A quick google search will return images of toenail fungus that aren’t too pleasant on the eyes - yet we can’t look away. Perhaps you’re one of the 33 million Americans who suffer from this disease. It’s not hard to find treatments on the internet and it ranges from at home remedies to removal of the nail itself in extreme cases.
I don’t know about you, but I put medicine and science above most things when it comes to my health, so I’ve steered clear of the at home remedies that sound suspect like bleach and cough syrup. I’ve exhausted the over-the-counter options and unfortunately, they just don’t work. I found myself at the doctor asking, ‘what are my options?’ They fall into 3 main categories ranging from the least invasive to the most: topical treatments, oral pills, and removal of the nail.
If you’re like me, you’re probably going to try everything before option 3. My doctor explained orals are a fantastic and effective way to treat nail fungus from the inside out, but I would have to take blood tests and give up the coffee and cocktails for a couple of months. No thank you. Next.
She explained that the topicals are an excellent choice with no side effects or lifestyle tradeoffs except for pedicures (more on that later). She called in a script, and I was off to CVS. When I went to check out, I had sticker shock at the price of $600 for a tiny little bottle that I would inevitably have to get refilled until the fungus was completely treated. I thought to myself, there MUST be a better way to get prescription treatment without the price tag.
Hence, I got to work to find an alternative solution. This is where the internet can be both your friend and foe. I can’t tell you how many videos I watched of extreme cases of toenail fungus and removal. After a couple of failed searches, I stumbled across Caratin. I was immediately drawn in by the website. A prescription topical medication that I can access from the comfort of my couch? Yes, please! However, the cynic in me wasn’t 100% convinced this would work so I emailed the Caratin care team who connected me with a doctor right away. Here’s the main takeaways from our call.
The Topical is handcrafted for each patient after an evaluation by a Caratin board-certified dermatologist. These dermatologists were frustrated by the plethora of prescription topicals on the market that disappointed for one reason or another. Caratin's formulations contain up to three prescription ingredients in one topical formula, working together to kill fungus.
So, at this point I wanted to understand how it all works together. This is where it gets really interesting (IMO). The Caratin team connected me with Dr. John Yost, a Caratin board certified dermatologist and the director of the Nail Disorder Clinic at Stanford. “We’re using numerous different medications and all of them treat fungus in a different way thus we’ve developed a multi-pronged approach to treating nail fungus and that isn’t something that has been done in the past.” Caratin doctors have access to several powerful medications they can customize for their patients.
There are a few concepts that matter here.
First, Dr. Yost explained that with certain prescription ingredients, "1 + 1 = 3". For example, Caratin’s formulations contain a couple of drugs - ciclopirox and terbinafine – that are classic, standalone drugs for treating nail fungus. However, in the lab studies show that when used together, these 2 drugs are more powerful than the sum of their individual impact. That is, they are “synergistic” in killing fungi2. There have been no prescriptions available where these medications are used together in a topical formulation – until now. This is what compounding allows us to do.
Second, unusual fungi, such as non-dermatophyte molds (NDMs) and yeasts, can cause nail infection alone or as part of a “mixed” infection. These unusual fungi are found in up to 40% of nail fungal infections1. Terbinafine and ciclopirox – the mainstays of medical therapy for nail fungus – don't work well on NDMs or yeasts. Caratin’s doctors have access to two additional drugs called amphotericin and tavaborole that kill NDMs and yeasts. Amphotericin is a powerful medication previously only available for use in the hospital4. Tavaborole was previously unavailable due to a patent3.
Finally, Dr. Yost explained the following general clinical principle: the more ways you simultaneously attack a microbe, the more likely you are to achieve a cure. The scientific term is “mechanism of action”, or MAO; the more MAOs at work, the higher the impact. That’s the reason why Caratin combines multiple active, prescription ingredients into one formula.
Needless to say, after this in-depth conversation I was convinced of Caratin's science backed, multi-drug approach. I took the assessment on the spot and had a treatment in my hands in a couple of days. I’ve since been applying it religiously every night. To be honest, the first month I didn’t see any improvement – something the doctor had prepared me for. Now in month 2, I’m starting to see early results and the new healthy nail growing in. That’s my personal journey with toenail fungus.
1. Gupta, A. (2020, Septembe 29). High prevalence of mixed infections in global onychomycosis. PLOS ONE, 15 (9).
2. Gupta, A., & Kohli, Y. (2003). In vitro susceptibility testing of ciclopirox, terbinafine, ketoconazole and itraconazole against dermatophytes and nondermatophytes, and in vitro evaluation of combination antifungal activity. British Journal of Dermatology, 149, 296-305.
3. Jinna, S., & Finch, J. (2015). Spotlight on tavaborole for the treatment of onychomycosis. Drug Design, Development and Therapy, 6185-6190.
4. Lurati, M. (2011). Efficacious Treatment of Non-Dermatophyte Mould Onychomycosis with Topical Amphotericin B. Dermatology (223), 289-292.