Care Management Options For Toenail Fungus

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    Fungal toenails, medically known as onychomycosis, is a common condition that can affect both toenails and fingernails, but is more often seen in toenails.

    What is Fungal Toenails

    Fungal infections are caused by the same microorganism that cause tinea of the skin. The fungi (or dermatophytes) feed off the nail (made up of the protein keratin).

    For an infection to flourish, the fungus prefers an environment that has moisture, warmth, darkness, and a ready supply of food. The area under a toenail is perfect for fungus growth.


    The infestation of fungi in the nail eventually weakens the nail and causes it to split and become brittle. The nail may look thickened and discoloured. Look for the below visual signs:

    • Darkening or discolouration of nail
    • Thickening of the nail
    • White or yellow streaks on the nail
    • Crumbling corner or tip of the nail
    • Separation of nail from nail bed

    toenail fungus_1 toenail fungus_2

    Toenail fungus doesn’t resolve on it own and is contagious. It is important to manage it as soon as you spot the symptoms to avoid further damage and deterioration of your toenails.

    stages of toenail fungus_1

    stages of toenail fungus_2

    Fact: Toenails grow much slower than your fingernails at an average rate of 1.62 mm per month. Patience and consistency are key to the care management process.

    Effectiveness of Fungal Toenails Care Management

    Clinical studies show the Lunula laser course of care management has the highest success rate of all the care management available with around an 80% success rate, which is much higher than topical care management (10% success) and oral medications (60% success).

    Lunula Laser Therapy

    •   Over 80% success rate
    •   Only non-thermal laser to receive FDA Market Clearance
    •   No side effects, pain-free care management
    •   Only takes 12 minutes for each foot during a session

    Lunula Laser Care Management is a low-level cold laser therapy to target onychomycosis. Laser care management is completely drug free, meaning it does not impose any health risks associated with the oral antifungal medications. There are no adverse reactions or known side effects. This revolutionary laser has proven to be highly effective with over 80 % success rate.

    Care Management involves weekly laser sessions that last twelve minutes per foot; The whole care management course ranges from six to eight sessions on average, depending on the severity of the infection.

    Lunula Laser combines two laser beams to alter cellular function:

    Red ray – damages the fungal pathogen, which can cause immediate death but also weakens the pathogen’s immune defenses.

    Blue ray – increases blood flow and improves the toenail’s immune response.

    Thermal (hot) laser care management is currently not available in Asia.

    pactmed therapy

    Pactmed Therapy

    • Around 50-60% success rate
    • Can be used in conjunction with Lunula laser care management
    • 9.5 minutes of photodynamic light per affected toe

    Photodynamic antimicrobial therapy (PACT) uses photodynamic light to destroy the dermatophytes, yeast and other fungus in conjunction with a blue gel.

    Pactmed session starts with applying a special PACT gel to the affected nail for 10 minutes. This gel stains the fungal cells, making them sensitive to the light emitted by the PACT LED lamp.

    Patients with moderate to severe fungal toenails may be advised to use both pactmed and lunula laser therapy at the same time. The whole care management course consists of four to eight sessions on average, depends on the severity of the infection.

    topical agents

    Topical agents

    • Low success rate: 10%
    • Long course of care management: 6-12 months
    • Poor penetration into the nail
    • More effective as combined care management or preventive treament

    Topical antifungals are mostly available as creams, liquids and powders.
    Despite being a common self-care management option, topical preparations don’t penetrate the nail well and therefore can’t reach the nail bed where the infection can thrive. Frequently, people try multiple topical preparations before becoming disheartened.

    OTC topical agents, however, are considered safe and useful in conjunction with other care management or as preventive agents for new or recurring infections.

    Topical medications usually will take on average 6-12 months to show any progress.

    Over-the-Counter Products at MyFootDr Singapore Online Shop

    1. Mycoril

    mycoril spray

    Broad spectrum antifungal spray on feet and in shoes

    2. Tea Tree Oil

    tea tree oil

    Natural antiseptic for fungal infected skin or toenails

    3. Daktarin


    Antifungal powder that also helps keep the feet dry

    4. Lamisil


    Antifungal cream for athlete’s feet, which is usually co-associated with fungal infections of the toe nails.

    oral medication

    Oral medication

    • 50-60% success rate
    • Side effects
    • Can be used as preventive measure

    The most commonly used oral antifungal drugs are griseofulvin, terbinafine, itraconazole and ketoconazole.

    The course of care management generally last for 6-12 weeks as liver toxicity can occur with prolonged use.

    Prescribed oral medications can interact with other drugs and can produce adverse effects, making them unsuitable for some people. If you have a history of blood or liver disease or you plan to drink alcohol during care management, these pills are not safe for you.

    Oral medication, however, can be used as prophylactic therapy; it can be used to prevent reinfection.

    Toenail Fungus Prevention

    toenail fungus prevention

    Keep your feet dry – fungi thrives in moist, dark environment

    Wear comfortable and breathable footwear, avoid tightly fitted shoes

    Trim your toenail regularly to avoid trauma and abrasion of shoes

    Don’t go barefoot in public and avoid sharing of towels, nail-clips





    Seek care management at early stage: Fungal toenail infections that have been present for long time are generally more resistant to care management. If you have concerns about the shape, colour or any other change in your nails, please see your podiatrist as soon as possible.

    The Podiatry team at my FootDr Singapore are all highly trained and skilled at managing and resolving these conditions holistically.

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