Treatment of onychomycosis in diabetic patients (2023)

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Part 24, number 4

October 1, 2006

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Functions| October 1, 2006

Jason A.Winston;

Jason A.Winston

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Jami L. Miller, MD

Jami L. Miller, MD

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Klin diabetes2006; 24 (4): 160-166

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Jason A.Winston,Jamie L. Miller; Treatment of onychomycosis in diabetic patients.Klin diabetesOctober 1, 2006; 24(4): 160-166.

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Onychomycosis is more common in diabetic patients than in non-diabetic patients. It's more than a cosmetic problem, and diabetic patients are at greater risk for serious complications of the disease, including limb amputations. This article reviews the various diagnostic and therapeutic options available for onychomycosis, focusing on their role in diabetic patients.

IIn 2005, the estimated number of Americans with diabetes was 20.8 million people, with an additional 1.5 million cases diagnosed that year in those ≥ 20 years of age.1Onychomycosis is a fungal infection of the nail that is estimated to cause up to 50% of all nail problems2and 30% of all skin fungal infections.3About one in three people with diabetes suffer from onychomycosis.4Many studies have been conducted to assess whether diabetic patients are more likely to develop onychomycosis than those without diabetes.4-10and most have concluded that they do. One study found an increased risk in all three main groups of organisms that can cause onychomycosis: dermatophytes, yeasts, and non-dermatophyte fungi.5

Onychomycosis in people with diabetes is more than a cosmetic nuisance; it increases the risk of other foot conditions and limb amputation.4,10-22The outcome of not treating onychomycosis in diabetic patients may be worse than in people without diabetes. Therefore, effective treatment of these patients is of utmost importance.13Because onychomycosis can lead to many complications in diabetic patients, most insurance companies reimburse the treatment in documented cases. Thickened, dystrophic nails can be very painful and make walking difficult. Injury to the adjacent skin by fungal nails can occur without the patient's knowledge and can lead to secondary infections, both fungal and bacterial, including paronychia and cellulitis.3,4,9,14,15Thickened nails can cause erosion of the nail bed and hyponychium due to pressure, just as tight shoes can cause friction blisters in these patients. In combination with peripheral neuropathy, blisters and erosions may develop into cellulitis or osteomyelitis of the underlying bone.3,4,14,15Spread of the fungal infection to the surrounding skin causes tinea pedis, which can lead to tears in the plantar and interdigital skin. These can also provide a route for bacteria to enter.15

Patients with diabetes-related comorbidities are at particularly increased risk of morbidity in onychomycosis. Diabetic patients suffering from decreased foot sensation are more prone to trauma, which damages the nail and nail matrix, opening gateways for the fungus to infect the nail.13,15Some diabetic patients may be obese, which can make it difficult to bend over to examine their feet.15Diabetic patients with cataracts16of retinopathie15may not be able to properly examine their feet regularly. Retinopathy appears to be an independent risk factor for onychomycosis in diabetes.9Other risk factors include peripheral neuropathy,3,9,15impaired peripheral circulation,4,9age,4,9family history,4and taking immunosuppressants.4In addition, the duration of diabetes is correlated with the severity of onychomycosis, if any.4Male diabetic patients have a three times higher risk of onychomycosis than female diabetic patients.4

The presence of a fungal infection in the nails increases the risk of other infections of the foot and leg. In one study, diabetic patients with onychomycosis had 15% secondary infections, compared to 6% secondary infections in diabetic patients without onychomycosis. In addition, diabetic patients with onychomycosis had an approximately three times greater risk of gangrene or foot ulcers compared to non-diabetic patients.10

The total annual cost for toe, leg, and foot amputations in the United States was nearly $2 billion in 2003.17These costs covered a total of 112,551 amputations, with an average cost of $16,826 for each procedure.17In 2001, the total cost of amputations in diabetic patients was > $1.6 billion.18Most lower limb amputations occur in diabetic patients.19Because the risk of amputation increases with onychomycosis, it is imperative that clinicians examine the feet of diabetic patients and, when suspected, take a sample for diagnosis.

Causes of onychomycosis

Three types of fungi can cause nail infections in humans: dermatophytes (especiallyTrichophytonspecies), yeasts (eg.Candida albicans), and non-dermatophytic fungi.2,20Dermatophytes make up the vast majority of infectious etiologies.21In one epidemiological study, dermatophytes were found in 82% of isolates andCandida albicansin ∼ 7%.22

Diagnose van onychomycose

Medical diagnosis

Infected nails appear thick, brittle and discolored, often with a yellow tinge. The nail plate may separate from the nail bed (onycholysis) and there may be inflammation of the skin near the edge of the nail (paronychial inflammation).20

Onychomycosis has four classic clinical presentations in nails. Distal and lateral subungual infection is the most common type. In this pattern, the infection spreads proximally from the distal or lateral aspects of the nail, eventually elevating the free edge of the nail plate and causing onycholysis and thickening of the nail plate with subungual hyperkeratosis. The infection spreads proximally and causes yellow-brown discolorations.23The most common organism isTrichophyton rubrum, followed byTrichophyton mentagrophyten. Candidaspecies also cause this pattern of infection, as do fungi such as theAspergillisInFusariumkind. When complicated by infection with pigmented fungi or bacteria such asPseudomonas aeruginosa, the nails may appear dark green to black.23

Proximal subungual infection is rare, but more common in patients with AIDS and immunosuppression. In this pattern, the organisms invade through the proximal nail fold and spread to the nail matrix and then to the deep surface of the nail plate.23

White superficial onychomycosis is normally limited to the toenails. It presents with small well-defined superficial white spots on the nail that may coalesce to cover the entire nail.16,23The diseased nails are brittle and can crumble. The vast majority of cases are caused by the fungusTrichophyton interdigitale.

Total dystrophic onychomycosis is the most serious clinical manifestation of onychomycosis. In this form, the entire nail except for small fragments is destroyed, leaving a thickened nail bed.23

Differential diagnosis

Only 57% of diabetic patients with abnormal-appearing toenails are confirmed to have onychomycosis.4Common conditions including psoriasis, lichen planus, onychogryphosis, trauma and idiopathic dystrophic nails are included in the differential diagnosis.

Psoriasis is the most common condition similar to onychomycosis24and may show subungual hyperkeratosis, onycholysis and onychodystrophy of the entire nail.23Although psoriasis usually also has classic manifestations on other skin areas, it can be limited to the nails. Pits and "oil drops" are much more common in psoriasis than in onychomycosis.23,24Often with psoriasis, a "salmon patch" will be present, an irregular yellow or pink area under the nail plate. This does not occur in onychomycosis.25

Patients with lichen planus may have nail manifestations of the disease.24Clinicians should carefully examine the extremities and mucous membranes of the patient for the pathognomic violet-like papules.26Lichen planus can affect both fingernails and toenails, making them brittle and ridged. Subungual hyperkeratosis and distal onycholysis may also occur.27

Onychogryphosis is a severe deformity of the nail, usually affecting the big toes. The nail becomes very thick and discolored, resembling a ram's horn. The nail bed can become hypertrophied. Onychogryphosis is usually caused by occasional nail clipping and impaired peripheral circulation, but can also be caused by trauma.28

Repeated trauma to the nails, which can increase the risk of onychomycosis,5can cause distal onycholysis with subsequent microbial colonization and altered pigmentation.24In addition, a subungual hematoma from trauma can cause discolorations that can be confused with onychomycosis.25

Normal nails can show morphological variations, especially as an individual ages. White spots and lines in the nails, leukonychia punctata and striated leukonychia are benign and can result from minor trauma to the nail matrix.27Onycholoysis can be idiopathic or caused by trauma.28Dermatophytes can be found in idiopathic onycholysis but are considered commensal.29

Laboratory diagnosis

The standard of care in diagnosing onychomycosis is a clinical impression with one confirmatory laboratory finding, such as KOH-prepared direct microscopy, fungal culture, or histopathology with periodic acid-Schiff stain (PAS).30-32It is important to verify clinical suspicion with laboratory tests. One study compared the cost of empirical treatment of all patients with onychodystrophy with antifungal drugs versus PAS staining of all nails and treatment of only those with positive histology. The study found that it was cost-effective to first diagnose and then treat empirically.33

Samples for microscopy, culture, or histopathology can be collected from the nail plate or subungual debris. Care should be taken when collecting a sample in diabetic patients to avoid damaging the nail bed, which may increase the risk of a secondary bacterial infection.15

Histological examination.Most clinicians find it easiest to send nail clippings for histopathological evaluation with a PAS stain. Clippings are sent to the pathology lab in formalin, embedded in paraffin, and stained with hematoxylin, eosin, PAS, and toluidine blue.23This method, also called "PATHPAS", has proven to be the most sensitive test.30,32,34One study evaluated 105 patients with suspected onychomycosis using KOH preparation, culture, biopsy with PAS staining, and biopsy with calcoflur white staining. Biopsy with calcoflur white spot was considered the gold standard. The study found that the KOH preparation was 80% sensitive and 72% specific, biopsy with PAS stain was 92% sensitive and 72% specific, and culture was 59% sensitive and 82% specific.34

Instant inquiry.Collected pieces are placed on a slide and treated with 10-30% KOH solution. The slide can be heated over a flame to speed up nail clearing and emphasize fungal features. Some recommend a combination of KOH and dimethyl sulfoxide for clearer and faster results.23Onychomycosis caused by dermatophytes can be diagnosed based on the appearance of long, regularly shaped hyphae. If yeasts are the etiological agent, the appearance of budding spores can often be seen.21Although the appearance of the nail can provide clues to the etiological agent, it cannot be used to diagnose the agent.23

Culture.Culture alone without clinical manifestations should not be used to diagnose onychomycosis.21Cultures may be positive without a truly invasive infection due to contamination with comorbid onychodystrophy.5For culture, nail plate and subungual keratosis samples should be placed in Sabouraud's agar and incubated at 26°C for 7-14 days.20,23Antibiotics in the agar prevent the growth of coexisting bacteria. If possible, samples should be placed on agar both with and without cycloheximide, as cycloheximide inhibits the growth of most non-dermatophytes.23Unfortunately, culture is less sensitive than direct microscopy, especially when a patient has already been treated. However, culture is the only method available for identification of the specific pathogen, which may be helpful in the choice of therapy, especially if the nails do not respond to oral terbinafine therapy (discussed below).20

Treatment of onychomycosis in diabetes

The treatment of onychomycosis in diabetic patients is the same as in non-diabetic patients.13Toenails grow at one-third to one-half the rate of fingernails and therefore require longer treatment.23The nails of older diabetic patients may grow even more slowly and require longer treatment times.15Different modalities can be used for the treatment of onychomycosis in diabetic patients: local therapy, systemic therapy, combination therapy and nail removal.15,23Patients older than 55 years may have a higher risk of relapse. In addition, patient education is vital to reduce the risk of recurrence. Many studies have compared the mycological cure rates, recurrence rates and cost-effectiveness of the different treatment options. Although diabetic patients with onychomycosis have been shown to have more complications and infections than diabetic patients without onychomycosis,10to our knowledge, no study has compared treatment options with outcomes such as diabetic complications or secondary infections.

topical therapy

There are three classes of topical antifungal creams: polyenes (eg, nystatin), imidazoles (eg, clotrimazole), and allylamines-benzylamines (eg, terbinafine). All three are actively opposedCandida, but only imidazoles and allylamines-benzylamines are active against dermatophytes.20In general, topical therapy is not sufficient to cure nail infections, probably due to insufficient penetration of the medication into the affected tissues and nail bed.23The exception to this is superficial white onychomycosis, which is easily treated with a topical agent because the organism grows on the top nail plate rather than in the nail bed.

Antifungal nail polishes are available for the treatment of onychomycosis and penetrate the nail better than creams and gels. One lacquer contains the active ingredient amorolfine, which is part of a new class of antifungal agents, the morpholines. Another varnish contains ciclopirox, which has a broader spectrum of activity.23Nail polishes are applied daily for 48 weeks and removal with nail polish remover once a week is required. Mycological cure rates (negative results on microscopy and fungal culture) in US studies were as high as 36%.35

Topical antifungals alone have a place in the reduction of recurrences and re-infection once the initial infection has been fully treated.14One author recommends using a miconazole nitrate 2% powder on the webs every 3 days to prevent relapse once the initial infection has been fully treated.14

Oral therapy

Many studies have evaluated systemic treatments for onychomycosis in the general population. However, diabetic patients with onychomycosis pose a special problem because they often take other medications and have other health problems.36

Oral agents (summarized in Table 1) are absorbed through the circulation through the nail bed and take approximately 7 days to reach minimum inhibitory concentration (MIC). Once the drug is discontinued, it can remain active in the nail for up to 90 days, and the nail does not need to be completely clear before stopping the drug.14

Table 1.

Oral medications for onychomycosis

Treatment of onychomycosis in diabetic patients (2)

View large

Treatment of onychomycosis in diabetic patients (3)

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Griseofulvin was the standard oral therapy for onychomycosis for more than 30 years. However, it has a narrow therapeutic window and significant side effects. It also has several interactions with other drugs and is only active against dermatophytes, with a <40% cure rate. For these reasons, it is rarely used to treat onychomycosis today.23

The imidazole class of drugs is active against most organisms that cause onychomycosis. However, they are not approved for the treatment of onychomycosis in the United States. Ketoconazole is slightly more effective than griseofulvin, but also has many side effects and drug interactions.20It is rarely used to treat onychomycosis today.23Fluconazole, 300 mg once a week for 6 months, is more effective and has been shown to be safe.37

Itraconazole, a triazole antifungal agent, binds more specifically to fungal cytochrome P-450 than other azoles, reducing the incidence of side effects. It is active against dermatophytesCandidaInAspergillusbut notScytalidium, a mold.23Because it is fat soluble, it remains in the nail plate long after the drug is discontinued. It was discovered 6 months after discontinuation after a 3 month course. The use of 200 mg per day for 3 months achieved a mycological cure rate of 79% 6 months after therapy.38Due to the high cost of itraconazole, a pulse regiment has been developed and tested. Pulse treatment involves using 200 mg twice daily for 1 week for each of 2 months in fingernails and 3 months in toenails. Pulse therapy has been reported to be as effective as continuous therapy with fewer side effects and half the cost.39

Azole antifungals, including itraconazole and fluconazole, have been shown to increase levels of oral antidiabetic drugs.15Nevertheless, systemic therapy with itraconazole has been shown to be safe and effective for use in diabetic patients at a dose of 200 mg twice daily.40,41No statistically significant changes in hemoglobin A1clevels have been observed in diabetic patients receiving pulse itraconazole for 3 months.40

Terbinafine, an allylamine antifungal medication, is the first-line agent for the treatment of onychomycosis. In contrast to the broad spectrum of action of itraconazole, terbinafine is only active against dermatophytes in vivo and does not treatCandidaof schimmelsoorten.23Terbinafine 250 mg once daily for 3 months has been shown to achieve a mycological cure rate of 82% in toenail onychomycosis and 71% in fingernail onychomycosis.42In one multicenter study, 89 patients with diabetes (both insulin-dependent and non-insulin-dependent) and onychomycosis were treated with continuous oral terbinafine 250 mg for 12 weeks and followed for 36 weeks post-treatment. After 48 weeks, a mycological cure rate of 73% was achieved. There were no reported episodes of hypoglycaemia.36Another study in 81 diabetic patients with onychomycosis found equal efficacy of terbinafine in subjects with and without diabetes.43Pulse therapy with terbinafine has not been shown to be as effective as continuous therapy.44,45

Terbinafine has no significant interactions with oral antidiabetic drugs.46A study examining the safety and efficacy of terbinafine found that although 9.1% of diabetic patients experienced serious side effects while taking terbinafine, a causal relationship between the drug and the events could not be found. It was concluded that terbinafine is relatively safe in diabetic patients and acceptable for the long-term maintenance of nail health in diabetic patients.47

Studies comparing continuous terbinafine and continuous itraconazole have produced mixed results. One study found a mycological cure rate of 73% for continuous terbinafine compared to 45.8% for continuous itraconazole over 12 weeks. Both drugs were well tolerated.48Another study comparing continuous terbinafine and pulse itraconazole in elderly patients for 12 weeks plus an additional 4 weeks, if needed, after 6 months found a mycological cure rate for continuous terbinafine of 64% compared to 62.7% for pulse itraconazole.49A second study in 496 patients with onychomycosis, comparing continuous terbinafine to pulsed itraconazole, showed that after 72 weeks in groups treated for 12 weeks, 75.7% of the terbinafine group achieved mycological cure compared to 38.3 % in the itraconazole group. In groups treated for 16 weeks, 80.8% of the terbinafine group achieved mycological cure compared to 49.1% in the itraconazole group.50A third study looked at long-term cure and relapse rates on continuous terbinafine compared to pulsed itraconazole over 12 and 16 weeks. After 5 years, 47% of the terbinafine group compared to 13% of the itraconazole group still had negative mycology.51

The newer antifungal drugs, including terbinafine and itraconazole, rarely cause serious side effects.52Common adverse reactions that occurred while patients were taking terbinafine were headache (12.9%), diarrhea (5.6%), rash (5.6%) and dyspepsia (4.3%). Liver enzyme abnormalities occurred in 3.3%.53Common adverse reactions that occurred while patients were taking itraconazole to treat toenail onychomycosis were headache (10%), rhinitis (9%), upper respiratory tract infection (8%), and sinusitis (7%). Liver enzyme elevations caused therapy discontinuation in 4%.54With both drugs, the frequency of side effects is comparable to placebo.52The manufacturer of terbinafine recommends pre-treatment liver function tests in all patients and complete blood counts in immunosuppressed patients receiving terbinafine for > 6 weeks.53The manufacturer of itraconazole recommends that liver function tests be performed only in patients with pre-existing liver function abnormalities or who have had liver abnormalities while taking other medications.54

Another consideration when choosing medications is cost, especially given the long course of treatment for onychomycosis. One study examined the total cost of therapy for continuous terbinafine compared to continuous itraconazole. This study included the cost of the initial doctor's visit, follow-up visits, mycology, various recommended lab tests while patients are on the drugs, and the cost of treating the various side effects that can be expected for each of the drugs. The final cost for the treatment of onychomycosis with continuous terbinafine was $697.55-$699.11 compared to $1,216.40-$1,218.80 for continuous itraconazole.55However, the cost is similar when comparing pulse itraconazole to continuous terbinafine.

Combination therapy

Combining oral and topical antifungals is a newly developed treatment option that increases the chances of a cure. One study showed improved efficacy of terbinafine when combined with topical amorolfine.56Another showed improved efficacy of continuous itraconazole in combination with topical amorolfine.57Yet another compared three groups of patients: those who received terbinafine (4 weeks on, 4 weeks off) and 48 weeks of topical ciclopirox; those who received continuous terbinafine for 12 weeks and 48 weeks of ciclopirox; and those who received terbinafine continuously for only 12 weeks with no topical antifungal agent. Mycological cure was observed in 66.7, 70.4 and 56.0%, respectively.58Another study found a mycological cure rate of 88.2 versus 64.7% when continuous terbinafine for 16 weeks was combined with topical ciclopirox for 9 months.59

Nail removal, avulsion

Removal of diseased nails can be used as an additional therapy, but not as the only therapy for onychomycosis.23Surgical nail avulsion is rarely used to treat onychomycosis in diabetic patients because of their increased risk of secondary infections, gangrene, and poor wound healing.60However, in severe or refractory cases, nail removal may be used.20It can also be used when oral therapy is contraindicated or ineffective.3,61


High-risk diabetic patients, especially those with peripheral neuropathy or peripheral vascular disease, should be educated about appropriate foot and leg exams.14In patients with a history of onychomycosis, it is especially important to examine the webspaces, heels, and perionychium for any breaks in the skin.14It is important to emphasize that patients cannot rely solely on discomfort or pain due to decreased sensation.14


Onychomycosis is a major cause of morbidity in diabetic patients, increasing their risk of limb amputation and local and systemic secondary bacterial infections. Because onychomycosis is more common in diabetic patients and can complicate the disease, clinicians must be vigilant in diagnosis and comprehensive in treatment.

The most sensitive method of diagnosis is pathology with PAS staining. Culture is also important to guide therapy choice. Currently, the most effective therapy is 250 mg oral terbinafine per day for 12 weeks, possibly with concomitant topical therapy with a nail varnish, such as amorolfine or ciclopirox. Patients should be treated until mycological cure is achieved and closely monitored for recurrent infection. If the causative organism is a yeast or fungus, pulse itraconazole should be used instead. After treatment, suppressive topical therapy can be used, such as miconazole nitrate 2% powder every 3 days. In addition, patient education, including proper foot and toe examinations, is essential to prevent relapses and complications.

Jason A. Winston is a 4th year medical student at Vanderbilt University School of Medicine in Nashville, Tenn. Jami L. Miller, MD, is an assistant professor in the Department of Dermatology, Department of Internal Medicine at Vanderbilt University Medical Center in Nashville, Ten.



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Arc Dermatol




(Video) Just in 7 Days Cure Toenail Fungus At Home | Best Remedy For Toenail Fungus - Dr. Vivek Joshi




Gupta AK, Shear NH: A risk-benefit analysis of the newer oral antifungal drugs used to treat onychomycosis.

drug safe







Terbinafine package insert

. East Hanover, NJ, Novartis Pharmaceuticals,



Itraconazole package insert

. Titusville, N.J., Janssen Pharmaceutical Products,



Bootman JL: Cost-effectiveness of two new treatments for onychomycosis: an analysis of two comparative clinical trials.

J Ben Acad Dermatol







Baran R: Topical amorolfine for 15 months combined with 12 weeks of oral terbinafine, a cost-effective treatment for onychomycosis.

Br J Dermatol


(Addition 60):





Lecha M: Amorolfine and itraconazole combination for severe toenail onychomycosis; results of an open randomized study in Spain.

Br J Dermatol


(Addition 60):





Gupta AK, Onychomycosis Combination Therapy Study Group: Ciclopirox Topical Solution, 8% combined with oral terbinafine for the treatment of onychomycosis: a randomized, evaluator-blinded study.

JDrugs Dermatol







Avner S, Nir N, Henri T: Combination of oral terbinafine and topical ciclopirox compared to oral terbinafine for the treatment of onychomycosis.

J Dermatologist Treat







Robbins JM: Treatment of onychomycosis in the diabetic patient population.

J Diabetescomplicaties







Del Rosso JQ: Advances in the treatment of superficial fungal infections: focus on onychomycosis and dry tinea pedis.

J Ben Osteopath Assoc






American Diabetes Association



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(Video) 60% Of Diabetics Have Toenail Fungus Without Knowing. Cure Is Here!


How is onychomycosis treated in diabetic patients? ›

Terbinafine and itraconazole have been investigated for the treatment of onychomycosis in diabetic patients and have been shown to have efficacy and safety profiles comparable to those in the nondiabetic population.

Which antifungal is safe for diabetics? ›

Azole antifungals, including itraconazole and fluconazole, have been shown to elevate levels of oral hypoglycemic drugs. Nevertheless, systemic therapy with itraconazole has been found to be safe and effective for use in diabetic patients at a dose of 200 mg twice daily.

Can diabetics use terbinafine? ›

Oral antifungal agents are not contraindicated in patients with diabetes. For example, there are no significant interactions between hypoglycemic drugs and terbinafine (Lamisil, Novartis). Most patients with diabetes are reducing cardiovascular risk with statin therapy.

How do diabetics treat toe infections? ›

For severe infection, parenteral broad‐spectrum antibiotics that have been proven clinically effective for diabetic foot infections are recommended; these include imipenem/cilastatin, newer fluoroquinolones (e.g. levofloxacin and ciprofloxacin), third‐ or fourth‐generation cephalosporins (e.g. ceftazidime and ...

What is the first line treatment for onychomycosis? ›

Oral terbinafine is typically the first-line treatment for confirmed onychomycosis. The treatment course is generally 6 weeks for fingernails and 12 weeks for toenails.

Can diabetics use anti fungal cream? ›

Antifungal cream helps relieve itching, scaling, cracking, redness, soreness, burning, and irritation. Specifically formulated for diabetic skin and contains natural ingredients including inula viscosa and tea tree to help repair damaged skin and promote healing of painful cracks and fissures.

What is the best topical antibiotic for diabetic foot? ›

Clindamycin has excellent oral bioavailability as well as bone penetration. It is also a very useful drug in patients sensitive to penicillin and vancomycin. Combining clindamycin and ciprofloxacin can be effective for severe and life-threatening diabetic foot infections.

Why do diabetics get toe fungus? ›

Because diabetes frequently causes nerve damage, you may not be aware when you injure your toenail. Such an injury can create an opening for fungus, allowing an infection to take hold. Without treatment from a foot doctor, the infection can spread beyond the nail to the foot.

What is the best antibiotic ointment for diabetic foot? ›

Clotrimazole is one of the most effective ointments for preventing and treating infections in diabetic foot ulcers. It belongs to a class of medicines called Imidazoles.

Why can't diabetics cut their toenails? ›

Diabetes are more prone to infection, and fungi and bacteria can transfer from clipping or foot care tools to any open wounds.

Is toe fungus bad for diabetics? ›

DeMarco, DPM, we advise our patients with diabetes to be extra cautious of toenail fungus, as it can cause serious complications if not taken care of properly.

Which is better Lamisil or terbinafine? ›

Lamisil has an average rating of 6.8 out of 10 from a total of 139 ratings on 60% of reviewers reported a positive effect, while 27% reported a negative effect. Terbinafine has an average rating of 6.4 out of 10 from a total of 471 ratings on

Why are foot infections hard to treat in diabetics? ›

Infections in patients with diabetes are difficult to treat because these individuals have impaired microvascular circulation, which limits the access of phagocytic cells to the infected area and results in a poor concentration of antibiotics in the infected tissues.

What is the most common diabetic foot infection? ›

Staphylococcus aureus is the most important pathogen in diabetic foot infections, but as the depth and severity increase, these become polymicrobial.

What does a diabetic infected toe look like? ›

The symptoms of diabetic foot infections are similar to those of any infection. The area around the injury will become red, eventually spreading from the original site. People with diabetic foot infections will also experience pain or tenderness at the site of the wound, and the original cut may seep pus.

What is the best antifungal for onychomycosis? ›

Antifungals from the azole and allylamine classes are the most widely used oral medications for the treatment of onychomycosis. The azole class includes itraconazole (Sporanox), fluconazole (Diflucan), and ketoconazole; however, ketoconazole is rarely prescribed because of drug interactions and hepatotoxicity.

What is the best nail treatment for onychomycosis? ›

Your health care provider may prescribe an antifungal cream, such as efinaconazole (Jublia) and tavaborole (Kerydin). You rub this product into your infected nails after soaking. These creams may work better if you first thin the nails.

What is the gold standard treatment for onychomycosis? ›

Oral Antifungal Agents. Oral antifungal therapy is considered the gold standard for onychomycosis both in children and adults because of shorter courses of treatment and higher cure rates when compared with topical antifungal therapy [88, 95, 97, 98].

Is there a foot cream for diabetics? ›

CeraVe Diabetics' Skin Relief Hand and Foot Cream is specifically formulated with ceramides, urea and bilberry to help target these common dry skin areas. CeraVe Diabetics' Dry Skin Relief Hand and Foot Cream was developed with dermatologists to provide soothing, 48-hour hydration for diabetics' dry skin.

Should diabetics put cream on their feet? ›

Do not put oils or creams between your toes. The extra moisture can lead to infection. Also, don't soak your feet—that can dry your skin. Calluses occur more often and build up faster on the feet of people with diabetes.

What antibiotics should diabetics avoid? ›

A class of antibiotics called fluoroquinolones, used to treat illnesses like pneumonia and urinary tract infections (UTIs), has been shown to cause both very low and high blood sugar, a study published in October 2013 in the journal Clinical Infectious Diseases found.

Is Neosporin good for diabetic foot ulcers? ›

You can also apply Neosporin which contains a mild antibiotic – it's best to then cover the open wound with a band-aid. Once a podiatrist treats such a mild, extreme, or severe foot ulcer, it's of the utmost importance to continue to see the podiatrist even after the wound is healing and feeling better.

Is Vaseline good for diabetic feet? ›

Moisturize Your Skin

If you've got diabetes, itchy skin due to dryness can be a concern. A good moisturizer like Vaseline® Intensive Care™ Advanced Repair Unscented Lotion may help to soothe and relieve itchiness.

What are 3 things you should never do to the feet of someone with diabetes? ›

Avoid soaking your feet, as this can lead to dry skin. Dry your feet gently, especially between the toes. Moisturize your feet and ankles with lotion or petroleum jelly. Do not put oils or creams between your toes — the extra moisture can lead to infection.

What is the difference between onycholysis and onychomycosis? ›

Onychomycosis is a fungal infection of the nail unit [1]. Subungual thickening or hyperkeratosis can occur under the nail plate, resulting in onycholysis or lifting of the nail bed. Onycholysis, specifically is the loss of plate-bed adhesion. Onycholysis does not by itself signify onychomycosis.

Can I use Lamisil cream on my toenails? ›

Do not apply this medication on the scalp or nails unless otherwise directed by your doctor. The dosage and length of treatment depends on the type of infection being treated. Do not apply more often or use longer than directed. This may increase the risk of side effects.

What gel helps diabetic foot pain? ›

Aspercreme® Lidocaine Pain Relief Cream For Foot Pain – Diabetic Skin provides targeted pain relief that's safe for diabetics' skin when used as directed and uses seven essential moisturizers to hydrate dry feet. In fact, 93% of users saw a visible improvement from the dryness of their feet.

What ointments can I use for diabetic foot ulcers? ›

Product and formulationsFormulations
Povidone iodinecOintment, 1%, 4.7%, 10%; solution, 1% and 10%; also wash, scrub, cleanser, gel, aerosol, gauze pad, swab, and other forms
Sodium hypochlorite (Dakin's solution and EUSOL)Solution, 0.0125%, 0.125%, 0.25%, and 0.5%
Hydrogen peroxidecSolution, 1% and 3%; and cream, 1%
8 more rows

How should diabetic foot infections be treated? ›

A patient with a diabetic foot infection should be treated with an antibiotic agent whose efficacy has been demonstrated in a published randomized, controlled trial and that is appropriate for the specific individual; among the agents to consider are penicillins, cephalosporins, carbapenems, metronidazole (in ...

Why is Epsom salt not good for diabetics? ›

Typically, epsom salt soaks are not recommended for people with diabetes. The primary reason is that such soaks can dry out the feet. When the skin is dry it is more vulnerable to cracking and chafing, which can lead to skin lesions and wounds, which if not properly attended to can lead to ulcerations.

Why are bananas bad for diabetics? ›

Bananas contain carbs, which raise blood sugar

If you have diabetes, being aware of the amount and type of carbs in your diet is important. This is because carbs raise your blood sugar level more than other nutrients, which means they can greatly affect your blood sugar management.

What is a diabetic pedicure? ›

A waterless pedicure is performed to avoid the risk of contracting any type of infection due to cross-contamination, especially with clients with diabetes since, as mentioned before, they have a compromised immune system.

Can you scrape out toenail fungus? ›

Treatment usually begins with your dermatologist trimming your infected nail(s), cutting back each infected nail to the place where it attaches to your finger or toe. Your dermatologist may also scrape away debris under the nail. This helps get rid of some fungus.

Should diabetics around their toenails? ›

It is generally safer to avoid trimming the cuticles. Some providers may advise diabetic patients to trim their own nails after proper instruction. Some providers encourage their patients to have nail care performed by a medical professional, such as a podiatrist.

Can metformin affect your nails? ›

Clinicians should be aware of metformin induced yellow discolouration of nails, though a curable and reversible condition if diagnosed well in time.

What is the most effective treatment for onychomycosis? ›

Terbinafine and itraconazole are the therapeutic agents of choice.

Is onychomycosis a complication of diabetes? ›

Onychomycosis is a well known complication of diabetes mellitus. About one third of diabetic patients are affected.

How do you treat diabetic athlete's foot? ›

If you do end up with athlete's foot, be sure to get it treated immediately, especially if you have diabetes. In most cases athlete's foot can be treated with over-the-counter antifungal creams, but prescription medicines may be needed for more serious infections.

What is the treatment of choice for onychomycosis? ›

The most commonly used oral drugs for treatment of onychomycosis is griseofulvin, terbinafine, itraconazole and ketoconazole. The disadvantages of oral antifungal agents are, they require a longer treatment period and they have more side effects, e.g. terbinafine (Lamisil®).


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