Isla Bennett
Fungal nail infections are unsightly and can cause nails to become discoloured, thickened, brittle, and distorted. While it may be tempting to ignore the infection, it won't clear up on its own and may even worsen over time. Treatment options range from over-the-counter antifungal creams and lotions to prescription medications and, in severe cases, nail removal. If you suspect you have a fungal nail infection, it's important to seek medical advice promptly to determine the best course of treatment.
| Characteristics | Values |
|---|---|
| Appearance | Nails become white, yellow, brittle, thick, discoloured, and distorted |
| Causes | Constantly warm and damp feet, wearing trainers for long periods, having hot sweaty feet |
| Treatment | Antifungal pills, creams, gels, sprays, patches, laser treatment, surgical or non-surgical nail removal |
| Prevention | Keeping feet clean and dry, not wearing tight shoes for long periods |
| Diagnosis | Microscopic examination of nail sample, blood test |
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What You'll Learn
Surgical and non-surgical removal methods
Fungal nail infections can cause the nail to become discoloured, thickened, distorted, and brittle. While there are several non-surgical methods to treat the infection, sometimes surgical intervention is required.
Non-surgical removal methods
Non-surgical methods are typically the first line of treatment for fungal nail infections. Topical treatments, such as antifungal creams, gels, ointments, sprays, and patches, can be applied directly to the nail. These treatments can take several months to show improvement and must be used consistently until the infection clears. Oral antifungal medications, such as itraconazole and terbinafine, are also effective and have high success rates. However, they may have side effects and require careful monitoring by a doctor due to potential interactions with other medications.
Another non-surgical approach is the application of urea ointment, which softens the nail bed, allowing the infected nail to be removed after about 10 days. This method does not require surgery and can be performed by a doctor or podiatrist.
Surgical removal methods
Surgical nail removal is generally reserved for severe or recurring fungal nail infections when a large portion of the nail is diseased, damaged, or causing significant pain. The procedure can be performed in a doctor's office or clinic. Before the surgery, the area around the nail is numbed to prevent pain. Then, a tool is used to loosen the skin around the nail, and the entire nail or just the diseased portion is carefully separated from the skin. If necessary, the nail matrix can be destroyed using a chemical application to prevent the nail from growing back and reduce the risk of future infections.
After surgical nail removal, it is common to experience numbness, pain, throbbing, swelling, bleeding, or fluid discharge from the wound. Keeping the affected area elevated above the heart can help manage these symptoms and aid in healing. The nail bed usually takes about 2-3 weeks to heal, and a new nail may take up to 18 months to grow back completely. During this time, doctors may recommend creams or other treatments to prevent fungal recurrence and maintain nail health.
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Antifungal pills
A fungal nail infection causes the nail to become discoloured, thickened, distorted, and easy to break. It can be treated surgically or non-surgically. Non-surgical treatments include antifungal creams, gels, sprays, patches, and pills. Antifungal pills like itraconazole (Sporanox) and terbinafine (Lamisil) are more effective than creams and gels. However, they may have side effects like nausea, vomiting, headaches, skin rash, upset stomach, and respiratory infection. Moreover, terbinafine can affect the liver and itraconazole can negatively interact with other medications, so a doctor's supervision is necessary.
Oral medications or pills generally work faster than topical medications that are applied to the toenail. They have higher cure rates, and the overall treatment time is shorter. However, it can still take 9 to 12 months to see full results and a prescription is required for these pills. Typically, you take these pills once a day for 6 to 12 weeks, but the fungus may not be completely gone for 10 months or longer.
Your doctor may also prescribe an antifungal medicine that you paint on your nails. This will look like a colourless nail polish and will contain a drug like ciclopirox. You will be instructed to paint it on the affected toenail once a day, allowing it to dry for 30 seconds before putting on socks or shoes. Each week, remove the polish with rubbing alcohol and clip away as much of the diseased nail as possible. This method may take 6 months or more to show results and is less effective than pills, so your doctor may combine it with oral medication.
If you suspect you have a fungal nail infection, it is best to consult a pharmacist or a doctor for advice on the most suitable treatment option for you.
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Antifungal creams and gels
There are many antifungal creams and gels available to treat fungal nail infections. Some creams and gels are more effective than others. Terbinafine is the most effective topical agent, according to some sources. Other topical agents such as azoles, ciclopiroxolamine, butenafine, tolnaftate, and undecanoate were also found to be effective in curing athlete's foot. However, there is little evidence that topical anti-fungals are effective in treating onychomycosis or fungally infected toenails.
Amorolfine lacquer is another treatment option, but the data on its effectiveness is limited. It showed a 6% treatment failure rate after one month of treatment. Butenafine 2% had a higher treatment failure rate of 20%. Tea tree oil has been evaluated in small trials, but it was found to be ineffective for fungal nail conditions when compared to topical butenafine.
Oral antifungal medicines tend to work better than topical treatments, but they are associated with more side effects and drug interactions. Antifungal pills like itraconazole (Sporanox) and terbinafine (Lamisil) are more effective than creams and gels, but terbinafine can affect the liver, and itraconazole can negatively interact with other medications. Therefore, it is important to consult a doctor or pharmacist for advice on the best treatment option.
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Laser treatment
Several types of laser treatments are available, which may affect how well the therapy works for a person. Some types of laser treatments use light, while others use carbon dioxide (CO2). For treating onychomycosis, CO2 lasers or yttrium-aluminum-garnet (YAG) lasers with wavelengths of 870 nm, 930 nm, or 1320 nm are used. Laser treatment may also work by heating up the nail layers specific to the fungus and attempting to destroy the genetic material responsible for fungal growth and survival.
Home laser treatment is also available, though it may not be effective for all types of fungal toenails. These devices emit a low-level laser that penetrates the nail plate, killing the fungus. While they are not as effective as professional laser treatments, they can help reduce symptoms and promote healing.
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Home remedies
One home remedy is to keep nails short, dry, and clean. It is important to keep feet dry, wear cotton socks, and change them daily. Maintaining good foot hygiene and wearing clean shower shoes in communal showers can also help.
Some essential oils and products with antimicrobial and antifungal properties, such as Vicks VapoRub, tea tree oil, and menthol rubs, may help treat toenail fungus. An older study found that Vicks VapoRub, which contains camphor and eucalyptus oil, had a positive clinical effect in treating toenail fungus. Similarly, a small 2011 study suggested that mentholated ointments may help with toenail fungus, although they are unlikely to cure the infection. Baking soda may also help absorb moisture that causes toenail fungus and prevent fungal growth, although there is not much scientific evidence to support this.
It is important to note that home remedies may not provide significant benefits, and if there are no improvements or complications occur, individuals should consult a doctor and stop using the home remedy.
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Frequently asked questions
Yes, your doctor may surgically or non-surgically remove your nail. Surgical treatment involves loosening the skin around the nail and removing it from the toe. Non-surgical treatment involves applying urea ointment to the infected nail surface, wrapping it in plastic and tape, and removing the nail from the nail bed after 10 days.
A fungal nail infection can cause the nail to become white, yellow, brittle, thick, discoloured, and distorted. It may also crumble or break easily.
There are several treatments available for fungal nail infections, including antifungal pills, creams, gels, sprays, patches, and nail polishes. Laser treatment is also an option, although it is not typically covered by insurance.
To prevent a fungal nail infection, keep your feet clean and dry, avoid wearing trainers for long periods, and maintain good foot hygiene.
