6 best remedies for nail fungus

Review of the best according to the editorial board. On the selection criteria. This material is subjective and does not constitute advertising and does not serve as a purchase guide. Before buying, you need to consult with a specialist.

Among all fungal infections, the most dangerous are systemic mycoses, which affect the internal organs of a person and can lead to death. Such serious illnesses are often found in HIV-infected patients in the AIDS stage, with profound impairments of the immune system. But even in an ordinary, healthy person with a normal immune status, fungal lesions of the skin, and especially nails, can occur. These diseases are called onychomycosis, and they can be cured with the correct use of antifungal drugs (they are called fungicides, or antimycotics), and with careful adherence to the principles of secondary prevention.

The fact is that located in the depths of the nail plate, the fungus is protected from all harmful factors. It has the most favorable conditions for growth and reproduction, especially when it comes to toenails. A person is almost always in closed shoes during the day, especially in winter. This gives the fungi the necessary darkness and the absence of harmful ultraviolet radiation, moisture and excess nutrients. The nail plate also mechanically protects the fungus. All this makes the treatment of onychomycosis difficult, especially if the damage to the nail plate is significant, but there are no indications for nail removal yet.

There are various agents, both for local and internal use, for the treatment of onychomycosis. Medicines taken by mouth must be prescribed by a dermatologist, taking into account the indications and contraindications. But even local treatment should begin after the initial consultation with a specialist, and taking the nail discharge for analysis to confirm the diagnosis. This rating includes the most modern and popular remedies for the treatment of nail fungus. But, before we start reviewing fungicidal agents, it is necessary to tell a little about antifungal ointments and creams.

Ointments and creams do not cure nail fungus

There is a common misconception that nail fungus can be cured with various ointments and creams. Unfortunately, this is far from the case. Ointments and creams are intended for use on the skin and mucous membranes. Only with the correct application of the product, the active substance is rapidly absorbed, and the necessary fungicidal concentration is created. Therefore, the entire rich range of creams and ointments from the fungus is mainly intended for the treatment of dermatomycosis, or fungal skin lesions, for the treatment of vaginal candidiasis and other similar localizations.

Such widely known drugs as Nizoral cream, Lamisil containing terbinafine, Zalain, Mifungar, Candide, and other soft dosage forms are too weak for the treatment of onychomycosis, and are not intended for the treatment of nail fungus. They will not be able to penetrate the thickness of the nail, which consists of keratin. The keratin protein is strong enough, and the frustration of such inappropriate treatment of onychomycosis will be significant, especially if large funds are spent on the cream or ointment.

There is another danger here. Those minimum concentrations that will nevertheless pass through the nail and reach the fungus, but not kill it, will help it adapt to this active substance and develop resistance to fungicides in the fungus.

However, antifungal ointments and creams are quite used for onychomycosis of nails to be applied to the skin surrounding the nail, on the interdigital spaces, and can be used in the complex therapy of onychomycosis to prevent the spread of fungus from the nail to nearby soft tissues. This is what explains the inclusion of such an indication as 'onychomycosis' in official instructions.

Important! The only exception when antifungal creams and ointments are indicated is the situation when the patient's nail has already been completely removed, and the agent can be rubbed directly into the bare nail bed. This is done several times a day until healthy nail tissue grows back.

If we are talking about the popular salicylic ointment, then it is used as a keratolytic agent for foot fungi, and with nail fungi, its task is to soften and remove excess keratinized masses, which accumulate in abundance mainly on the heels, in middle-aged and elderly people. and are a food source for the fungus. It is known that the crumbling masses released from under the nail affected by the fungus contain a large amount of mycelium – the 'embryos' of the fungus.

Distributed over the inner surface of shoes, over insoles and house slippers, socks, the mycelium of the fungus enters the keratinized masses, gradually passes from the subungual space to the skin, first to the zone of interdigital spaces, and then to the feet. Therefore, the use of salicylic ointment for onychomycosis of toenails is shown as a prophylactic agent that deprives fungi of nutrients. But this ointment is not a fungicidal, or real antifungal drug with proven activity. Now you can go to the rating of really popular and effective drugs for the treatment of nail fungus.

Rating of the best remedies for nail fungus

Nomination	a place	Name of product	price
The best fungicidal liquids and varnishes for nail fungus	1	Exoderil	564 r
	2	Varnish Batrafen – cyclopirox	RUB 2,035
	3	Varnish Lotseril	828 RUB
The best oral tablets	1	Lamisil	546 r
	2	Diflucan	412 RUB
	3	Orungal	RUB 2 855
The secret to correct nail fungus treatment

The best fungicidal liquids and varnishes for nail fungus

It must be immediately explained that the treatment of nail fungus with liquids and varnishes is a regular and daily process. There is a rule: until the nail plate is completely renewed, there is no guarantee that the fungus is eliminated. It is known that toenail renewal is much slower on the feet than on the hands, and a complete toenail replacement can take from 9 months to one year.

Therefore, in the case of damage to the thumb (and this is most often the case), it is precisely this duration of treatment that is needed, and then about 2 more weeks of applying the agent to the completely renewed and healthy nail plate is needed to avoid relapse. This applies to liquids, the same can be applied to antifungal varnishes, and even to traditional therapies. If the patient treats nail fungus for one day, or one month, then there will still be no sense from this. There will be a relapse of onychomycosis.

Important! Some local means, that is, liquids and varnishes, can be used to treat nail fungi only if a person has no more than 3 nails affected, and each of them is no more than 50% in area, counting from the free edge. In the event that a larger number of nails are affected, there is a fungal infection of the skin, or the fungal growth zone is localized on the side of the growth of the nail plate, then it is necessary to combine the application of local agents with the intake of antifungal drugs inside.

Exoderil (Micoderil, Exostat) – naftifine

Rating: 4.9

Exoderil for the treatment of onychomycosis is produced by the well-known pharmaceutical concern Sandoz, and is represented by a 1% solution of naftifine. This compound belongs to the class of allylamines, and inhibits the synthesis of new elements of the fungal cell wall. For the treatment of nail fungus, Exoderil is applied twice a day to the affected nail, being careful not to touch the periungual skin.

Before using the product for the first time, you need to cut off the free edge of the nail plate as much as possible, and grind the affected part of the nail, parallel to its surface with a special file, to make the nail plate in the affected area as thin as possible. This is necessary so that the concentration of naftifine under the nail plate is greatest.

The set also includes special disposable files that serve for grinding the surface of the nail for better contact of the liquid with the nail plate. This light sanding should be done before each application. Such treatment must be carried out for at least 4 months, without a pass, but the best period is 6 months. Exoderil is available in 10, 20, and 30 ml vials. Their average cost is 520, 880, and 1350 rubles, respectively. in autumn 2018 prices for major cities of the Russian Federation.

Advantages and disadvantages

The virtue of Exoderil will be the proven property of curing onychomycosis caused by dermatophytes. In the event that the nail is affected by yeast fungi, then the drug may not kill the fungus, but only prevents its reproduction, that is, act fungistatically. That is why a primary analysis for fungus is necessary, carried out in a skin and venereal dispensary.

The concentration of exoderil in the thickness of the nail with uncomplicated onychomycosis is considered sufficient in order to apply the agent no more often than 2 times a day. Naftifine is contraindicated in case of individual hypersensitivity, during pregnancy and during breastfeeding. Side effects sometimes occur, especially if the liquid is accidentally applied to the adjacent skin. Then dryness, burning and redness of the skin may occur. But in the event that the medicine is applied according to the instructions without gaps, and all prevention rules are followed, then the percentage of cure for onychomycosis will be very high.

Important! Each time you apply an antifungal liquid, or any varnish, you must use disposable nail files, spatulas, disposable napkins, and other disposable instruments. It is strictly forbidden to grind and file the affected nail with one file, and even more so it is forbidden to use this nail file to process other nails.

Varnish Batrafen – cyclopirox

Rating: 4.8

Batrafen is a transparent varnish that contains the active ingredient ciclopirox-olamine. The varnish exhibits high fungicidal activity against more than 40 varieties of fungi. Cyclopirox inhibits the metabolism of fungal cells, and interferes with the exchange of substances with the external environment.

The basic principles of preparing the nail for applying varnish are similar to the preparation for the above-described Exoderil, since they are the same. First, the nail affected by the fungus is cut as short as possible, then the remaining nail plate should be sanded with a nail file to create an uneven surface. This will increase the area and strength of the varnish application. It is necessary to apply the varnish with specially applied disposable spatulas in a thin layer, the increase in the effect will not depend on the thickness of the layer. The application procedure is as follows:

1. during the first month, the varnish is applied every other day;
2. in the second month – twice a week;
3. in the third month – weekly.

During the course of treatment, it is necessary to remove all the applied varnish every week with the help of a conventional cosmetic for nail varnish remover, then again shortly trim the nail and prepare it for applying varnish for the next week.

According to the prescription of the attending physician, depending on the type of fungus, other options are possible: for example, within one and a half months, the varnish is applied every other day, during the next one and a half months – twice a week, during the next one and a half months – weekly.

The maximum period of treatment with Batrafen should not exceed six months. The famous pharmaceutical company Sanofi-Aventis produces Batrafen, and a small 3 ml bottle of varnish has an average cost of 2,200 rubles.

Advantages and disadvantages

Lac Batrafen is one of the most effective agents for the treatment of onychomycosis, both as monotherapy for uncomplicated forms, and as complex therapy in combination with the internal use of drugs. Batrafen is well tolerated, practically does not cause intolerance and allergic reactions. Once opened, a bottle of varnish is stored for 6 months, provided it is tightly corked. In the event that the purchased bottle was kept closed, then its shelf life is no more than 3 years.

Of course, the high price will be a relative disadvantage, but at the same time it must be remembered that this remedy really has proven effectiveness, and has not yet been represented by either analogues or generics. It is known that for people with very limited financial resources, doctors can prescribe cheap drugs, such as Nystatin and Levorin tablets, and recommend smearing the affected fingers with tincture of iodine. This type of treatment will be extremely cheap, but its effectiveness is practically close to zero.

Varnish Lotseril (Oflomil, Exolorphinlac) – amorolfine

Rating: 4.7

Another representative of highly active fungus varnishes is Lotseril. And, if Batrafen had neither analogues nor generics, then Lotseril had two of them: Oflomil and Exolorphinlac varnish. The first drug is manufactured by Glenmark and the second by Sandoz. The original Lotseril is produced by the French company Galderma.

The active ingredient of Lotseril is amorolfine. Lotseril is on sale in the form of a set. The varnish is packaged in bottles of 2.5 or 5 ml. The varnish comes with special napkins with isopropyl alcohol, which clean the nails before applying, disposable nail files, as well as special spatulas for applying and evenly distributing the varnish. The active ingredient amorolfine disrupts the synthesis of the structural components of the fungal cell, which are represented by sterols. After the accumulation of abnormal and improperly synthesized sterols inside the fungal cell, the fungal cell is gradually destroyed.

The rules for applying Lotseril are simpler than those of Batrafen. It is necessary to apply varnish either once or twice a week. The sequence of operations is as follows: first, all affected areas of the nail plate are removed with a file on the maximum area, the free edge is cut off as much as possible, then the surface of the nail is treated with napkins with isopropyl alcohol, then varnish is applied. Unlike Batrafen, Lotseril has no limitation on the duration of the course of treatment. Treat as much as necessary, up to a treatment duration of 1 year.

The cost of one small bottle of Lotseril in 2.5 ml is 800 rubles. A small bottle of Oflomil – varnish costs 688 rubles, and the cost of Exorolfinlac is 798 rubles for the same dosage. As you can see, the range of prices is small. The cost of a large bottle is, on average, 1,300 rubles.

Advantages and disadvantages

The only drawback of Lotseril and its analogs is such a side effect as a temporary slight burning sensation at the site of varnish application. Also, this tool is contraindicated for application in childhood, and this refers to newborns and babies under the age of three. The manufacturer recommends not to use cosmetic varnish during treatment, as well as artificial nails, as this can lead to insufficient effectiveness of treatment, and to relapse of onychomycosis. Lotseril is also a highly effective drug with proven effectiveness, but, unlike Batrafen, it is much more affordable, and the consumer can purchase a 2.5 ml bottle, or 5 ml, depending on the duration of the upcoming course of treatment.

Important! The main advantage of all topical preparations used to eliminate nail fungus is the absence of various side effects and symptoms of intoxication that can occur when prescribing drugs for internal use, and especially when they are overdose.

The disadvantage common to this group of agents is that the drug can not always reach the pathogen, especially if the fungus is located in the area of ​​the nail bed, or in the structures of the nail matrix. If the nail is significantly thickened, that is, there are phenomena of hyperkeratosis, then you need to resort to such means as removing the nail plate, cleaning the nail bed. If the nail matrix is ​​affected by the fungus, then local treatment will not achieve its goal. Then it is recommended to prescribe systemic drugs prescribed in the form of tablets.

The best oral tablets

In the event that a fungal infection of the nails in a patient with onychomycosis has gone beyond the maximum permissible limits described above, then the doctor prescribes, together with local agents for the treatment of onychomycosis, tablets. There are a very large number of antifungal agents, but since each original drug has 5-6 commercial copies, or generics, from other companies and even more, the number of the most effective tablets for treating nail fungus is significantly reduced.

Below will be listed the drugs that are used to treat onychomycosis. It is very important to understand that if local remedies for the treatment of nail fungus can independently cope with minor manifestations of infection, then tablets used alone cannot cure nail fungus. Their task is to create from the inside, in the blood, a high concentration of antifungal agent. Thus, the fungus will have no chance to get rid of the unfavorable conditions of existence. A local preparation will act outside, and the tissues of the subungual space will be saturated with fungicides coming from the blood.

Lamisil (Terbizil, Binafin, Thermikon, Exiter, Exifin) – terbinafine

Rating: 4.9

In modern dermatological practice for the treatment of onychomycosis, terbinafine is the first-line drug, or the drug of choice. Terbinafine is a synthetic allylamine with a high level of antifungal activity. The mechanism of action of this substance is to disrupt the synthesis of structural elements of fungal cells. With prolonged use of Lamisil tablets, a fungicidal concentration is created not only in the subungual space, but also in the skin and hair.

Take Lamisil for onychomycosis, and any localization, you need 250 mg per day (once a day) on average, for one and a half months. We are talking about adults and children weighing more than 10 kg. In some cases, treatment can last up to 3 months. The duration of treatment depends on the rate of nail growth, which is individual.

Lamisil is an original drug, and therefore its cost is the highest. It is produced by the Swiss company Novartis Pharma, and the minimum cost of a two-week course of treatment, that is, a pack of 14 tablets, is 1,820 rubles. The average cost of this package is around 2370 rubles. Of course it is expensive for the average Russian consumer. After all, the cost of the course will already be more than 14 thousand rubles, if we take the average market price of a package.

You can offer more affordable options. So, the drug terbinafine Teva, produced by the Israeli company of the same name, will cost 600 rubles, and for 28 tablets. Perhaps the most affordable will be terbinafine, produced by the domestic company Vertex. So, 30 tablets of this drug, designed for a monthly course, can be found at a price of 400 rubles and more. But the question of the quality of the initial substance and the results of treatment in this case remains open.

Advantages and disadvantages

Lamisil is the international standard for the treatment of not only onychomycosis, but also fungal diseases of other localizations. But, since this drug is serious enough, it has a spectrum of side effects. It is usually well tolerated, but the most common side symptom will be headache, impaired taste, and rarely bile stasis may occur. Most often there is a loss of appetite, a feeling of fullness in the stomach, and various allergic skin reactions, such as hives and rashes. Some patients complain of joint and muscle pain. Terbinafine can interfere with the metabolism of other drugs in the body.

That is why it is necessary to carry out treatment only under the supervision of a doctor. This medication is contraindicated in breastfeeding and pregnancy. Terbinafine is not used in children under two years of age, and in children over two years of age, a large clinical experience has been accumulated in the use of this drug, and its tolerance is good.

Diflucan (Diflazon, Mikomax, Mikosist, Fangiflu, Flucostat) – fluconazole

Rating: 4.8

Diflucan, aka the original fluconazole, is also a powerful antifungal drug, and is used not only for onychomycosis, but also for skin lesions, for severe fungal infections with damage to internal organs, including HIV infection, as well as the development of fungi against the background decrease in immunity in the treatment of malignant neoplasms.

Fluconazole is available in both tablets and capsules, and even in solutions for intravenous infusion. For the treatment of fungal infections of nails, the most acceptable dosage of Diflucan 150 mg in one capsule. In case of onychomycosis, it is recommended to take fluconazole one such capsule weekly for 3 to 6 months. According to indications, the duration of the course can be changed by the attending physician. The same dosage of Diflucan is used for mycoses of the feet, skin, and inguinal lesions. For comparison, it can be indicated that with deep and systemic fungal lesions of internal organs, it may be necessary to use fluconazole at a dosage of 2 capsules per day for up to a year or longer, therefore, the appointment of 150 mg per week can be considered very gentle.

Diflucan is produced by the well-known pharmaceutical company Pfizer, and a package of 12 capsules, designed for 3 months of treatment, which is a course of minimum duration, costs 2200 rubles on average. Of course, this can also be considered a large amount, but still it is already the cost of the whole course, and it is 6 times lower than when using Lamisil.

There are also more affordable options for fluconazole. So, one of the cheapest, if not the cheapest, is fluconazole – verte, a domestic manufacturer of CJSC Canonfarma Production. Two capsules will cost only 20 rubles, respectively, the exchange rate cost of such a domestic fluconazole, calculated for 3 months of admission, will be only 120 rubles. This is 18 times cheaper than the cost of the original drug. Most of the cost of any drug is the active ingredient, or substance. Therefore, the question of the ratio of price and quality in the case of choosing such a cheap drug will also be open.

Advantages and disadvantages

The main advantage of fluconazole in the treatment of fungal nail diseases is the excellent price / quality ratio when it comes to the original drug, Diflucan, and relatively expensive generics (Mikosist). Since the agent needs to be taken only once a week, the exchange rate is much lower compared to terbinafine of the original production. Therefore, a large number of doctors prefer Diflucan as a first-line agent, if necessary, to prescribe treatment with oral drugs.

However, such an excessive enthusiasm for fluconazole entails the risk of developing insensitive varieties of fungi, by analogy with the resistance of bacteria that develops to commonly used antibiotics.

This medicine can cause side effects like any other serious medicine, although the medicine is usually well tolerated. Most often, headache, abdominal discomfort, skin rash are noted, with prolonged use in high doses, toxic effects on the red bone marrow are possible, and toxicity to the liver. Fluconazole interacts with a number of other medications, so only a doctor should prescribe and monitor treatment. But good quality fluconazole will always be necessary in the treatment of nail fungus if indicated.

Orungal (Irunin, Canditral, Orungamin, Orunit, Rumikoz) – itraconazole

Rating: 4.7

Itraconazole is a reserve agent, and is used in cases where there are contraindications to the use of terbinafine and fluconazole, or if fungal resistance develops to the first two drugs for any reason, although such cases are almost never encountered in clinical practice.

The original itraconazole, or Orungal, is available in 100 mg capsules, and is used for fungal infections of the nails immediately after a meal, and two schemes for its use are known:

1. according to the first treatment regimen for fungal nail infections, it is recommended to take 2 capsules per day (200 mg daily) for 3 months;
2. the second scheme involves taking 4 capsules a day (2 in the morning and 2 in the evening), while it is applied at 1 and 5 weeks from the start of treatment.

The first scheme is distinguished by a low constant dosage, and the second scheme is characterized by a doubled, 'shock' dosage, but not in the form of a constant, but an intermittent course. Itraconazole is not used to treat fungal nail infections in children. The manufacturer also recommends a longer treatment for toenail lesions than in the case of fingernail lesions. This is completely justified, since more comfortable conditions are created for the causative agents of onychomycosis on the legs, and they are more protected, as mentioned in the introduction to the rating.

Orungal is produced by the famous pharmaceutical concern Janssen Silag, Italy. The cost of this drug is also very high. So, a package of 14 capsules costs an average of 3150 rubles. Even if you try and find the minimum price, it is hardly possible to find Orungal cheaper than 2,200 rubles. This means that the cost of a three-month course according to the first scheme will be over 28 thousand rubles, and according to the second scheme – about 9 thousand, which is much more profitable.

As in all previous cases, there are more affordable and cheaper analogs. If you buy the antifungal drug Orunit, produced by JSC Obolenskoye, in a pharmacy, then one package of 15 capsules will cost starting from 617 rubles, which means that the cost of a monthly course will be about three times cheaper.

Advantages and disadvantages

Itraconazole is relatively infrequently used in the treatment of onychomycosis; it is not without reason that it is a reserve drug. Therefore, resistance to it develops less often, and the tool justifies its high price. But, like any serious remedy, Orungal has contraindications and side effects. Side effects often include an allergic rash, abdominal discomfort and a feeling of nausea, other side effects such as frequent urination, increased hepatic transaminases, blurred vision are rare. This means – not more often than with a frequency of 0.01%.

Orungal is contraindicated for severe liver damage, for impaired renal function, in childhood (up to three years), during pregnancy, and during breastfeeding. Also, a contraindication is chronic heart failure, as well as gastritis with reduced secretion, since against the background of low acidity of gastric juice, the absorption of the active substance from the capsules worsens. For the same reason, it is recommended to separate the intake of itraconazole from antacids. This means that you need to take Orungal no later than 2 hours before taking Maalox, Almagel, Fosfalugel, omeprazole and other antacids, or 2 or more hours after their use.

With all the pros and cons, the treatment of nail fungus with the help of tablets in the entire world medical practice is on these whales – terbinafine, itraconazole, and fluconazole. Of course, there are other antifungal pills that do not belong to these names, but their effectiveness is significantly lower, and sometimes absent altogether, especially since it is not possible to quickly destroy fungi protected by the nail plate even with modern drugs.

Of these old drugs that appeared in pharmacology textbooks about 50 years ago, but are still produced, and even prescribed, Nystatin and Levorin tablets can be attributed. So, Nystatin in the amount of 20 tablets is sold, starting from 33 rubles, but if you are prescribed Nystatin for onychomycosis, look for another specialist. Even if you have only 33 rubles in your pocket, you will simply waste them.

The secret to correct nail fungus treatment

If a respected reader has reached this section, then, most likely, he is looking for means for self-treatment. Otherwise, he would just go to the pharmacy and buy what the doctor ordered. Therefore, instead of listing folk remedies, it is necessary to know about those treatment conditions, without which the use of any, the most powerful antifungal drugs will either give a short-term effect or be completely useless. Of course, we are talking about the rules of secondary prevention, which must be observed by everyone with onychomycosis. We give them for the case of fungal infection of the toenails:

1. the patient needs, after suspicion of the presence of nail fungus, and even more so, after confirming the diagnosis, purchase a separate basin for washing feet and for baths;
2. socks should be changed daily, it is highly desirable that after drying they are ironed with steam;
3. the skin on the feet must be treated with a special spray against fungi;
4. insoles should be changed as often as possible, or they should be ironed with steam in the same way as socks;
5. to treat the inner surface of shoes, it is necessary to use special antifungal sprays for shoes, or regularly irradiate the inner surface of shoes with special dryers with ultraviolet radiation, in the summer you can listen to shoes in the bright sun;
6. you should abandon closed slippers, and go to open slippers, which are also treated with anti-fungal compounds for shoes;
7. you should be conscious not to visit fitness centers, public baths, saunas and pools during treatment, even if the fungal infection of the nails exists in a limited area, or you already have a certificate for visiting the pool.

Finally, in the event that the treatment of a fungal infection of the legs was ineffective, it is necessary to visit a doctor and make sure that there are no chronic diseases such as diabetes mellitus, vascular insufficiency of the lower extremities, immunodeficiency, and all those conditions that complicate the fight against the fungus .

Treating nail fungus is difficult, troublesome and time-consuming. In the treatment of onychomycosis, it is no longer so much the use of the most expensive drugs that is required, but rather careful adherence to the rules of secondary prevention and discipline, because regular nail treatment and taking medications can last for many months. Only in this case will the fungal infection be defeated.

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Attention! This rating is subjective and does not constitute an advertisement and does not serve as a purchase guide. Before buying, you need to consult with a specialist.