If your nail changes are asymptomatic (you have no symptoms), you may decide against treatment after weighing the risks. In the past prolonged oral treatment was the only option. For early nail fungal infection a new penetrating antifungal lacquer has provided another alternative with no risk of systemic side effects.
Patients who have diabetes or peripheral vascular disease may be at increased risk of developing complications such as secondary bacterial skin infections from having persistent nail or skin fungal infection
Terbinafine is the oral treatment of choice. For the toenails a minimum of 3 months treatment is required, whereas 6 weeks may do for the fingernails. Severe liver reactions have been observed rarely with this drug. It is recommended that LFTs be measured before and one month into treatment. This drug can also alter your ability to taste.
Itraconazole is an alternative drug that can be used. It is effective if there is Candida or in the immunosuppressed patient with non-dermatphyte infection such as Aspergillus. Care must be taken with this drug in those at risk of heart failure, or in the elderly who are on negative inotropic drugs. Liver function tests are recommended if there is a history of liver disease or for treatment periods longer then 1 month .
This drug can be taken daily for 1 week out of every month for 3 to 4 cycles.
Ciclopirox Nail Lacquer is a useful product in treating early nail fungus infection. It avoids the risks of oral medication, it is useful when the infection is limited to part of the nail, as well as for the superficial type of infection showing white nail changes. It has also been useful for treatment of chronic paronychia which causes the skin around the nail to become red and mushy, and can give the nail a green tinge.