What is toenail fungus, and why does it develop? How can you treat it?

What is toenail fungus, and why does it develop? How can you treat it?

Toenail fungus impacts about 14% of people in the United States. It makes about 42 million cases of onychomycosis, resulting in pain, infection, and yellow, brittle, unattractive nails. Fungal conditions can spread to other nails without proper treatment, and constant discomfort can make even simple activities like wearing shoes very painful. Ongoing infections can eventually lead to very unpleasant odors as well.

Getting rid of toenail fungus can be very difficult, mainly because the fungus is hidden underneath the nail. The tough layer provides a hard and protective barrier against most of the topical antifungal medications penetrating and treating the infection. The roots of nail fungus are usually deep and can spread over large tissue areas, making them difficult to eradicate without ongoing intervention completely. While several antifungal medications are available to treat onychomycosis, each comes with its limitations and side effects.

Traditional Antifungal Medications

Traditional topical antifungal medications like fluconazole and miconazole can effectively eradicate the fungus that causes infections. Because these medications have been available for some time now, they’re very accessible and affordable. However, they have a significant limitation: they cannot penetrate the nail bed as effectively as required to destroy the infection at its roots. It means they must be applied for long periods – often a year or even more – to be effective. Exposure to them for longer periods also exposes patients to side effects and medical risks associated with long-term antifungal use. Plus, fungal infections can recur if these agents don’t penetrate the tissues at the strength required for fungal eradication.

Even if the affected nail is removed to allow creams and ointments to be effective in a better way, topical antifungal agents are usually unable to penetrate the entire area of infection. It ultimately leaves enough fungal bodies in the affected area to cause recurrent symptoms and subsequent infection.

Oral Medication

Most physicians rely on oral medications such as fluconazole and terbinafine to treat fungal infections systemically to address the problem of tissue penetration. Although oral antifungal medications can be efficacious in relieving onychomycosis, these agents must move throughout the body to reach the infected nail. This means that relatively higher or prolonged doses must be given to reach the blood levels required to fight off the stubborn toenail fungus and prevent a recurrence.

Long-term oral antifungal medications, particularly at medium to high doses, can significantly increase the risks of severe side effects, like nephrotoxicity. Nephrotoxicity is the increased risk of damage to the liver where these drugs are metabolized and increased risks of drug interactions. Preferably, a topical helps relieve some of these risks by concentrating the medication in the toe area where the infection occurs.

Plus, topical ways of administration offer a further advantage over oral medications as they treat the nail structure itself. As the fungal infection grows, the nail lifts from the skin, creating a space that prevents oral medications from reaching the fungus properly.

As the topical agents get into the nail itself, they can be much more effective in eradicating fungi attached to the inner of the nail until they can reach the fungus at the required concentration levels. This is how it has remained for years with traditional topical medications that lacked penetrating capability and how long-term use of oral antifungals as the two primary options for onychomycosis treatment was risky.

The latest topical agents come at a price

Recently, scientists have found fresh and unique topical antifungal medications that have proven to be very effective in treating toenail fungal infections in vitro and Vivo. Though they may be a better treatment option for eradicating fungal infections in some patients, their high cost makes them relatively inaccessible for all. 

These newer agents’ high cost is partly due to their manufacturing, as new drugs are pricey, particularly in their early stages of development and production. Their protection by patents also adds to the cost. The higher costs during the early stages help compensate for the costs associated with researching and developing the drug before its release. Fluconazole and miconazole, compared, have been on the market for many years; patents no longer protect them, and they are widely available, which keeps their costs low and affordable.

But there are more than only research and development costs adding to the high cost of care – such as in onychomycosis. The treatment can take several months, significantly increasing care costs. Long-term treatment is important to enable the topical agents to reach the infection site and eradicate the infection. And with that being said, we all reach the drugs delivered to those target tissues well. 

The two latest topical antifungal medications, Jublia (efinaconazole) and Kerydin (tavaborole) are priced at more than $500 per bottle in most regions, and each bottle contains only about 80 drops. Most therapies are about a year long. Considering all these facts, the cost of treating toenails would rise according to how many toenails are affected.

Recura: a cost-effective solution to toenail fungus

Recura topical cream was specifically compounded for improved delivery and more affordable onychomycosis medications like fluconazole and miconazole. Recura uses a distinctive formulation designed to hold the antifungal medication and prevent it from disseminating or diluting before reaching the target area. In this formula, more medication reaches the fungal site to destroy the fungal roots, eliminating the infection and destroying the fungi to prevent further infections.

How effective is Recura? 

A clinical study using Recura on fungal toenail models showed significant improvements through the delivery of fluconazole 10% and miconazole 10%. Two models were used in this study, and the results were compared with treatments using Jublia and Penlac, a more costly generic antifungal medication. The researchers found that recur increased penetration of both fluconazole and miconazole to help them achieve clinically-effective levels equivalent to or superior to the more expensive agents. 

Hence, by improving the delivery of low-cost and mostly-available options like fluconazole and miconazole, patients can get the same benefits of the latest topical antifungal medications or oral medications without any risks associated with long-term uses or the prohibitive costs.

Compounded formula

Another significant benefit of recura is its compounded formulation, which enables the prescribers to customize the dosage according to each patient’s needs, keeping their health profile in view. And obviously, because fluconazole and miconazole have been used for several years to treat toenail fungal infections, there’s a lot of research and data associated with potential side effects and safety issues. It means patients can have the peace of mind that comes from using medications that have been comprehensively vetted rather than blindly relying on medications that have been recently introduced and have very limited clinical history and background. Harbor Compounding Pharmacy can provide tailored medication according to your needs.


Toenail fungal infections can be significantly discomforting and embarrassing, and finding the correct treatment is the key to treating and preventing infections as quickly as possible. As researchers study more about the toenail fungal infection process and the lifecycle of the fungus itself, they will be able to discover and develop more medications and delivery systems that offer greater efficacy in shorter periods without increasing the risk of any potential side effects. Till then, Acura provides an effective treatment option for millions of people dealing with the painful symptoms and cosmetic effects of hard-to-treat toenail fungal infections.


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