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Dr. Robert
Dr. Robert, Doctor
Category: Medical
Satisfied Customers: 6680
Experience:  M.B.B.S, Experienced Family Physician
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My pedicurist confirmed my suspicion that I have a toenail

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My pedicurist confirmed my suspicion that I have a toenail fungus, with browish-blackish discoloration of both great toenails. I thought the discoloration was due to having my toes run into by a shopping cart. (I was wearing sandles). I have no pain. I have mild type 2 diabetes, well controlled by metformin. I take 40 mg Lipitor BID, and several antidepressants as well. I don't want to add another oral med to the list and possibly add to the possibility of liver damage. Do you know of a topical OTC treatment? Are any of them effective? Is it even worth treating this fungus?
Hello,
Welcome here and thank you for your question.I am Dr.Robert & will do whatever I can to help answer your questions.First I need a little more information-

What is your age?
Do you have toe nail fungus in one foot?
Is there any itching or discharge?

I am waiting for your reply.
Kind Regards,
Dr. Robert
Customer: replied 3 years ago.


I am 71. Big toe nails on both feet. No other nails seem to be affected. No discharge or itching.

Dear XXXXX,
Thank you for providing quick additional info.

An infection with toe nail fungus may be difficult to treat.Your doctor may prescribe a medicated nail polish containing either Loceryl (amorolfine) or Loprox (ciclopirox).The most effective anti fungal treatments are terbinafine (Lamisil) and itraconazole (Sporanox).You typically take these medications for six to 12 weeks.

Topical ointment/creams may not be sufficient to cure the fungal infection of toe nails as the fungus lies deep in the nails & hence oral anti fungal treatment is required along with topical treatment.

You can apply anti fungal cream like monistat.It is available as over the counter(OTC) without prescription & will help you greatly.

But again,oral anti fungal treatment is usually required to cure the infection completely.

Hope this helped.

My goal is to provide you with excellent service – if you feel you have gotten anything less, please reply back, I am happy to address follow-up questions.

Thank you for your repeat business!

Kind Regards,
Dr. Robert





Customer: replied 3 years ago.

Thank you, XXXXX XXXXX



Monostat? Is it the same as sometimes given for vaginal yeast infections? Does it come in just a regular tube suitable for applying other places on the body. Are there any risks from this fungus if I do not take oral medication and it doesn't clear up entirely? It causes no distress except for minor embarrassment.

Dear XXXXX,
Thank you for asking follow up question.

Yes,monostat is also given for vaginal fungal infections but that is vaginal preparation & you need skin preparation now.

Monistat 1 is the strongest formulation of Monistat cream and can allow for yeast infection treatment in ideal situations.It is very effective.

Yes,it is a regular tube & can be applied anywhere on the body where you have fungal infection.

The only risk is that toe nail fungus may spread from one of your nails to other nails.

So oral medications are usually required.So I advice you to apply monistat cream & see if it gets cured.Otherwise you need oral anti fungal medications.

Hope this helped.

My goal is to provide you with excellent service – if you feel you have gotten anything less, please reply back, I am happy to address follow-up questions.

Thank you for your repeat business!

Kind Regards,
Dr. Robert

Dr. Robert and 3 other Medical Specialists are ready to help you
Hi Donna,

I'm just following up with you to see how everything is going. Did my answer help?

How is your symptoms now?
Have you applied monistat?

Kind Regards,
Dr. Robert

Let me know,
Dr.Robert
Customer: replied 3 years ago.

Yes, I am using monistat cream as you suggested. I use it twice a day.
But I think it is too soon to tell if it is helping.


I did consult my physician. He said, as you did, that topical preparations are not always effective.


I already have had some abnormal liver tests. But he prescribed Lamisil for 3 months, and set me up for monthly liver function tests. I don't know if it makes any difference, but I've adjusted my medication schedule so that I take my dose of Lamisil and my dose of Lipitor 12 hours apart. Of course, I don't know how much time it takes either of the drugs to clear the liver.

Dear Donna,

Yes,as the topical preparations are usually not effective in for curing toe nail fungus,oral anti fungal medication are the best choice.

You need to have liver function test at regular intervals.

Hepatotoxicity may occur in patients with and without pre-existing liver disease therefore periodic monitoring (after 4-6 weeks of treatment) of liver function test is recommended. Lamisil tablets should be immediately discontinued in case of elevation of liver function test.

Hope this helped.

My goal is to provide you with excellent service – if you feel you have gotten anything less, please reply back, I am happy to address follow-up questions.

Thank you for your repeat business!

Kind Regards,
Dr. Robert