Isla Bennett
Fungal nail infections are characterised by thick, discoloured, and brittle nails that are easy to break. They are typically caused by fungi called dermatophytes that infect the skin beneath the nail, and yeast is another common cause. Toenail fungal infections are more common than fingernail infections, and they can be caused by wearing closed shoes for extended periods, causing dampness and warmth. Treatment for fungal nail infections can take a long time, and medical treatments are the only known effective method. Over-the-counter treatments include antifungal creams, ointments, sprays, and liquids, while prescription drugs include oral antifungal tablets and topical medications. Laser therapy and nail removal are also treatment options for severe cases.
| Characteristics | Values |
|---|---|
| Treatment time | It can take several months for the nail to return to its normal state after successful treatment. |
| Treatment options | Antifungal medications (oral or topical), combination therapies, laser therapy, surgery, non-surgical nail removal, over-the-counter treatments, home remedies. |
| Treatment duration | Oral antifungal medications may need to be taken for up to 6 months. |
| Treatment frequency | Oral antifungal medications are typically taken daily. |
| Treatment success rate | Prescription antifungals can cure most cases. |
| Treatment side effects | Oral antifungal medications can have side effects and may affect the liver, so liver function tests are recommended. |
| Treatment availability | Over-the-counter treatments are available for mild toenail fungus. |
| Treatment prevention | Keeping nails trimmed and filing them down can help reduce pain and pressure during treatment. |
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Antifungal medications
Oral antifungal pills, such as itraconazole (Sporanox) and terbinafine (Lamisil), are more effective than topical treatments and work faster. They are typically taken for 12 weeks, but the fungus may not be completely eradicated for 10 months or longer. It is important to note that these pills can have side effects, including nausea, vomiting, and headaches, and may affect the liver. Therefore, it is recommended to have blood tests or liver function tests to monitor for any problems during treatment.
Topical antifungal nail medicines that are brushed onto the affected nail are also an option, but they may need to be used for 6 to 12 months before seeing improvement. These treatments include nail polishes containing antifungal ingredients such as amorolfine or ciclopirox. One study found that about 30 out of 100 people who used ciclopirox no longer had detectable fungal nail infections, but the cosmetic results were not always satisfactory.
Another topical treatment option is bifonazole cream, which is applied after soaking and drying the affected toe or finger. This treatment is carried out over 14 days, and the softened nail layers are scraped off, followed by additional treatment for four weeks.
In conclusion, while antifungal medications are effective in treating fungal nail infections, oral pills are generally more efficient and faster-acting than topical treatments. However, it is important to consider the potential side effects and liver-related risks associated with oral antifungal medications.
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Laser therapy
Onychomycosis, or toenail fungus, is a chronic fungal nail infection that causes tissue damage to the nail matrix or plate bed. It is estimated to account for over half of all nail diseases. Toenail fungus causes thickened, discoloured, and distorted nails that eventually start to crumble away. It can spread to other toenails and even other people. Toenail fungus will not go away on its own and must be medically treated.
The duration of laser therapy treatment for toenail fungus may vary depending on the type of laser used, the severity of the infection, and individual response. Some people may see improvement after a few treatments, while others may require more sessions. In one study, patients received three sessions of a CO2 laser at four-week intervals, and 50% of them achieved a "complete cure" three months after the last treatment. Another study used five treatment sessions at four-week intervals, with a single follow-up at one month after the final treatment. While laser therapy may offer a promising alternative to traditional medications, it is important to note that it may not be covered by insurance and can be expensive.
While laser therapy has shown effectiveness in treating toenail fungus, it is important to consult with a healthcare professional to determine the most suitable treatment option for your specific condition. The choice of treatment may depend on various factors, including the severity of the infection, your medical history, and your individual needs and preferences.
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Surgery
If you have tried various treatments for your fungal nail infection but it still won't go away, surgery may be an option. Before considering surgery, it is important to consult with a medical professional to determine if this is the best course of treatment for you.
During the surgery, the doctor will numb the area around the nail, similar to how gums are numbed at the dentist. Once the area is numb, the doctor will use special tools to remove the entire nail or just the infected portion. Antibiotic cream and a bandage will then be applied to the nail bed to prevent bacterial infections and aid in healing. The surgery typically lasts less than an hour and can be performed in the doctor's office.
After the surgery, it is important to keep the arm or leg elevated above the level of the heart for 48 hours to help manage pain and swelling. The recovery process can vary, but it typically takes at least 2–3 weeks for the nail bed to heal. During this time, it is essential to change bandages regularly and apply any prescribed antifungal medicine to prevent any remaining fungus from growing back.
The regrowth of nails after surgery can take a significant amount of time, with fingernails usually regrowing in six months and toenails taking up to 18 months or longer. It is important to note that nails grow slowly, and the time frame for complete nail regrowth may vary.
While surgery is not a common treatment for fungal nail infections, it can be considered when other treatments have failed. It is crucial to discuss all available options with a healthcare professional before deciding on the best treatment plan for your specific condition.
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Non-surgical nail removal
Fungal nail infections are characterised by thick, discoloured, and brittle nails that can affect both toenails and fingernails. While it is not a serious condition, it can take a long time to treat. In some cases, badly infected nails may need to be removed.
During the non-surgical nail removal process, the doctor will apply chemicals to the affected area to dissolve the nail. This procedure is typically performed under local anaesthesia to numb the area and minimise discomfort.
After the nail is removed, proper care is crucial to ensure the area heals properly. Keeping the area clean and dry is essential to prevent further infection. Additionally, your doctor may prescribe antifungal medications to be applied topically or taken orally to treat the underlying fungal infection.
The recovery process after non-surgical nail removal may vary depending on the severity of the infection and the individual's health. It is important to follow your doctor's instructions for proper wound care and to attend any follow-up appointments to monitor the healing process.
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Home remedies
One study found that treating toenail samples with baking soda stopped fungal growth in 79% of cases and reduced it in 17% of cases. To use this remedy, make a paste with baking soda and water and apply it to the affected nail. Leave it on for at least 10 minutes before rinsing. Alternatively, some people advocate making a foot soak with baking soda, or sprinkling it on your feet to absorb moisture.
Another home remedy is apple cider vinegar. Mix one part vinegar with three parts warm water and soak your feet for at least 10 minutes. However, this remedy has not been proven effective in clinical studies.
Some people also use Vicks VapoRub, a topical ointment designed to suppress coughs. Its active ingredients, camphor and eucalyptus oil, have antifungal properties. Apply a small amount to the affected area at least once a day. However, there are no established instructions for using Vicks VapoRub to treat fungal nail infections.
Tea tree oil is another potential remedy, as it has been used traditionally as an antiseptic and has antifungal properties. In one study, tea tree oil was applied to the affected nail twice a day for six months, with cure rates on par with the cream clotrimazole.
It is important to note that home remedies should be paired with prescription medication for faster results. If your symptoms do not improve with home treatment, make an appointment with your doctor or a podiatrist.
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Frequently asked questions
It can take several months for your nail to return to its normal state after treatment. For mild toenail fungus, over-the-counter treatments may take months to work. For severe cases, you may need to take antifungal tablets for up to six months.
Symptoms include discolouration (white, yellow, brown, green or black), brittleness, and thickness.
Treatments include over-the-counter creams, ointments, sprays and liquids, prescription-strength topical medication, oral anti-fungal pills, and laser therapy.
