Ava Monroe
Toenail fungus, or onychomycosis, is a common condition that causes nails to thicken, discolour, and become brittle and crumbly. It occurs when fungi multiply in warm, dark, and moist places, such as sweaty shoes or communal showers. While it usually starts as mild nail discolouration or lifting, it can progress and cause nail loss without treatment. Treatment options include antifungal drugs, creams, sprays, gels, and laser treatment. Home remedies like vinegar, baking soda, and tea tree oil may also help. However, it's important to consult a healthcare professional for proper diagnosis and treatment to prevent the fungus from destroying the nail.
| Characteristics | Values |
|---|---|
| Appearance | Thick, discoloured, brittle, crumbly, white, brown, or yellow spots |
| Causes | Walking around barefoot in communal showers, gyms, or around pool decks or locker rooms; wearing trainers for a long time; sweaty feet; athlete's foot |
| Treatment | Antifungal drugs, tablets, creams, sprays, gels, or laser treatment; home remedies like vinegar, baking soda, tea tree oil, or mouthwash |
| Prevention | Treating athlete's foot, maintaining foot hygiene, wearing shoes in communal areas |
| Cure | Fungus is cured when healthy nail growth is visible at the base |
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What You'll Learn
Fungal nail infection symptoms
A fungal nail infection, or onychomycosis, occurs when a fungus attacks a fingernail, toenail, or the skin under the nail, called the nail bed. Toenails are more susceptible to fungal infections than fingernails because fungus thrives in dark, warm, and moist places, and because toes have less blood flow, making it harder for the body to detect and prevent an infection.
Fungal nail infections usually start mild and get more serious over time. Initially, you may notice a white or yellow spot under your nail, which can spread and turn your whole nail white, yellow, green, or black. The nail may thicken and become difficult to trim, and it may start to curl up or down or loosen from the nail bed. The nail could become brittle and crumble when touched, and may become misshapen. In some cases, a bad smell may be noticeable.
Fungal nail infections are often painless at first, but if left untreated, they can cause pain when pressure is applied to the area, and in severe cases, can even make it difficult to walk. The infection may also spread to other parts of the body. It is important to take extra care if you have diabetes and suspect a fungal nail infection.
Fungal nail infections can spread from other people, so you are more likely to contract one if you walk barefoot in communal areas such as gym showers, swimming pools, and locker rooms.
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Treatment options
Over-the-counter treatments
For mild toenail fungus, over-the-counter (OTC) treatments are available without a prescription. These include antifungal creams, gels, sprays, and patches containing clotrimazole (Lotrimin) or terbinafine (Lamisil). While OTC treatments can be effective, they may take months to show results and are typically insufficient for moderate to severe cases.
Prescription medications
For more severe or persistent infections, prescription medications may be necessary. These include oral antifungal tablets, such as terbinafine, which are prescribed by a doctor or dermatologist. Before prescribing these medications, a healthcare professional will typically test the patient's liver function and may monitor it during treatment. It's important to note that antifungal tablets are contraindicated in individuals with liver or kidney disease and may not be suitable for pregnant or breastfeeding individuals.
Topical prescription medications
Topical prescription medications, such as efinaconazole 10% solution, are applied directly to the nail. To enhance the effectiveness of these treatments, a dermatologist may file down the nail surface to allow the medication to penetrate deeper.
Natural remedies
Some natural remedies have been suggested for treating toenail fungus, although their effectiveness is not yet fully supported by research. These include soaking the feet in a mixture of apple cider vinegar and warm water, using baking soda as a foot soak or paste, and treating the nail with tea tree oil.
Nail avulsion
In some cases, particularly when the infection is severe or causing significant pain, a dermatologist may recommend nail avulsion, which involves surgically or chemically removing some or all of the infected nail. Nails typically grow back over time, but this process can be slow.
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Home remedies
- Apple cider vinegar: Mix one part apple cider vinegar with three parts warm water. Soak your feet for at least 10 minutes, but longer soaks are better (up to 40 minutes).
- Baking soda: One small study found that treating affected nail samples with baking soda stopped fungal growth in 79% of cases and reduced it in 17% of cases after 7 days of treatment. You can make a foot soak with baking soda, create a paste to apply to the toe, or simply sprinkle it on your feet to absorb moisture.
- Vicks VapoRub: An older study from 2011 found that Vicks VapoRub had a positive clinical effect in treating toenail fungus. Apply a small amount to the affected area at least once a day.
- Snakeroot extract: Snakeroot extract was found to be as effective as the drug ciclopirox in treating toenail fungus. It is made from plants in the sunflower family and can be painted on the nail as a natural nail polish.
- Listerine mouthwash: Listerine contains thymol, menthol, and eucalyptus, which have antifungal and antibacterial properties. Soak your feet in a basin of amber-colored Listerine for 30 minutes daily.
- Oregano oil: Apply oregano oil to the affected nail twice daily with a cotton swab. Oregano oil is potent and may cause irritation or allergic reactions.
- Tea tree oil: Tea tree oil has antimicrobial and antifungal properties. In one study, tea tree oil was applied to the affected nail twice a day for 6 months, resulting in a cure rate comparable to the cream clotrimazole.
- Nail scraping: This method involves gradually removing parts of the affected nail every day over 2 to 3 weeks using an over-the-counter (OTC) kit with a urea paste and a scraping device. While nail scraping may help remove an active infection, it may not eliminate all of the fungus, and antifungal medication may still be needed.
It is important to note that home remedies should not be used as a substitute for medical treatment, especially if you have diabetes or a weakened immune system. Always consult with your doctor or pharmacist for appropriate treatment options.
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Preventing fungal nail infections
Fungal nail infections cause the nail to become thick, discoloured, and brittle. While these infections are not serious, they can take a long time to treat. The infection usually starts at the edge of the nail and spreads to the rest of the nail, causing it to crumble or break easily.
Fungal nail infections can spread from other people, so it is important to avoid walking barefoot in places like communal showers and gyms. Additionally, fungal nail infections are often caused by athlete's foot, so treating athlete's foot promptly can help prevent the infection from spreading to your nails.
To prevent fungal nail infections, it is important to maintain good nail hygiene and keep your nails clean and dry. This includes washing your hands and feet regularly and drying them thoroughly, especially after swimming or exercising. Keeping your nails short and filing them smoothly can also help prevent the accumulation of dirt and moisture, reducing the risk of infection.
Wearing well-fitting shoes and socks that absorb moisture can create an unfavourable environment for fungal growth. Changing your socks daily and choosing breathable footwear can also help keep your feet dry and reduce the risk of infection.
It is also important to practice good hygiene when getting manicures or pedicures. Ensure that the tools used are properly sanitized, and avoid sharing nail clippers, files, or other personal care items with others.
If you have previously had a fungal nail infection, you may be at a higher risk of developing another one. In such cases, your dermatologist may prescribe maintenance therapy, which involves using treatment to prevent another infection. This may include medication that you apply to your nails for an extended period to maintain infection-free nails.
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When to see a doctor
Fungal nail infections are usually not serious, but they can become painful and even cause nail loss if left untreated. Therefore, it is important to know when to seek medical help.
Speak to a pharmacist if the look of your nail bothers you or it's painful. They can examine your symptoms and provide a proper diagnosis and treatment plan. Treating the fungus as soon as possible prevents it from growing and destroying your nail.
If your fungal nail infection is causing you pain or discomfort, or if you notice any changes in nail colour or texture, it is important to see a doctor. A GP can prescribe antifungal tablets if you have a fungal nail infection and treatments from a pharmacy have not worked. Before prescribing medication, your doctor will take a sample of your nail to test what kind of infection you have. They may also need to do a blood test before and during your treatment to check that your liver is functioning properly. Antifungal tablets may need to be taken for up to six months.
It is important to continue taking any prescribed medication until you are told to stop, even if your toenail starts to look better. Stopping treatment early could cause the infection to return. If you think your fungus has returned, see your doctor.
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Frequently asked questions
Symptoms include nail discolouration, thickening, and lifting. In some cases, the nail may become brittle and crumbly, and even fall off.
No, but it can cause nail loss.
Medical treatments are the only known methods to effectively treat nail fungus. You can use antifungal drugs, tablets, creams, sprays, gels, or even laser treatment.
Some home remedies include soaks in apple cider vinegar or baking soda, or applying tea tree oil.
