Ava Monroe
Toenail fungus is a common condition that can be challenging to treat. Characterized by thick, discolored, and brittle nails, fungal infections occur when fungi invade the space between the toenail and the nail bed, often through cracks or cuts. While not a serious health concern, these infections can cause unsightly nails and pain as the nail lifts away from the nail bed. Treatment options range from topical and oral antifungal medications to laser therapy, but recurrence is common due to the resilient nature of fungal spores and their affinity for warm, moist environments. Preventative measures, such as maintaining rigorous foot hygiene, investing in breathable footwear, and disinfecting shoes, are crucial to breaking the cycle of infection and promoting healthy nail growth. With consistent care and patience, it is possible to restore nail health and prevent future fungal issues.
| Characteristics | Values |
|---|---|
| Appearance of nail fungus | Thickened, discoloured, and brittle nails |
| Nail fungus causes | Fungi in shoes, athlete's foot, fungal skin infections, communal spaces |
| Treatment | Oral medications, topical treatments, laser therapy, orthotic inserts, antifungal powders or sprays |
| Prevention | Breathable footwear, regular cleaning and drying of feet, moisturising, trimming and filing nails, avoiding nail polish |
| Nail growth after treatment | May take several months, requires patience and consistent care |
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What You'll Learn
Toenail removal
The procedure involves the partial or complete removal of the toenail under local anaesthesia to ensure comfort and reduce pain during the surgery. The specific technique employed depends on the underlying condition. For example, partial nail avulsion involves removing one or both sides of the infected nail, while total nail avulsion, or nail avulsion, is the complete removal of the nail. Other techniques include wedge excision, where the part of the nail growing into the skin is removed along with the underlying tissue, and nail-bed ablation, which involves removing part or all of the nail and then applying a chemical to prevent regrowth.
After toenail removal, it is common to experience some discomfort and swelling for a few days, and taking a few days off work to rest and recover is generally recommended. The nail will continue to grow from the root at the base, but it may grow back odd in shape and appearance.
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Treatments for fungal infections
It is important to treat fungal nail infections early to save your nails. If left untreated, you risk losing your toenail. Toenail fungus is notoriously difficult to cure without oral treatments, which can affect liver function. However, there are a variety of treatment options available, which vary in cost and effectiveness.
Over-the-counter antifungal treatments
Antifungal nail medicines that you brush onto the nail are available over the counter. These may improve the appearance of fungal nails, but they are not an effective way to cure the problem. You will need to use this type of treatment regularly for a few months before seeing any improvement, and you should keep using the treatment until advised to stop. Stopping too early could cause the infection to return.
Prescription topical treatments
Effective prescription topical treatments include efinaconazole (Jublia), tavaborole (Kerydin) and ciclopirox (Penlac). These treatments require daily application, and it may take up to a year to see noticeable improvement. Filing down the surface of the nail may help the treatment penetrate more deeply.
Oral medications
Oral antifungal medications can stop nail fungus from growing. Terbinafine is a prescription antifungal medication that is taken daily for 6 weeks to treat fingernail infections and 12 weeks for toenail infections. It is important to get tested before and after taking this medication to check that your liver is functioning properly, as liver damage is a rare side effect. Itraconazole (Sporanox) is another oral medication that eliminated the fungus in 10 months for 55-70% of people in clinical studies. However, this drug can also harm the liver and interact with other medications, and it requires the user to avoid alcohol and sunlight during treatment.
Nail removal
In some cases, toenail removal may be recommended as part of a complete fungal treatment plan. Removing the toenail exposes the nail bed, allowing topical medications to penetrate as the nail grows back. However, the toenail may grow back thickened, and permanent nail removal may be considered in rare cases.
Laser treatment
The FDA has approved laser treatment to improve the look of a nail after a fungal infection has cleared, but it has not approved any laser to treat the infection itself. Insurance companies typically do not cover the cost of this treatment.
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Preventing future fungal infections
Fungal nail infections are notoriously difficult to get rid of and can take a long time to treat. The good news is that, even though it may not look pretty, it's not a serious health problem. However, it's better to prevent nail fungus than to treat it. Here are some ways to prevent future fungal infections:
Keep your feet clean and dry
Fungi thrive in warm, damp environments, so it's important to avoid having damp or sweaty feet for too long. Wear moisture-wicking socks, and change them if they get sweaty. Give your shoes 24 hours to dry before wearing them again, and opt for breathable shoes made of materials like leather, canvas, or mesh.
Use antifungal products
Place an antifungal powder or spray on your socks and in your shoes, especially in hot weather or before a workout. While these products cannot treat nail fungus, they can prevent fungi from growing in your shoes.
Be cautious in public spaces
Fungi thrive in warm, moist places like locker rooms, gyms, spas, shared showers, and pool decks. When in these spaces, wear shoes, flip-flops, or shower sandals to avoid direct contact with the floor.
Don't share personal items
Fungal infections spread easily from person to person. Never share nail-grooming tools like nail clippers, unwashed towels, shoes, and other personal items.
Keep your nails short and well-maintained
Long nails provide more surface area for fungi to collect under. Keep your nails trimmed straight across and shorter than the end of your toes. Disinfect your nail clippers after each use by first washing them with warm water and soap, then soaking them in a bleach and water solution for five minutes. If you don't have a nail fungus, you can use 70% rubbing alcohol instead.
Treat infections promptly
If you or someone you live with has athlete's foot, treat it as soon as possible to prevent it from spreading to your nails.
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Home care tips to promote nail regeneration
Toenail fungus is an invasion by a microscopic organism that thrives in warm, damp environments. While it is not a pressing health problem, it can ruin the appearance of your nails and cause pain as it lifts the nail away from the nail bed.
If left untreated, toenail fungus can spread to other nails or through your body, and the nail may need to be removed. However, this is not the end of the world, as toenails usually grow back within 12 to 18 months. While you wait for your nail to grow back, your doctor will likely prescribe a cream or other treatment to prevent the fungus from returning.
- Keep your nails clean and dry. Fungi thrive in warm, damp environments, so it is important to keep your nails as clean and dry as possible.
- Apply topical treatments. Prescription topical treatments such as efinaconazole (Jublia), tavaborole (Kerydin), and ciclopirox (Penlac) can improve the appearance of fungal nails and may help to prevent the recurrence of infection.
- File your nails regularly. Filing down the surface of the nail may enable treatments to penetrate more deeply into the nail or nail bed. Be sure to file or cut off any white markings on your nails.
- Soak your nails. Before applying medicated cream, soak your nails in water and dry them off.
- Take oral medications. Oral antifungal medications such as itraconazole (Sporanox) and terbinafine (Lamisil) can be effective in eliminating the fungus. However, these drugs can affect the liver and interact with other medications, so they should be taken under medical supervision.
- Consider laser treatment. Laser treatment heats up the nail layers where the fungus is located and tries to destroy its genetic material. While this treatment is not covered by insurance, it may be an option for those who wish to avoid oral medications and their potential side effects.
Remember to consult with your doctor or dermatologist to determine the best treatment plan for your specific needs and circumstances.
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Oral medications
Toenail fungus is an invasion by a microscopic organism that thrives in warm, damp environments. Fungal spores are in the air and will grow if they land on a receptive surface like your toenail. They feed off the nail tissues, burrowing into the skin under the nail. Over time, the nail thickens and may lift off the nail bed as fungal debris accumulates. Once your nail is raised off the nail bed, it won't reattach, and a new nail will continue to grow from the root at the base.
Terbinafine is a prescription medication used to treat fungus infections of the scalp, body, groin (jock itch), feet (athlete's foot), fingernails, and toenails. The dosage for onychomycosis in adults is typically 250 milligrams once a day for 12 weeks. It is recommended to take terbinafine tablets with food or on an empty stomach, and it is important to follow the instructions provided by your doctor carefully. Elderly patients should exercise caution when taking terbinafine due to potential age-related liver, kidney, or heart problems.
Oral treatments for toenail fungus have shorter treatment times and better cure rates than topical preparations. They are more commonly prescribed for onychomycosis due to their effectiveness. However, it is important to consider the potential side effects and risks associated with oral medications. Appropriate studies on the relationship between age and the effects of terbinafine oral granules in children and the geriatric population have not been performed, and safety and efficacy have not been established in these groups.
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Frequently asked questions
Yes, a nail can grow back after a fungal infection, but it may take several months. The nail may still appear thickened, discoloured, or brittle, and the infection can permanently damage the nail matrix, or the area responsible for nail growth.
There are several treatments for fungal nail infections, including oral treatments, topical treatments, and laser therapy. Oral treatments like Itraconazole and terbinafine can eliminate the fungus, but they can also harm the liver. Topical treatments can improve the appearance of nails, but may not be as effective at curing the problem. Laser therapy can be used for recurring or stubborn cases, and targets residual fungal elements while stimulating healthier nail growth.
To prevent a fungal nail infection, it is important to maintain rigorous foot hygiene. Keep your feet clean and dry, and wash your feet daily with gentle soap and water. It is also important to invest in breathable footwear, as shoes made with breathable materials help keep your feet dry, reducing the risk of fungal growth.
A fungal nail infection can cause the nail to become thick, discoloured, and easy to break. The nail may turn yellow and crumble, and white or yellow spots may begin to appear.
A fungal nail infection is caused when fungi get between the toenail and the nail bed, often through a crack or cut in the toenail. Fungi thrive in warm, damp, and dark environments, and can be spread by walking barefoot in communal spaces like gyms and locker rooms.
