Problems with thick, ugly toenails? It is probably fungal nail – clinically known as onychomycosis. Traditionally, this problem has been treated with oral antifungal medications that require frequent laboratory monitoring due to potential liver toxicity. These medications are also costly which is problematic for those patients who do not have prescription coverage.

The reason that oral medications have been used is because it is difficult to penetrate the thick nail with topical medications. For example, topical antifungal medications used for problems like jock itch, athlete’s foot and ringworm won’t help fungal nail.

Here is the good news! Studies have shown that when ingredients such, as urea, that soften the nail or otherwise increase the penetration of the antifungal medicine are added to topical antifungal nail “lacquers”, these preparations can produce excellent results.

A randomized, double-blind study enrolled 70 patients with onychomycosis of the finger and toenails. Clinical and antifungal effects as well as safety were assessed monthly for a maximum of 6 months of treatment. Results indicated topical treatment of onychomycosis with a combination of fluconazole 1% and urea 40% was more effective (82.8%) than fluconazole 1% (62.8%) nail lacquer alone in treatment of dermatophytic onychomycosis. Fluconazole was well tolerated and side effects were negligible. At the end of therapy and the end of the 6-month follow-up, fluconazole 1% and urea 40% demonstrated statistically significant superiority in clinical and antifungal responses compared with fluconazole 1% alone.

Ask our compounding pharmacist about the advantages of topical therapy for fungal nail.

References

J Dermatolog Treat. 2012 Dec;23(6):453-6.