April showers bring more than just May flowers each year to the podiatry office. Spring tends to mark the beginning of nail fungus season and habitual pedicures. It seems there may be a symbiotic relationship between these common female rituals and onychomycosis, but how can we be certain? Many patients who first discover the unsightly look of a fungal toenail come to their podiatrist for a cure, and then to their pedicurist for a quick fix. Nail polish is the hallmark of a cosmetically acceptable solution to hide that dreaded fungal toe infection.
So, what advice can a
“Let’s fix your feet”
kind of doc give to these patients asking about a personal lifestyle choice -
To wear nail policy this season- or not??
Q: Does Nail Polish Harbor Fungus?
The literature suggests Yes and No. In a recent review article by
Klafke GB et al
, T. Rubrum was used to inoculate a red and white polish, a base coat and a top coat. Fungal growth was not seen in the red, white or base coat after 60 days incubation. However, the top coat did produce viable cultures in all brands tested.This study concurs with a prior study of
Goncalves et al
, in which the top coat was hypothesized to act as a fomite in the transmission of onychomycosis (OM). The theory is that top coats are rich in mineral and soy oil and do not contain toxic chemicals like toluene, xylene, formaldehyde, chromium and nickel, that often exist in standard nail polishes and base coats. Bottom line, bring your own top coat to be safe.
Q: Can prescription antifungals be used with nail polish and still produce results?
That depends. There are currently 3 commonly prescribed topical brand name antifungals on the market-Jublia, Penlac, and Kerydin. All 3 are indicated for treating T. Rubrum and T. Mentagrophytes, common pathogens in OM. Studies have been performed on both Jublia and Kerydin to test whether or not combining nail polish and these topical medications will alter the clinical outcome for our patients. Penlac has not been studied with nail polish and the package insert strictly prohibits use with nail polish.
In a 2015 study, Vlahovic et al
penetration of up to 4 layers of brand nail polish with two commonly prescribed antifungals- tavaborale (Kerydin) and efinaconazole (Jublia). The study suggested that concomitant use of nail polish does not affect the penetration of tavaborale beneath the nailbed ,where the infection commonly resides. In another study, efinaconazole did penetrate through unpolished and polished nails. However, the nail poish became “tacky” and possibly undesirable in appearance Ziechner et al
In 2016, Vlahovic et al
, published a followup study to further evaluate the appearance of nail polish in the presence of the same antifungals- tavaborale and efinaconazole. This study demonstrated that nail polish color remains intact after a once-daily application of tavaborale 5% to non-diseased, cadaver nails, for 7 days. No color transfer was apparent to the applicator, brush, or watercolor paper. Conversely, efinaconazole-treated nails showed changes in both color and appearance as well as transfer of the color ( ie pigment bleeding) immediately after application, making this a somewhat less desirable alternative for keeping your nails fungus free and
Klafke GB, da Silva RA, de Pellegrin KY, Xavier MO. Analysis of the role of nail polish in the transmission of onychomycosis. An Bras Dermatol. 2018; 93(6):930-1.
Goncalves MG, Castilino EM, Games CT, Brizzatti NS, Almeida MTG, Nail Polishes: Vehicle for transmission of onychomycosis? In: Abstracts of the 18th Congress of the International Society for Human and Animal Mycology, 11-15 Jun 2012, Berlin, Germany, Mycoses 2012:55:95-338.
Vlahovic T, Merchant T, Chanda S, Zane L, Coronado D. In vitro nail penetration of tavaborale topical solution , 5% through nail polish on ex vivo human fingernails. J Drugs Dermatol. 2015; 14: 675-678.
Zeichner JA Stein GL, Korotzer A. penetration of (14C)-efinaconazole topical solution, 10% does not appear to be influenced by nail polish. J Clin Aesthet Dermatol. 2-14; 7:34-36.
Vlahovic T, Coronado D, Chanda S, Merchant T, Zane L. Evaluation of the appearance of nail polish following nail treatment of ex vivo Human nails with topical solution of tavaborale and efinaconazole. Jan 2016, JDD Vol 15:(1) 89-94.