Nail Infection: Should I Take Antifungal Pills
What is a Decision Point?
Nail Infection: Should I Take Antifungal Pills?You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them. Nail Infection: Should I Take Antifungal Pills? Get the facts Your options
Key points to remember
FAQs What is a fungal nail infection?A fungal nail infection occurs when a fungus attacks a fingernail, a toenail, or the skin under the nail, called the nail bed. Fungi (plural of fungus) can attack your nails through small cuts in the skin around your nail or through the opening between your nail and nail bed. Fungal nail infections are more common in toenails than fingernails. In toenails they grow very slowly, giving the fungi more time to develop and get worse. It also takes more time to treat toenails than fingernails. Yeasts, molds, and different kinds of fungi can cause fungal nail infections. Most are caused by the same type of fungus that causes athlete's foot. Fungi grow best in warm, moist places, and they can spread from person to person. You can get a fungal nail infection from walking barefoot in public showers or pools or from sharing personal items, such as towels and nail clippers. If you have athlete's foot, the fungus can spread from your skin to your nails. Why would you use antifungal pills to treat a nail infection?A fungal nail infection doesn't go away on its own. And it slowly gets worse over time. An infection may spread into the nail root, where new nail growth begins, and may spread to other nails. The longer you have an infection and the worse it gets, the harder it is to treat. Severe infections, especially in older people who have had the condition for many years, can cause very thick nails that are hard to trim. They may cause pain or discomfort when you walk. If this happens, it is hard to cure a fungal infection, even with antifungal pills. Why wouldn't you use antifungal pills to treat a nail infection?Not all fungal nail infections need treatment with pills. Some people decide not to treat a fungal infection until it is uncomfortable or painful. Nail infections are hard to treat, and antifungal pills can be costly. There is no guarantee that the pills will work or that the infection won't come back. Of people whose infection goes away with antifungal pills, 15% to 20% start to get another infection in the next year.2 This means that out of 100 people who use antifungal pills, 15 to 20 will get another infection in the next year, and 80 to 85 will not. The pills used to treat fungal nail infections can cause serious side effects, including liver damage and heart failure. You might think about trying other treatments, such as using an antifungal cream or removing the nail, either surgically or nonsurgically. How well do antifungal pills work?Curing the infection with pills doesn't work as well in people who are 65 and older.3 Pills to treat fungal nail infections include terbinafine (Lamisil) and itraconazole (Sporanox). Studies comparing these two medicines found that terbinafine cured the infection in 55 out of 100 people and itraconazole cured the infection in 26 out of 100 people after 16 weeks of treatment.3 Fluconazole (Diflucan), ketoconazole (Nizoral), and griseofulvin (Grifulvin V) are used less often. Fluconazole seems to help, but not as much as terbinafine or itraconazole.3 And ketoconazole and griseofulvin may work, but there is not enough evidence from studies to say just how well they work.4 What are the risks of not using pills to treat a nail infection?If you are healthy, an ongoing fungal nail infection has no serious risks. But over time, the nail may get thick and look bad. It may be painful when you wear shoes or walk. If you have diabetes or a weak immune system, a fungal infection can lead to a more serious bacterial infection. Why might your doctor recommend antifungal pills for a fungal nail infection?Your doctor may advise you to use pills if:
Compare your options Compare
Take antifungal pills
Take antifungal pills
Don't take antifungal
pills Don't take antifungal
pills Instead, you could:
Personal stories Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide. Personal stories about taking oral antifungal medicine for fungal nail infectionThese stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions. My toenails have always been a little thick and hard to trim, but lately they are starting to really make my feet hurt. I was never sure what the problem was, and now my doctor says it's some type of fungal infection. She says that the medicine may help but that my nail is probably damaged and will never grow back in completely normal. She also mentioned that the medicine is pretty expensive, and that's a concern for me. I'm going to try some other treatment that takes off part of the nail and see if that helps with the pain. Tom, age 68 I think this fungal toenail infection is the ugliest thing! It's so embarrassing. I always keep my nails trimmed and polished, and this one ugly toenail really bothers me. I asked my doctor about these new medicines, and it sounds like they will work well for me, because the problem is just in one of my nails. I just can't believe how long it's going to take to work! Tammy, age 35 Taking medicines for almost 3 months to treat something that really doesn't bother me? That doesn't make any sense to me. I have a hard enough time remembering everything I need to do at the office, much less remembering to take a pill every day. If the problem gets any worse, then I'll reconsider. For now, I'll just keep that toenail out of sight. Bonita, age 40 I will always remember my dad's feet. He had these thick, ugly yellow toenails, and he used to wince when he would walk, because they hurt his feet. My doctor says that I could wind up in the same situation. But since I just got this fungal toenail infection in the last year, if we treat it now, we have a good chance of curing it. I'm going to try this oral medicine that takes several months to work. I'm also going to try all the other things he mentioned, like rotating my shoes so they dry, changing my socks more, and using antifungal foot drying powder. I don't care so much what my feet look like, but I sure don't want them to hurt when I'm older. Bob, age 60 What matters most to you? Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements. Reasons to take antifungal pills Reasons not to take antifungal pills I'm worried about my infection getting worse. I'm not worried about my infection getting worse. More important Equally important More important I'm willing to have regular blood tests to check that my liver and kidneys are okay. I don't want to be bothered with a lot of tests. More important Equally important More important I accept the risk of pills. Taking these pills is too risky for me. More important Equally important More important I don't mind taking pills every day for several months. I don't want to take pills every day. More important Equally important More important My other important reasons: My other important reasons: More important Equally important More important Where are you leaning now? Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now. Taking antifungal pills NOT taking antifungal pills Leaning toward Undecided Leaning toward What else do you need to make your decision? Check the facts 1.
Do antifungal pills give you the best chance of curing severe fungal nail infections?
2.
Can antifungal pills cause serious side effects?
3.
Is taking antifungal pills the only way to treat a fungal nail infection?
Decide what's next 1.
Do you understand the options available to you? 2.
Are you clear about which benefits and side effects matter most to you? 3.
Do you have enough support and advice from others to make a choice? Certainty 1.
How sure do you feel right now about your decision? Not sure at all Somewhat sure Very sure 2.
Check what you need to do before you make this decision. 3.
Use the following space to list questions, concerns, and next steps. Your Summary Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision. Your decisionNext steps Which way you're leaning How sure you are Your comments Your knowledge of the factsKey concepts that you understood Key concepts that may need review Getting ready to actPatient choices Credits and ReferencesCredits
References Citations
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them. Nail Infection: Should I Take Antifungal Pills?Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
1. Get the factsYour options
Key points to remember
FAQs What is a fungal nail infection?A fungal nail infection occurs when a fungus attacks a fingernail, a toenail, or the skin under the nail, called the nail bed. Fungi (plural of fungus) can attack your nails through small cuts in the skin around your nail or through the opening between your nail and nail bed. Fungal nail infections are more common in toenails than fingernails. In toenails they grow very slowly, giving the fungi more time to develop and get worse. It also takes more time to treat toenails than fingernails. Yeasts, molds, and different kinds of fungi can cause fungal nail infections. Most are caused by the same type of fungus that causes athlete's foot. Fungi grow best in warm, moist places, and they can spread from person to person. You can get a fungal nail infection from walking barefoot in public showers or pools or from sharing personal items, such as towels and nail clippers. If you have athlete's foot, the fungus can spread from your skin to your nails. Why would you use antifungal pills to treat a nail infection?A fungal nail infection doesn't go away on its own. And it slowly gets worse over time. An infection may spread into the nail root, where new nail growth begins, and may spread to other nails. The longer you have an infection and the worse it gets, the harder it is to treat. Severe infections, especially in older people who have had the condition for many years, can cause very thick nails that are hard to trim. They may cause pain or discomfort when you walk. If this happens, it is hard to cure a fungal infection, even with antifungal pills. Why wouldn't you use antifungal pills to treat a nail infection?Not all fungal nail infections need treatment with pills. Some people decide not to treat a fungal infection until it is uncomfortable or painful. Nail infections are hard to treat, and antifungal pills can be costly. There is no guarantee that the pills will work or that the infection won't come back. Of people whose infection goes away with antifungal pills, 15% to 20% start to get another infection in the next year.2 This means that out of 100 people who use antifungal pills, 15 to 20 will get another infection in the next year, and 80 to 85 will not. The pills used to treat fungal nail infections can cause serious side effects, including liver damage and heart failure. You might think about trying other treatments, such as using an antifungal cream or removing the nail, either surgically or nonsurgically. How well do antifungal pills work?Curing the infection with pills doesn't work as well in people who are 65 and older.3 Pills to treat fungal nail infections include terbinafine (Lamisil) and itraconazole (Sporanox). Studies comparing these two medicines found that terbinafine cured the infection in 55 out of 100 people and itraconazole cured the infection in 26 out of 100 people after 16 weeks of treatment.3 Fluconazole (Diflucan), ketoconazole (Nizoral), and griseofulvin (Grifulvin V) are used less often. Fluconazole seems to help, but not as much as terbinafine or itraconazole.3 And ketoconazole and griseofulvin may work, but there is not enough evidence from studies to say just how well they work.4 What are the risks of not using pills to treat a nail infection?If you are healthy, an ongoing fungal nail infection has no serious risks. But over time, the nail may get thick and look bad. It may be painful when you wear shoes or walk. If you have diabetes or a weak immune system, a fungal infection can lead to a more serious bacterial infection. Why might your doctor recommend antifungal pills for a fungal nail infection?Your doctor may advise you to use pills if:
2. Compare your options
Personal storiesAre you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide. Personal stories about taking oral antifungal medicine for fungal nail infectionThese stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions. "My toenails have always been a little thick and hard to trim, but lately they are starting to really make my feet hurt. I was never sure what the problem was, and now my doctor says it's some type of fungal infection. She says that the medicine may help but that my nail is probably damaged and will never grow back in completely normal. She also mentioned that the medicine is pretty expensive, and that's a concern for me. I'm going to try some other treatment that takes off part of the nail and see if that helps with the pain." — Tom, age 68 "I think this fungal toenail infection is the ugliest thing! It's so embarrassing. I always keep my nails trimmed and polished, and this one ugly toenail really bothers me. I asked my doctor about these new medicines, and it sounds like they will work well for me, because the problem is just in one of my nails. I just can't believe how long it's going to take to work!" — Tammy, age 35 "Taking medicines for almost 3 months to treat something that really doesn't bother me? That doesn't make any sense to me. I have a hard enough time remembering everything I need to do at the office, much less remembering to take a pill every day. If the problem gets any worse, then I'll reconsider. For now, I'll just keep that toenail out of sight." — Bonita, age 40 "I will always remember my dad's feet. He had these thick, ugly yellow toenails, and he used to wince when he would walk, because they hurt his feet. My doctor says that I could wind up in the same situation. But since I just got this fungal toenail infection in the last year, if we treat it now, we have a good chance of curing it. I'm going to try this oral medicine that takes several months to work. I'm also going to try all the other things he mentioned, like rotating my shoes so they dry, changing my socks more, and using antifungal foot drying powder. I don't care so much what my feet look like, but I sure don't want them to hurt when I'm older." — Bob, age 60 3. What matters most to you?Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements. Reasons to take antifungal pills Reasons not to take antifungal pills I'm worried about my infection getting worse. I'm not worried about my infection getting worse. More important Equally important More important I'm willing to have regular blood tests to check that my liver and kidneys are okay. I don't want to be bothered with a lot of tests. More important Equally important More important I accept the risk of pills. Taking these pills is too risky for me. More important Equally important More important I don't mind taking pills every day for several months. I don't want to take pills every day. More important Equally important More important My other important reasons: My other important reasons: More important Equally important More important 4. Where are you leaning now?Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now. Taking antifungal pills NOT taking antifungal pills Leaning toward Undecided Leaning toward 5. What else do you need to make your decision?Check the facts1. Do antifungal pills give you the best chance of curing severe fungal nail infections?
You're right. Antifungal pills give you the best chance of curing a severe fungal nail infection. 2. Can antifungal pills cause serious side effects?
That's right. Antifungal pills can cause rare but serious side effects, including liver damage and heart failure. 3. Is taking antifungal pills the only way to treat a fungal nail infection?
You are right. Having your nail removed, either surgically or nonsurgically, is another treatment option for a severe nail infection. Decide what's next1. Do you understand the options available to you? 2. Are you clear about which benefits and side effects matter most to you? 3. Do you have enough support and advice from others to make a choice? Certainty1. How sure do you feel right now about your decision? Not sure at all Somewhat sure Very sure 2. Check what you need to do before you make this decision.
3. Use the following space to list questions, concerns, and next steps. Credits
References Citations
Note: The "printer friendly" document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version. Last Revised: July 20, 2010 Author: Healthwise Staff Medical Review: Kathleen Romito, MD - Family Medicine & Alexander H. Murray, MD, FRCPC - Dermatology eMedicineHealth Medical Reference from Healthwise 
This information does not replace the advice of a doctor. Healthwise disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions. To learn more visit Healthwise.org © 1995-2012 Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated. |
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