To effectively treat fungal nails, you need to attack the fungus from three directions: the surface, the deep tissue, and the immune system.
Most treatments fail because they only go after one layer. The fungus lives in the nail, under the nail, and sometimes even inside the nail root.
We start with a compounded topical that includes tolnaftate and urea. Tolnaftate is an antifungal. Urea helps soften the nail and break down the barrier so the medication can get through.
Patients apply this daily. It goes after the outer surface of the nail.
Topical alone is not enough because it doesn't reach deep inside the nail bed. That's where we use pinpoint cold CO₂ laser therapy.
It targets the fungus without damaging the nail. We do 12 treatments — once a month — and we track progress as we go.
This helps destroy the fungal organisms inside the tissue. It's safe, doesn't require anesthesia, and most patients tolerate it very well.
In cases where the infection is more advanced or stubborn, we add an internal strategy.
I often prescribe low-dose terbinafine — one week per month. It's less toxic than daily dosing but still helps clear the infection from within.
We also use reishi mushroom extract. It's a natural immune modulator. Reishi helps the body mount a better response to fungal organisms, especially in people with chronic infections or weakened systems.
This is not a quick fix. You're working against a protected, layered infection that takes time to resolve. But with this combined approach, we're seeing real results.
The key is treating it from all three directions — not just the outside.