycosis (fungal infection of the nail) spreads from athlete’s foot. The infection starts on the skin and then spreads to the toenails. Onychomycosis can also spread from toe to toe, from toe to finger, and to other people.

How do I know if the changes on my nail are from a fungus? Nail clippings are sent for microscopic evaluation. Diagnosis should be made on a nail clipping to distinguish it from psoriasis or nail bed trauma.

Do topical medications for nail fungus work? It is important to understand that no matter what antifungal medication you are prescribed, the medication is not going to fix the nail that is already abnormal looking. Effective treatment allows a new, healthy nail to come in and push out the old, abnormal nail. The rate at which your nail gets better depends on how quickly the new nail grows and in most, it takes 12 months for a new toenail to form.

What are the two new options?

  1. Jublia (efinaconazole) works by inhibiting an enzyme that disrupts a part of the fungal cell membrane. Jublia works, but the number of people it cures may seem a bit low: about 28% of people with mild to moderate nail fungus who applied it daily for 48 weeks had a complete or near complete (<5% of their nails still affected by fungus) cure.
  1. Kerydin (tavaborole) is another nail solution for fungus. Kerydin blocks fungal protein synthesis. In people with mild to moderate nail fungus who were treated for 52 weeks 26% had a completely clear or almost clear nail.

What’s better, the nail solutions or pills for onychomycosis? The two new topical nail solutions listed above are appealing because they don’t carry the potential for liver damage, and so on, but they are expensive. Pills for antifungal treatment, like Lamisil (terbinafine), achieve cure in approximately 60% of people.

Dr O.

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