The diagnosis of onychomycosis is difficult, so the treatment should be tailored to the particular cause of the infection. The first step in management is the confirmation of mycology. The culture of specimens is mandatory, but often multiple organisms are identified. The treatment should target the causative organism, so a consultation with a microbiologist is recommended. Antifungal drug resistance is a growing concern among fungal pathogens, and its influence on the management of onychomycosis is not yet understood.
There is limited evidence supporting the use of an onychomycosis treatment laser. Currently, only two randomized controlled trials (RCTs) have been conducted, two of which were nonrandomized comparative studies, and four were case series. These studies did not pool the data, and their results were inconsistent. Further, they lacked controls and large sample sizes. Additionally, most studies excluded patients with severe or dystrophic onychomycosis.
Terbinafine is a potent antifungal agent. It inhibits the biosynthesis of ergosterol in fungal cells by inhibiting squalene epoxidase. This results in ergosterol-depleted fungal cell membranes and toxic intracellular squalene accumulation. Terbinafine has excellent antifungal activity against dermatophytes and variable activity against yeasts. It is well distributed in body tissues and poorly perfused nail matrix. It has a prolonged effect, lasting about 30 weeks after treatment.
Among all the drugs available for treating onychomycosis, Itraconazole appears to be the most effective and safest. It is highly effective against dermatophytes, the fungus responsible for most cases of onychomycosis. However, it is not as effective against non dermatophytes, including Candida species and molds. Concomitant use of this drug may increase the risk of adverse effects and decrease the absorption of itraconazole.
The Vicks VapoRub has been studied for its efficacy in treating onychomycosis. A family medicine group completed a 48-week clinical trial with 18 patients with symptoms of the disease. The study did not follow standard protocols for topical antifungal studies, limiting patients with a culture of dermatophytes to the nail apex. It also did not control the percentage of nails affected by the disease.
Over-the-counter remedies like Vicks VapoRub are very popular for treating toenail fungus. While not scientifically proven to be the best treatment for onychomycosis, they often work. It is important to note that these products are not strong enough to cure the disease. To avoid side effects, you should use a clean Q-tip to remove any product that may be a part of the treatment.