THREE NEW MEDICATIONS
FOR FUNGUS NAILS
Fungal nails could possibly be the most common foot problem
in the world. It is also one of the least talked about. People who have no problem talking
about their bunions or heel pain sometimes cringe to even think about their thick,
brownish-yellow nails. What these people need is a perfect drug: a medicine taken for a
very short time, with nearly no side effects, interacts with few medications, causes no
damage to their bodies and works for a very long time. To the relief of those suffering
with fungal nails, such medication may finally exist.
TOPICAL TREATMENT
In the past, treating fungus nails with anything less than
an oral medication was less than successful. All that has changed with PENLAC, the new
prescription topical medication. PENLAC is applied once a day using a fingernail
polish-type brush. It builds up a slightly yellow tinge to the nail. Used on nails
partially infected with a superficial fungus the medicine provides success between 10% and
35% of the time. Thoroughly infected nails are less successful. A little (3.3 ml.) bottle
provides 400 applications and costs about $60. PENLAC probably increases the effectiveness
of the oral medications.
GRISEOFULVIN AND KETOCONAZOLE
In the recent past the only two oral medications available
for fungus nails were Griseofulvin (also called Fulvicin or Gris-peg) and Ketoconazole
(Nizoral.) The former worked only 20% of the time. Ketoconazole had a 60-80% effectiveness
but had an unacceptable risk of kidney and liver damage. Both had to be taken daily for
12-18 months and both required frequent liver function tests. Unfortunately, the moment
the medication was stopped the fungus often returned.
SPORANOX
Sporanox was the first of the new medications to hit the
market. The European pulsed method involves taking 4 tablets a day for a single
week (28 tablets) repeated for two more consecutive months at a cost of about $600 for 84
tablets. This method cures about 70% to 80% of fungus nail infections. A temporary
nail removal or aggressive trimming the nail will increase the effectiveness of the
treatment.
Aside from the cost, the only drawback to Sporanox is its
interaction to a variety of other medications such as blood thinners and oral
anti-diabetes medications.
LAMISIL
Lamisil is taken one tablet a day for three months (cost:
about $550 for 90 tablets.) Cure rates are reported in excess of 70%. Again, temporary
nail removal or trimming can increase the cure rate. Lamisil does not interact with other
drugs. Its only drawback is a report that it does not kill certain uncommon types of
fungus.
DIFLUCAN
Diflucan has not been approved for oral treatment of fungal
nails but it is sometimes used anyway. The dosage is one tablet a week until the nail
looks better, usually six or seven months. The cost is $20-30 a pill!
LAMISIL OR SPORANOX
Both medications effectively treat most cases of fungus
nails. Certainly Lamisil is the cheaper of the two with no real drug interactions. If the
infection is one of the common fungi (and most are) Lamisil is your drug. If a culture of
your fungus shows it to be an unusual “saprophyte” and you are not taking one of
the interacting drugs, then Sporanox is suggested. If you are on a medication that
interacts with Sporanox but have a saprophyte fungus, you should probably take Lamisil and
hope for the best.
AM I CURED?
If you take either of the oral medications you stand a 70%+
chance of clearing your nails of the fungus. I do not believe this will be a permanent
correction, however. There must be some underlying condition that caused the nails to be
invaded by the fungus organisms. This condition is probably not changed by taking the
medication so I expect that the nail fungus will recur.
CONSIDER YOURSELF LUCKY IF YOUR NAILS STAY CLEAR AND FREE
OF FUNGUS FOR THREE
YEARS!
LABORATORY CULTURES FOR FUNGUS
Before taking an oral medication you probably should have a
fungus culture that proves your problem is due to a fungus. Certain conditions
(like psoriasis) can make your nails look like they have a fungus when, in reality, they
do not.
BLOOD TESTS
Lamisil and Sporanox have been used for many years and
appear to be very safe. Still, most authorities recommend that blood test be made to
assess liver function prior to starting treatment and after the first third of the
treatment is completed.
INSURANCE APPROVAL
Many insurance companies will cover the two approved oral
medications for fungus without a hitch. Some, like the Blues in California, want to call
this a cosmetic condition and refuse to cover the medication costs. I beg to differ,
however. A fungus nail infection is an infectious disease and deserves treatment. A
cosmetic procedure is designed to take something that is normal and try to improve on it.
Bringing an abnormal part back to normal is a RESTORATIVE procedure and deserves to be
reimbursed by those insurance companies that reimburse for medications. I use the example
of a breast augmentation as a cosmetic procedure but a post-surgical reconstruction after
mastectomy as a restorative procedure. Now I do not mean to equate the severity of fungus
nails with breast cancer, but it does point out the differences between restorative and
cosmetic.
TEMPORARY NAIL REMOVAL
There is no question that the effectiveness of any fungus
treatment is increased if the contaminated part of the nail is removed. Usually this is
done with an office visit. Occasionally it may require local anesthesia. Alternatively, a
urea cream applied to the nails for two days can easily and painlessly remove most of the
bad nail.
PERMANENT NAIL REMOVAL
Believe it or not sometimes people choose to have a thick
toe nail permanently removed. These people are sick of dealing with thick, discolored and
painful nails. The procedure is done under local anesthesia in the office and takes just a
few minutes. The nail is removed and the nail root is treated with a chemical to kill the
nail root. The result is not all that bad. I do not advocate this for everybody, but for
those who do not mind the look of such a nail, it is a very acceptable alternative.
George is a retired
photographer who was sick and tired of his fungal nails, especially on his big toes. He
asked to have both of them removed permanently. I talked him into doing just he left one
first. It took longer than expected to heal fully, about 4 months. Now he is happy. This
photo is of his nails about 5 months after the procedure. Note that you can make an
argument that the thick right big toe nail is actually less attractive then the left
(on the right, of course) one
with the nail removed permanently.
