I had an interesting conversation this morning with a carpenter who came to see me regarding a fungal infection of the toe nails. My first thought was, ‘smart man’ in that it’s early spring and he’s getting a jump on treatment prior to sandal season. He proceeded to tell me that he had already done one 90 day round of Lamisil, one year ago, that seemed to work well on the lesser nails, but he still had an infection of the great toe nails. He posed an interesting question to me; how often can or should he use Lamisil and what really is the most effective way to go about using Lamisil.
History of Lamisil clinical trials
Oral Lamisil, also known as terbinafine, is used to treat fungal infections of the finger nail and toe nail (onychomycosis). The origin of Lamisil use for nail infections is interesting. McNeil Pharmacueticals was the lab that originally developed Lamisl to treat aspergillosis, a fungal infection of the lung that commonly affects immune compromised patients such as AIDS patients or those folks undergoing chemo-therapy for cancer. What McNeil found was that terbinafine treated the aspergillosis but remarkably terbinafine also treated each and every patient’s fungal toe nail infection. McNeil had created a new and unique marketing opportunity. Could McNeil bypass doctors and market directly to consumers? Most of us know the answer to that question. McNeil had one of the most successful television and print marketing campaigns in the history of prescriptions drugs. As a provider, in the early 1990’s, I had a McNeil rep in my office virtually every day.
Is Lamisil effective in resolving nail fungus?
Is Lamisil effective in resolving nail fungus? Well, yes and no. In the short term, yes, it can be very effective. The summary of terbinafine dosing from Rxlist.com sums up what most clinicians consider to be the community consensus for oral dosing of terbinafine for finger nail and toe nail treatment of onychomycoisis;
Fingernail onychomycosis: One 250 mg tablet once daily for 6 weeks. Toenail onychomycosis: One 250 mg tablet once daily for 12 weeks. The optimal clinical effect is seen some months after mycological cure and cessation of treatment.
At this dosing, the majority of fungal nail infections do clear. But unfortunately, the recurrence rate of fungal nail infections is quite high with recurrence rates as high as 90% in 3-5 years.
If Lamisil is an effective but non-lasting solution, how can we make that solution better?
Take more Lamisil? Take Lamisil more frequently?
The goal of any pharmaceutical treatment is to use the least amount of medication to affect a cure. But there’s more to this specific fungal problem than what initially meets the eye. There’s a number of contributing factors to recurring fungal infections of the nail, the most important of which is moisture. Fungus is a plant. Water the plant with perspiration and you’re bound to see fungus recur. An easy win in finding a long term cure for onychomycosis is to dry the foot. Easy wins include:
- Frequent changes of socks
- Rotate shoes, leaving 24 hours between use
- Use a drying agent like Onox to inhibit perspiration
- Topical over-the-counter agents used to treat onychomycosis
I always feel like a success when I can divorce my patients from being dependent upon pharmaceuticals. When it comes to the treatment of dermatophytosis (fungal infections of the skin) and onychomycosis (fungal infections of the nail) I’m a big fan of tea tree oil based products. I get it, I know the chemistry. Pharmacueitcal grade agents are more effective as a short term solution but create a dependency on prescriptions. That’s the beauty of tea tree oil products.
How do I use tea tree oil products to treat fungal infections of the skin and nail?
I told my carpenter patient to think of the treatment of dermatophytosis and onychomycosis as daily hygiene, just like brushing your teeth. Start using teat tree oil products when you start using Lamisil. When your Lamisil script is complete, continue using the tea tree oil products. The benefits can be significant and prolong the clear time of the nails, decreasing the need for repeat dosing of Lamisil.
And lastly, here's a treatment guide to treatment of onychomycosis.