Toenail Fungus: What To Do If You're Worried About Liver Damage From Oral Pills

A reader recently wrote in to the NY Times with worries about certain toenail fungus treatments. “I have avoided using oral drugs for chronic toenail fungus because I don’t want to risk liver damage,” the reader writes. Furthermore, the toenail fungus sufferer wondered if there were any risks for allowing the fungus to persist untreated. These concerns seem perfectly valid, considering that labels for the top oral remedies warn patients with liver trouble to avoid them. So what’s a person to do?


Terbinafine labels warn users that they may be at increased risk for liver damage, although it is rare. Image Source:

Why Does Lamisil Cause Liver Damage?

Symptomatic liver injury from terbinafine (Lamisil) is a very rare occurrence — affecting 1 in 50,000 to 120,000 patients. However, people with known liver issues are generally advised to avoid the risk. Oral medication promising toenail fungus help may cause liver damage by prompting elevations in serum levels of aminotransferases (liver enzymes).  Some patients will then suffer from jaundice, auto-antibody formation, cell injury, and acute liver failure. Vanishing Bile Duct Syndrome (bile blockages and a sudden loss of bile ducts) and Stevens-Johnson syndrome (rash and allergic symptoms) are known risks associated with terbinafine. While it’s clear that adverse effects appear to be some type of hypersensitive reaction, the precise mechanism is not known.

liver damage lamisil

Reports of abnormal liver function tests. Image Source:

What If Toenail Fungus Goes Untreated?

Over time, fungus progresses from the tip of the nail down to the cuticle. The nail thickens, yellows, and crumbles. Pain and inflammation surrounding the damaged nail is common. This unsightly condition will not clear up on its own. If left for long periods of time, the nail can become so infected that it separates from the bed and falls off.

Dr. Boni E. Elewski, a professor of dermatology at the University of Birmingham, told the NY Times that fungus can migrate to other parts of the body — like the hands, back, and legs — in one out of every 24 cases. Older patients with weakened immune systems are at greater risk.

The other danger with fungus is that it causes cracks in the nail, which can allow other types of bacteria, fungus, and pathogens into the body. Diabetics must be especially mindful of areas where microbes may enter the body. Their impaired circulation makes it difficult to fight infection and heal wounds.

signs of liver failure

Systemic manifestations of acute liver failure. Image Source:

Do All Toenail Fungus Cures Hurt The Liver?

Unfortunately, all oral pills must be processed by the liver and carry the same risk factors. There are nail lacquers and topical treatments that can be applied directly to the fungus nails, but many people don’t like this course of therapy because it requires daily application for months on end to be effective. They also have a very low success rate currently. Future developments, such as the drug Tavaborale, may offer us a better alternative in the future, but it’s still a good year off. It would be nice if we could treat toenail fungus naturally, but little is known about folksy home remedies like tea tree oil or Vicks Vaporub. Laser treatment has become a popular alternative, although it costs up to $1,500 a session and is not covered by insurance.

What To Do About Toenail Fungus

Despite the limited options, see a podiatrist about your toenail fungus and make your best effort to rid yourself of the fungus. We find the most successful patients use multiple therapies to combat the problem. One reason why it seems people can’t shake their foot fungus is that they continually re-infect themselves  by putting their feet into fungus-contaminated shoes! SteriShoe UV shoe sanitizer was developed to end the practice of wearing unsanitary shoes and give toenail fungus patients an easy, at-home solution.


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