Liam Carter
Fungal nail infections are characterized by thick, discoloured, and brittle nails that are easy to break. They are caused by fungi called dermatophytes that infect the skin beneath the nail, and yeast is another common cause. Toenail fungus treatments include a wide range of options with varying success rates, from antifungal drugs and creams to laser treatment. Oral antifungal pills tend to work better than creams and gels, but they may have side effects and interact negatively with other medications. Mild cases of toenail fungus can be treated with over-the-counter antifungal creams, gels, sprays, and patches. Home remedies such as ozonized sunflower oil, baking soda, and Vicks VapoRub have also been found to be effective in treating toenail fungus.
| Characteristics | Values |
|---|---|
| Treatment | Antifungal pills, creams, gels, sprays, patches, nail medicines, tablets, and laser treatment |
| Treatment duration | 12 weeks or up to 6 months |
| Side effects | Nausea, vomiting, headaches, redness, itching, burning, oozing |
| Prevention | Keep your feet clean and dry, trim your nails, wear comfortable shoes, avoid barefoot walking in communal areas |
| Diagnosis | Sample of nail, blood test |
| Symptoms | Thick, discoloured, brittle, yellow, easy to break, white markings |
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What You'll Learn
Oral antifungal medication
Antifungal pills, such as itraconazole (Sporanox) and terbinafine (Lamisil), are more effective than creams and gels. Typically, these medications are taken for 12 weeks, but the fungus may not completely disappear for 10 months or more. These pills have a high success rate, but they can cause side effects such as nausea, vomiting, and headaches. Additionally, terbinafine can affect the liver, and itraconazole can negatively interact with other medications like Pepcid AC and Prilosec. Therefore, it is important to consult a doctor and undergo monitoring while taking these medications.
In some cases, a doctor may prescribe antifungal tablets after evaluating the type of infection and performing blood tests to ensure proper liver function. It is important to note that antifungal tablets may not be suitable for individuals with certain medical conditions.
Before resorting to oral medication, milder treatments are usually attempted. For example, a dermatologist can perform nail trimming or nail debridement to reduce nail thickness and make subsequent treatments more effective. Additionally, over-the-counter treatments, such as creams, ointments, sprays, and liquids, are available and can be recommended by a pharmacist. However, these treatments may take several months to show improvement, and it is crucial to continue their use as instructed to prevent the infection from returning.
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Topical antifungal medication
Antifungal creams are available at drugstores and online without a prescription. Examples include clotrimazole (Lotrimin) and terbinafine (Lamisil). Over-the-counter products are best suited for mild toenail fungus and may take several months to work. It is important to soak your nails in water and dry them before applying the medicated cream. Additionally, you should file or cut off any white markings on your nails while undergoing treatment.
Antifungal nail polishes, such as amorolfine and ciclopirox, are another option for topical treatment. Amorolfine is applied one to two times per week, while ciclopirox products are applied more frequently, with a decreasing frequency over time. With both treatments, the old layer of polish must be removed with an alcohol swab before applying a new layer. Cosmetic nail polish can be applied on top of the medicated nail polish. Newer ciclopirox nail polishes are water-soluble and can be applied daily, with the remaining polish removed with water before reapplication.
Treatment sets containing two creams and a nail scraper (spatula) are also available for topical treatment. One cream contains urea, which softens the nail for removal. The affected toe or finger is soaked in warm water for ten minutes and then dried. After applying the urea-based cream, the nail is covered with an adhesive bandage for 24 hours. The softened nail is then scraped off with a spatula, and the process is repeated for 14 days. Once the infected part of the nail is removed, the skin beneath is treated for another four weeks with a bifonazole cream, which has an antifungal effect.
While topical treatments are convenient and effective for mild cases, they may not be sufficient for severe infections. Oral antifungal medications are generally more effective but carry a higher risk of side effects and drug interactions. Therefore, it is important to consult a healthcare professional to determine the most appropriate treatment option for your specific condition.
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Laser treatment
The fractional CO2 laser ablates the nail plate, disrupting the growth of the fungus. The Ti:sapphire laser delivers a substantial amount of energy per pulse but spares the surrounding tissue from excessive heating due to its high thermal conductivity. The Nd:YAG class of solid-state lasers includes titanium (Ti): sapphire and erbium-based devices.
The cost of laser treatment for nail fungus can vary, ranging from $200 to $700 per session. Insurance may not cover the procedure, as it may be considered cosmetic.
While laser treatment is a promising option for treating nail fungus, more research is needed to assess its effectiveness.
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Surgical nail removal
Before the procedure, the doctor will administer an injection to the affected finger or toe to numb the area and prevent pain. Once the area is numb, the doctor will use special tools to loosen the skin around the nail, allowing them to separate and remove the nail from the skin. If only a part of the nail is infected, the doctor will remove only the diseased portion, preserving the healthy part of the nail.
In cases where future infections need to be prevented, the doctor can destroy the nail matrix by applying a chemical to the cuticle area after removing the nail plate. This step is optional and may be considered if the patient wants to avoid the nail from growing back.
After the nail removal, an ointment is applied to the wound, which is then covered with gauze and tape. It is important to follow the doctor's instructions for wound care, which typically includes washing around the wound with clean water twice a day for the first 24 to 48 hours. The nail bed usually takes about 2 to 3 weeks to heal, and a new nail will start to grow back gradually. However, it may take up to 18 months for the nail to grow back completely.
While surgical nail removal is effective in treating severe fungal nail infections, it is a relatively rare procedure due to the availability of alternative treatment options. These options include antifungal pills, creams, gels, and laser treatments, which can be explored before considering surgery.
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Home remedies
While home remedies for nail fungus are popular, there is little evidence that they are effective. They may relieve symptoms, but they do not kill the fungus. If you have severe symptoms, or pain, or your toenail turns brown or black, it is best to see a doctor. People with diabetes or a weakened immune system should not use home remedies.
One home remedy is to apply a few drops of oregano oil to the affected nail twice daily with a cotton swab. Some people combine oregano oil with tea tree oil, but both are potent and may cause irritation or allergic reactions.
Another option is to apply a paste of baking soda and water directly to the affected nail and let it sit for at least 10 minutes before rinsing. Alternatively, you can make a foot soak with baking soda, or sprinkle it on your feet to absorb moisture.
Vicks VapoRub has also been found to have a positive effect on toenail fungus. Apply a small amount to the affected area at least once a day.
Listerine mouthwash is another popular folk remedy for toenail fungus. Its ingredients, such as menthol, thymol, and eucalyptus, have antibacterial and antifungal properties. To use, soak the affected foot in a basin of amber-coloured Listerine for 30 minutes daily.
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Frequently asked questions
Some home remedies to treat nail fungus include ozonized sunflower oil, baking soda, Vicks VapoRub, vinegar, and hydrogen peroxide.
Over-the-counter treatments for nail fungus include antifungal creams, gels, sprays, and patches. These include clotrimazole (Lotrimin) and terbinafine (Lamisil).
Prescription treatments for nail fungus include antifungal pills like itraconazole (Sporanox) and terbinafine (Lamisil). In severe cases, a doctor may recommend surgical removal of the nail.
To prevent nail fungus, keep your feet clean and dry, especially when walking barefoot in communal areas like showers and gyms. Avoid wearing closed shoes for extended periods, and ensure your shoes and socks are dry and not damp from perspiration or heat.
