Onychomycosis, more commonly known as toenail fungus, is a frustratingly common infection. It can cause your toenails to thicken, change color, and even crumble. Nobody wants that!
When you’re looking for a treatment, you’ll likely come across two names: tolnaftate and terbinafine. Both are antifungals, but they work in different ways and are available in different forms. Tolnaftate is often found over-the-counter, while terbinafine is typically a prescription medication.
So, which one is better for you? This article will compare and contrast tolnaftate and terbinafine for toenail fungus, looking at how well they work, their safety profiles, and how they’re typically used. We’ll help you understand the differences so you can make an informed decision about your treatment.
Understanding toenail fungus (onychomycosis)
Toenail fungus is a common condition that can be challenging to treat.
Causes and risk factors
Most of the time, toenail fungus is caused by dermatophytes, such as Trichophyton rubrum and Trichophyton mentagrophytes. In some cases, yeasts and molds, such as Candida, can be the cause.
You’re more likely to get toenail fungus if you:
- Are older
- Have diabetes
- Have poor circulation
- Have had a recent injury to your nail
- Have a condition that weakens your immune system
Symptoms and diagnosis
If you have toenail fungus, you might notice that the affected nail has become thickened, discolored (yellow, white, or brown), brittle, or distorted in shape.
It’s important to get an accurate diagnosis from a healthcare professional. They’ll perform a clinical exam and may also order lab tests, such as microscopy, culture, or PCR, to confirm that you have a fungal infection.
The doctor will also want to rule out other conditions that can cause similar symptoms, such as psoriasis, nail trauma, and other nail disorders.
Tolnaftate: What it is, how it works, and how to use it
Tolnaftate is a synthetic antifungal medicine that belongs to a class of drugs called thiocarbamates. Think of it as a troublemaker for fungus. It messes with the structure of fungal cells and stops them from growing properly.
Tolnaftate has both fungicidal and fungistatic properties. That means it can kill some fungi, but it mainly just stops them from multiplying.
How well does it work?
Tolnaftate works well against many common dermatophytes, which are the fungi most often responsible for toenail infections. But it’s not so great against yeasts and molds, like Candida.
Studies show that tolnaftate is generally less effective than terbinafine when it comes to treating toenail fungus. So, while it can help, it might not be the strongest option available.
How to use tolnaftate
Tolnaftate comes in several forms:
- creams
- solutions
- powders
- sprays
You apply it directly to the affected toenail and the skin around it, usually twice a day for several weeks or even months.
While you’re using tolnaftate, it’s important to keep your nails clean, dry, and trimmed. Good hygiene, and perhaps complementary treatments like lemongrass oil, can help the medicine work better and prevent the fungus from spreading.
Terbinafine: How it Works, How Well It Works, and How to Use It
Terbinafine is an allylamine antifungal. That means it works by interfering with how fungi create ergosterol, a key component of their cell membranes. Terbinafine blocks squalene epoxidase, an enzyme the fungus needs to make ergosterol.
Without ergosterol, the fungal cell membrane breaks down, and the fungus dies.
How well does terbinafine work?
Terbinafine fights a wide range of fungi, including dermatophytes, yeasts, and molds. It’s especially good at killing Trichophyton, a common cause of toenail fungus.
Compared to tolnaftate, terbinafine is more likely to clear up a toenail fungus infection. Oral terbinafine, taken as a pill, is often the first choice for treating onychomycosis (toenail fungus).
In clinical trials, oral terbinafine has been shown to cure toenail fungus in a significant number of people.
How do you use terbinafine?
You can get terbinafine as a pill or as a cream or solution you put directly on the nail. Because it works better, the pill form is more common for treating toenail fungus.
If you take terbinafine pills, you’ll likely take them every day for 6 to 12 weeks.
If the infection is mild and only on the surface of the nail, your doctor might suggest trying a topical treatment, such as Loceryl Nail Lacquer.
Tolnaftate vs. terbinafine: Which is more effective?
When you’re choosing between tolnaftate and terbinafine for toenail fungus, you’ll want to consider how effective the medications are, how safe they are to use, and how much they cost.
Efficacy
Terbinafine usually clears up toenail fungus better than tolnaftate, especially when the infection is severe. But several things can affect how well either treatment works:
- How bad the infection is
- How closely you follow the treatment plan
- Your individual health and body chemistry
Safety and side effects
Tolnaftate is usually easy to tolerate, with very few side effects. Sometimes it can cause a little skin irritation.
Terbinafine, especially when taken as a pill, has a higher risk of side effects. It can affect your liver, cause stomach problems, and lead to skin reactions. If you’re taking terbinafine pills, your doctor will want to keep an eye on your liver function.
You shouldn’t take terbinafine if you have liver disease, are pregnant, or are taking certain other medications.
Cost and accessibility
Tolnaftate is almost always cheaper than terbinafine, and you can buy it without a prescription. Terbinafine pills require a prescription, and your insurance company may have rules about when they’ll cover the cost.
Frequently Asked Questions
What is the most aggressive treatment for toenail fungus?
The most aggressive treatment typically involves oral antifungal medications like terbinafine or itraconazole. These medications have a higher success rate compared to topical treatments but come with potential side effects and require monitoring by a healthcare professional.
How long does it take for terbinafine to work on toenail fungus?
Terbinafine requires patience. It can take several months (typically 6-12 months) to see complete clearing of toenail fungus, as the medication needs to allow for the growth of healthy, uninfected nails. It’s essential to continue treatment for the prescribed duration, even if you see improvement early on.
Which is better for toenail fungus, tolnaftate or clotrimazole?
Neither tolnaftate nor clotrimazole is great for toenail fungus. They are both topical antifungals, but tolnaftate is generally considered less effective than clotrimazole for treating toenail infections due to its limited ability to penetrate the nail. Both are better suited for athlete’s foot, for which Lamisil Cream is commonly used.
What kills toenail fungus permanently?
Unfortunately, “permanently” killing toenail fungus is tricky. Even with successful treatment, reinfection is possible. Oral antifungals offer the best chance of clearing the infection, but diligent foot hygiene and preventing recurrence are crucial for long-term management.
Is tolnaftate better than terbinafine?
No, tolnaftate is not better than terbinafine for treating toenail fungus. Terbinafine, particularly the oral formulation, is significantly more effective due to its ability to reach the infection site and its stronger antifungal properties. Tolnaftate is a weaker topical antifungal primarily used for athlete’s foot and other skin infections.
To Conclude
Terbinafine is usually more effective than tolnaftate at treating toenail fungus, but tolnaftate is safer and easier to get. The best choice for you will depend on how severe your fungal infection is, your overall health, and other things that only a healthcare professional can evaluate.
If you think you have toenail fungus, see a doctor or other healthcare provider. Getting diagnosed and starting treatment early on can help keep you from having complications and improve your quality of life.