A Note on Natural Treatments for Toenail Fungus

What do poison ivy, belladonna, oleander, castor bean plant, and foxglove have in common?

They’re not just naturally occurring plants but it can be toxic to humans in the smallest dose ranging from skin irritation to life-threatening heart complications. So it’s important to understand the role of natural products and it’s safety and efficacy.

Just because something is labeled as natural it does not necessarily imply safe for humans or effective for the condition to be treated.

In order to safely and effectively treat toenail fungus, here are some points to consider.

• Toenail fungus is stubborn to treat, which is why early treatment is recommended and usually easier than more severe cases

• Toenail fungus takes at least a year to show results, that means treatment must be consistent & preventive

• Diet is strongly involved with your immune system, and a diet rich in sugar and refined carbohydrates (Classic American diet) will make one more susceptible to toenail fungus

• Some people have a gene that makes them more susceptible than others to contract toenail fungus, making it difficult to cure

Treatment vs. Cure

When doctors talk about treating a medical problem, we hesitate to announce a complete cure. That is because some medical conditions live on a spectrum. For example, you may have heard about cancer remission, which means quieting cancer cells to a level that is undetectable or stable (not rapidly growing).

That is why patients with cancer are monitored routinely. The longer a person lives with an undetectable amount of cancer cells, this remission is how we measure relative success of treatment.

Monitoring the treatment of toenail fungus is similar. Although toenail fungus doesn’t command the same level of morbidity as cancer, we can talk about the success of treatment based on undetectable level of fungus based on nail sampling or it’s overall appearance. It is very difficult to achieve complete cure from toenail fungus. And even after toenail fungus “cure” it can recur, so maintenance and prevention is important.

That said, I rounded up a few of the most common natural treatments that have some scientific evidence behind it. Since toenail fungus is a spectrum ranging from mild (affects a small edge of the toenail) to severe (affecting the entire toenail), individual results will vary. Also, I loosely say some evidence because in order to have meaningful data, somebody has to fund the research project and often those who have money to fund a big study have a little bias towards a successful outcome. I won’t be going into much of that here, however.

Do natural treatments for toenail fungus actually work?

First, we need to define what it means to work, or success. Successful treatment can mean different things to different people, such as

• clinical cure rate - the nail looks better after treatment

• micrological cure rate - there is no microscopic evidence of the fungus on the nail sample (requires a physician, thus one may never really know if they’re own treatment “cured” toenail fungus)

Evidence of natural treatments (products) often come as anecdotal, or admitted by an individual rather than an organized scientific study. This is not a controlled study (we don’t know the severity, the frequency, dose or duration or the health or age of the individual) but someone said they tried a treatment and found positive clinical results. For some, that may be sufficient.

In instances where the toenail fungus is mild (affecting less than 10% of the nail plate), trying natural treatments is reasonable such as tea tree oil, oregano oil, garlic, Vick’s vaporub, vinegar soaks, coconut oil, lavendar oil or baking soda. The references for these are listed below.

However, I will cautiously say to monitor the situation and measure the progress closely. If there is no improvement or the condition is getting worse or you develop a skin reaction or other side effects, do not delay medical care. The most effective treatment with a relatively safe profile remains a prescription like terbinafine, itraconzole or other. This medication will depend on the type of fungus, which is why it’s important the treating physician takes a nail clipping to send it to the lab for analysis.

Prescriptions: Effective but are they safe?

I treat toenail fungus nearly everyday and the issue of safety always comes up. I am an advocate for both safe AND effective treatments, so I heavily rely on scientific data. However, I also recognize the importance of alternative options for those who cannot take prescriptions antifungals because of other health reasons or simply want to avoid the risks.

Here are some facts about oral antifungals for toenail fungus (terbinafine, itraconzole, etc)

• These prescriptions must be monitored by the prescribing physician

• Data shows the liver enzymes (a marker of liver health) goes up in 1 in 100,000 healthy individuals, which is reversible once the medication stops - which is why being monitored is important

• Treatment takes at least 3 months and an addition of pulse dosing (taking less of it) may be recommended for another 4 months, depending on the severity. Toenail grows up at 2-3mm per month, which is why I often tell patients it can take up to a year for the entire toenail to grow out

In general, oral prescriptions are safe when given to the right person and the correct dose. As I mentioned earlier, relative success relies on routine follow up appointments so don’t just take the prescription and disappear.

What about laser for toenail fungus?

I’m glad you asked. I have been monitoring laser technology for some time now and the data shows laser therapy is an alternative option for when the pill is contraindicated. Laser therapy is another natural way to treat toenail fungus using low level light energy. It requires at least 3 treatments 30 days apart. Each session takes a few minutes per toenail and is a comfortable experience where you may feel a warming sensation during treatment.

Success rates for this is cautiously optimistic, which is why I spend a lot of time talking about prevention and combination therapy with a topical antifungal, with or without a low dose pill option for severe cases. This advanced technology is not covered by insurance so it would be an out of pocket expense.

For those wanting an alternative option to treat toenail fungus that has a safe and effective profile, consider natural treatments like laser therapy.

References

Journal of the American Academy of Dermatology found that tea tree oil, when applied topically, was effective in treating fungal nail infections. (Syed et al., 1999)

Journal Phytotherapy Research demonstrated oregano oil's antifungal activity against various fungal strains, including those that cause nail infections. (Manohar et al., 2001)

Journal of the American Academy of Dermatology suggested that ajoene, a compound derived from garlic, exhibited antifungal activity against dermatophytes responsible for toenail infections. (Ledezma et al., 1996)

Journal of the American Academy of Dermatology reported that vinegar soaks showed some potential for improving the symptoms of toenail fungus. (Bristow et al., 1997)

Journal of Medicinal Food found that caprylic acid derived from coconut oil demonstrated antifungal activity against various fungal strains. (Ogbolu et al., 2007)

Journal of Medical Microbiology suggested that lavender oil exhibited antifungal effects against dermatophytes. (Sienkiewicz et al., 2011)

 Journal of the European Academy of Dermatology and Venereology indicated that a baking soda paste could potentially improve the appearance of fungal-infected nails. (Takahashi et al., 2013)