Medicines for nail fungus

General / Introduction

If the nail fungus is very pronounced, various systemic drugs are used. However, it has been shown that the combination of systemic and local therapy for nail fungus has an advantage over simple systemic therapy. Various antimycotics ("antifungal" drugs) can be used for therapy, which differ primarily in their spectrum of action.

Nail fungus drug: griseofulvin

With the nail fungus drug Griseofulvin it is a naturally occurring chemical compound produced by the bacterium Penicillium griseofulvum is secreted.
It is a benzofuran derivative and is also known as a mold toxin. This drug can be taken orally and is antagonistic Thread pile (Dermatophytes), which the Nail fungus can trigger. However, it is ineffective against other fungi, such as mold. If griseofulvin is taken in too high doses, it can lead to sleep disorders, dizziness or a headache to lead.

Nail fungus drug: itraconazole

Itraconazole is also a systemically effective drug against nail fungus Antifungal agentwhich can be taken orally. It is mostly in the Intestines absorbed and then enters the blood circulation. It can also be used as intravenous therapy.
The drug is metabolized via the Cytochrome P3 A4 and can cause damage to the liver or one Heart failure to lead. The effect of this drug is based on the reduction of the ergosterol synthesis in the fungal cells.It inhibits the conversion of the precursor lanosterol into the required ergosterol. Ergosterol is a vital component of the cell membrane of certain fungi and thus leads to the destruction of the fungal membrane.
Itraconazole is also not effective against all forms of fungus, but against a relatively large number. These include the Thread fungi (Dermatophytes), the yeasts, aspergillus and histoplasms. A few other types of fungus are sensitive to itraconazole, but they are much less common.

Nail fungus drug: terbinafine

With the nail fungus drug Terbinafine it is an allylamine derivative, which is a standard drug Fungal nail disease is used. This preparation can be used both locally and systemically. The oral and therefore systemic effect is preferred for severe fungal nail diseases. As well as Itraconazole inhibits Terbinafine the synthesis of ergosterol in the fungal cell membrane. This inhibition takes place by blocking the conversion of squalene-2,3-epoxide into lanosterol, and thus blocks the ergosterol synthesis one step before the effect of itraconazole. Lanosterol is a precursor to ergosterol, which means that the fungal cell membrane cannot be built up. At the same time, squalene accumulates in the mushroom cell. Lamisil® is an antifungal medicine that contains terbinafine.

Nail fungus drug: fluconazole

Fluconazole is a drug that belongs to the group of triazole derivatives. This too Antifungal agent ultimately blocks ergosterol synthesis. However, it initially blocks the 14-alpha-demethylase of the cytochrome P450 system of the fungal cell. Due to this inhibition, the conversion of lanosterol into ergosterol cannot take place, which leads to membrane defects in the fungal cells.
Fluconazole acts against a wide range of fungi, including against Candida, Cryptococci, Epidermophytes, Microspores and Histoplasms. For this reason, it is used for most systemic or local fungal infections and also for nail fungal disease. The most common fluconazole side effects are gastrointestinal symptoms like nausea, Vomit and diarrhea. In some cases, liver damage with an increase in transaminases can occur. For this reason, regular laboratory checks are indicated while taking fluconazole.

indication

Is the infestation of the Nail fungus very pronounced, for example when infected more than three nails must be treated with systemic therapy in some cases.

A prerequisite for such therapy is one healthy liveras the antifungal drugs can affect the liver function. In order to successfully complete the treatment, one is often required very long therapy duration necessary, which should be observed urgently. Therapy usually lasts three to six months; in exceptional cases, systemic therapy may also be necessary for 12 months.
With a purely systemic therapy, the The recurrence rate is often very high. Causes for this can be, for example, very slow nail growth in old age, poor defenses of the body or a lack of cooperation on the part of the patient.

In addition, more and more types of fungi are becoming resistant to the Antifungal drugs. A fact that is caused not least by a lack of cooperation. Furthermore, severe side effects can occur with the nail fungus drug such as gastrointestinal symptoms or one Deterioration in liver function lead to discontinuation of therapy. Even then, no success can be achieved and the nail fungus persists. In order to control the liver function in particular, regular laboratory controls with determination of transaminases are necessary during therapy.

Over-the-counter / prescription drugs

Basically, if you suspect a fungal infection of the nails, you should get one as soon as possible suitable specialist to be visited. As a rule, dermatologists are the right people to talk to for infections in the fingernail and toenail area. Depending on the extent of the nail fungus, the latter can decide which medication is suitable and whether over-the-counter or prescription-only substances (medication on prescription) must be used.

For some people, however, the presence of a fungal infection, regardless of which part of the body is affected, is so uncomfortable that they shy away from seeking a specialist. For these patients, trying a treatment of the nail fungus with over-the-counter drugs be helpful. Medicines for nail fungus come in the form of Varnishes, ointments, gels, solutions and as Tablets offered. In most cases, topical medications (especially varnishes and ointments) can be purchased without a prescription. In this context, however, it should be noted that not all of these locally applicable drugs are available over the counter in drugstores. Despite the lack of a prescription, many nail fungus drugs are subject to a general one Compulsory pharmacy. This means that they can only be sold in certified pharmacies. In the case of mildly developed nail fungus that has not yet infiltrated the nail bed, the use of this over-the-counter medication is usually sufficient to achieve a successful treatment. However, if there is no visible improvement even after several days of treatment, a dermatologist must be consulted urgently.

Pronounced nail fungus with involvement of the nail bed, on the other hand, has to be dealt with immediately in most cases Combination of topical and oral antifungal agents (Antifungal drugs) are treated. Because most oral medications used to treat nail fungus have a number of adverse drug effects (Side effects) they are only on prescription obtainable. In addition, those antimycotics that are sold on prescription are usually much more effective. Another justification for selling oral fungal nail medicines on prescription is the fact that these substances must be strictly controlled in their consumption. The success of the treatment depends to a large extent on regular and proper use of the drug.

Side effects

• Local antifungal drugs: In most cases, topical medication for nail fungus does not cause any side effects. In individual patients, after applying the varnishes or ointments Skin irritation strictly limited to the fingertips to be watched. These skin irritations are mostly uncomplicated redness and slight itching. As a rule, these complaints subside on their own after a few hours.
• Oral antifungal drugs: Oral antifungal agents, however, have a number of undesirable effects Drug effects (Side effects). Patients who Nail fungus For this reason, sufferers must be supervised by a doctor during treatment with oral nail fungus medication. As soon as peculiarities are observed or complaints arise, the affected patients should consult the treating specialist immediately. The exact side effects that can occur while taking oral antimycotics depends on the class of substance and the dosage of the drug.
• Allylamines: Nail fungus drugs from the group of Allylamines are generally considered to be very tolerable. The individual active ingredients are in the liver metabolized and broken down. The actual excretion then takes place through the kidneys. Because of this, long-term use of drugs of this group of drugs can help both Liver and kidney functions affect. Skin reactions and disorders of the gastrointestinal tract are rarely observed when taking these nail fungus drugs.
• Azoles: Medicines against nail fungus that can be assigned to the group of azoles, on the other hand, often lead to side effects in the form of Indigestion or Discomfort in the gastrointestinal tract. In many patients, it becomes more pronounced with the use of azoles nausea and the occasional Vomit. In addition, these drugs can have side effects such as a headache, Circulatory problems and dizziness observe quite often. Some patients also develop allergic rashes while taking substances from this group of nail fungus drugs. However, impairment of liver function is rather rare with the azoles.
• Amphotericin B: One of the most popular drugs used to treat nail fungus is Amphotericin B. In contrast to most of the antifungal drugs, Amphotericin B only through the vein (intravenous) can be administered. The reason for this is the fact that this drug cannot be absorbed through the gastrointestinal tract and would therefore simply be excreted unused if given orally. Typical side effects of amphotericin B include Damage to the kidneys (nephrotoxic). For this reason, the drug is usually only used for very severe fungal infections. Other side effects can include flu-like symptoms like fever, head- and Body aches be. In general, all drugs against nail fungus can cause allergic reactions and intolerance.

Use of drugs against nail fungus

The application of the various drugs depends on the type of drug.

Locally effective substances are in the form of Ointments, gels, or solutions offered. Medicines assigned to this group usually have to be assigned applied several times a day to the infected nail surface become. Hands should not be washed for half an hour after use.

Special paints A simple nail polish can be applied against nail fungus. Ideally, the affected patient should rub the nail surface with a fine grain arrows roughen. In this way, the active ingredient can better penetrate the nail substance and fight the fungal attack more specifically. In this context, however, it should be noted that the nail arrows used already after a single application as contaminated applies and must be disposed of immediately. If the same arrows were used several times, new fungal cells would always be distributed on the nail surface, making healing almost impossible.

In addition to the conventional nail fungus medication, different ones can be used, especially for mild fungal infections Home remedies be used. In most cases, the affected patient should get one Solution from the middle of the housel (for example vinegar) and plain tap water to make. During use, the solution can be picked up with a cotton ball or a cotton swab and spread generously on the nail surface. Even when treating nail fungus with a home remedy, the application must be applied over a period of several times a day for at least two to three weeks respectively. Stopping treatment too early leads to an increase in any remaining fungal cells and thus to a renewed outbreak of the nail fungus.

Even the typical ones oral medication against nail fungus differ in their application. Since these drugs can only be purchased under medical supervision (prescription drugs) the appropriate application must be discussed with the attending physician. The patient affected by the nail fungus should, however, be advised that the doctor's instructions are strictly followed.

Medicines for nail fungus during pregnancy and breastfeeding

While pregnancy and Lactation Many drugs against nail fungus must not be taken.

This is a serious problem for the women affected, especially when there is a strong fungal attack, because it is precisely the highly effective active ingredients Fluconazole and Itraconazole are absolutely contraindicated during pregnancy and breastfeeding. The reason for this is the fact that a transfer of these active substances from the womb via the placenta in the child's organism cannot be excluded. As a result, the risk of adverse drug reactions occurring applies to both the mother and the unborn child.

However, despite the restrictions on the use of oral antifungal agents, fungal nail infections should also be treated during pregnancy. Expectant and nursing mothers are therefore forced to do so other treatments to fall back on. In most cases, nail fungus can occur during pregnancy and breastfeeding mechanically treated become. With this method, the affected nail is treated with a Arrows or milling cutter freed from infected nail substance. The disadvantage of mechanical nail fungus treatment is the fact that a complete cure cannot always be guaranteed. Especially when the nail bed is involved, only oral antifungal agents can be sufficiently effective.

However, the chances of recovery from nail fungus during pregnancy and breastfeeding can be increased by a combined treatment with mechanical removal of the nail surface and application special paints and Anoint, can be increased significantly. The additional application of such a locally acting antifungal agent ensures that the attacked nail surface is sealed. In addition, a highly effective substance is released from the varnish layer, which penetrates the nail substance and fights the fungal attack. In this way, the fungus spread is stopped immediately and a Passing on the infection effectively suppressed on fellow human beings.

Figure nail fungus

Nail - Unguis

1. Free edge (of the nail) -
   Margo liber
2. Cover fabric of the nail bed -
   Hyponychium
3. Nail plate -
   Lamina unguis
4. Nail fold - Matric sulcus
5. "Moondchen" - Lunula
6. Horny layer of the nail wall -
   Eponychium
7. Distal phalanx -
   Phalanx distalis
8. Nail root - Margo occultus
   Nail fungus -
   Onychomycosis, Tinea unguium
   Nail fungus symptoms
9. Brittleness,
   Crumbling of the nail
10. Thickening of the nail
    (Bulge)
11. Whitish, yellow or
    gray-brown spots in the nail
12. White or yellowish
    Discoloration on the edge of the nail
13. Dullness of the nail
14. Chipping of the nail

You can find an overview of all Dr-Gumpert images at: medical illustrations