Caleb Foster
Fungal nail infections are common and can be stubborn. They occur when fungi grow in warm, dark, and moist environments, such as sweaty shoes and communal spaces like pools and locker rooms. The infection causes the nail to thicken, discolour, and become brittle and easy to break. While it may grow back, the nail is often permanently damaged, appearing thickened and discoloured. To promote healthy nail growth, it's important to practise good foot hygiene, keep your feet clean and dry, moisturize regularly, and trim and file nails carefully.
| Characteristics | Values |
|---|---|
| Nail appearance after fungal infection | Thickened, discolored, brittle, distorted |
| Nail growth after treatment | The nail takes time to grow out, and the damage may require additional steps to restore a normal appearance and structure |
| Treatment options | Topical treatments, oral treatments, laser therapy, nail removal, nail debridement, orthotic inserts |
| Preventative measures | Keep nails short and clean, use breathable footwear, use antifungal powders or sprays, practice good foot hygiene, avoid walking barefoot in public spaces |
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What You'll Learn
Oral treatments and their side effects
Oral treatments are more effective than topical treatments for nail fungus, but they also have more side effects. Tablets for treating nail fungus are usually taken for several weeks or months. Oral antifungals have higher cure rates and shorter treatment periods than topical therapy.
Oral medications such as itraconazole (Sporanox) and terbinafine (Lamisil) are known to be effective in eliminating nail fungus. In studies, these drugs eliminated the fungus in 10 months for 55% to 70% of people. However, the fungus returned within a few months for 15% to 20% of users. Both of these drugs can harm the liver, so your doctor will check your liver function at the beginning of treatment and again after six weeks. Itraconazole also interacts with a number of other drugs, so if you take it, you'll need to avoid drinking alcohol and stay out of the sun. Due to the risk of liver damage, people with liver disease are only given these medications if it’s absolutely necessary.
Oral therapy is preferred over topical therapy for onychomycosis, a chronic fungal infection of the fingernail or toenail bed, due to its better effectiveness and shorter treatment duration. However, patients taking terbinafine in combination with certain other drugs, such as tricyclic antidepressants and beta blockers, should be monitored for drug-drug interactions.
Oral treatments are typically necessary if several nails are infected, if the infection has spread, or if it started at the base of the nail. In children, topical therapy is usually recommended because most oral medications are not suitable for them.
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Topical treatments for nail appearance
While nail fungus is not a pressing health issue, it can be persistent and ruin the appearance of your nails. Topical treatments can help improve the appearance of nails affected by fungus, but they are not a cure.
Topical antifungal treatments are applied with a brush, in the same way, nail polish is applied. These treatments can improve the appearance of fungal nails but will not cure the infection. Prescription topical treatments include efinaconazole (Jublia), tavaborole (Kerydin), and ciclopirox (Penlac). Ciclopirox topical solution should be applied to the nails, the skin under and around the nails, and the underside of the nail. It is important to keep the nails clean and dry during treatment with ciclopirox and to avoid getting the solution on other areas of the skin.
Over-the-counter antifungal nail polishes are also available and are often tried as a first treatment. These include colorless nail polishes. However, these treatments are also not a cure for nail fungus.
Topical treatment sets containing two creams and a nail scraper can also be used. One cream contains urea, which softens the nail so it can be removed, and the other contains bifonazole, which has an antifungal effect. The affected toe or finger is soaked in warm water for ten minutes and then dried. The urea-based cream is then applied, and the nail is covered with an adhesive bandage for 24 hours. The process is repeated, and the softened nail is then scraped off with a spatula. Once the infected part of the nail has been removed, the skin beneath is treated with bifonazole cream for four weeks.
Home remedies such as tea tree oil or vinegar are sometimes recommended for nail fungus, but there is a lack of evidence supporting their effectiveness.
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Nail debridement for nail growth
A mycotic nail fungal infection can turn the nail brown, white, yellow, or black. The nail thickens, becomes fragile, and can separate from the nail bed. Toenail fungus is notoriously difficult to cure without oral treatments, which can affect liver function. While a fungal infection does not pose a serious health risk, it can ruin the appearance of nails and cause pain.
Nail debridement is a surgical procedure to remove the infected toenail or fingernail. This procedure may be necessary if the infection cannot be treated with medication. After debridement, it can take up to a year for the nail to grow back. However, mycotic nails can reoccur, even after successful treatment.
To prevent reoccurrence, it is important to maintain a good foot care routine and be mindful of your environment. Keep your nails cut short and file down any thick areas. Use different nail tools when switching between healthy and infected nails, and bring your own equipment to the nail salon.
Topical treatments can improve the appearance of nails during the regrowth process. Prescription topical treatments such as efinaconazole (Jublia), tavaborole (Kerydin), and ciclopirox (Penlac) can be effective. However, these treatments may not fully penetrate the nail and nail bed, and cure rates are lower than oral treatments.
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Laser therapy for recurring infections
Onychomycosis, or toenail fungal infection, is a common fungal infection that affects about 10% of the adult population in industrialized countries. It is caused by microscopic organisms that thrive in warm, damp environments. Toenail fungus is not a pressing health problem, but it can ruin the appearance of nails and cause pain as it lifts the nail away from the nail bed.
Fungal nail infections are notoriously challenging to treat and manage. While there are several established treatments for nail fungus, including topical antifungal creams and oral medications, laser therapy has emerged as a modern treatment option. Laser therapy is a newer therapy for nail fungus, and while studies show promise in its effectiveness and safety, particularly for at-risk populations such as those with kidney or liver disease, it is still considered an unproven therapy by entities like the American Academy of Dermatology Association (AAD).
Laser therapy works by ablating the nail plate and potentially disrupting the growth of the fungus. It may be effective for nail fungus, but it typically requires multiple sessions, and health insurance may not cover it. In a 2019 meta-analysis, researchers found evidence suggesting that laser therapy can be effective and safe for treating nail fungus, with an overall success rate of about 63%. The same study also found that CO2 laser therapy achieved the best overall results among several types of laser therapy, with a highly successful cure rate and a good safety profile.
In a 2012 clinical trial, patients received four or eight sessions of laser treatment at one-week intervals. The positive rates for microscopic examination and fungal culture were higher at 24 weeks than at 8 weeks, suggesting a relatively rapid recurrence of infection. Another study with a small sample size of 24 patients found that 50% of participants achieved a "complete cure" after three sessions of CO2 laser therapy at four-week intervals, in conjunction with the application of topical amorolfine cream to the feet daily.
While laser therapy may be a promising treatment option for recurring fungal nail infections, particularly for individuals who may not be suitable candidates for oral medications, more large-scale randomized controlled trials are needed to validate these findings and establish laser therapy as a standard treatment option.
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Preventing future fungal infections
Fungal nail infections are highly contagious and can spread from person to person. They thrive in warm, damp environments, such as gym areas, pools, and shared showers. Therefore, it is important to take preventive measures to lower the risk of contracting a fungal infection. Here are some ways to prevent future fungal infections:
Keep Nails Short and Clean
Keeping your nails short helps prevent fungi and other germs from collecting under your nails. It is recommended to cut toenails straight across and keep them shorter than the end of your toes. Maintaining clean and dry feet is also crucial, as fungi thrive in warm and damp conditions.
Sanitize Nail Grooming Tools
Properly sanitizing your nail clippers and other nail grooming tools can prevent infections. After each use, remove any nail clippings or fragments from your clippers, then wash them with soap and warm water before disinfecting. You can use a bleach and water solution or 70% rubbing alcohol for disinfection.
Wear Protective Footwear
When in public places like locker rooms, gyms, spas, or pool areas, wear protective footwear like flip-flops or shower sandals. This will prevent direct contact with fungi that may be present on the floor.
Avoid Sharing Personal Items
Fungal spores can easily spread from person to person. Avoid sharing nail grooming tools, towels, shoes, or other personal items to reduce the risk of contracting or spreading a fungal infection.
Treat Infections Promptly
If you or someone you live with has athlete's foot or nail fungus, seek treatment promptly. Athlete's foot can spread to your nails, and living in close quarters increases the chances of transmitting the fungus. Treating infections early can help prevent them from becoming more severe and reduce the likelihood of recurrence.
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Frequently asked questions
Yes, your nail will continue to grow from the root at the base. However, the infection can permanently damage the nail matrix, the area responsible for nail growth.
The regeneration process can span several months. With consistent care and appropriate treatments, you can promote stronger, healthier nail growth.
There are a variety of treatments for fungal nail infections, including oral treatments, topical treatments, laser treatments, and prescription antifungal tablets.
To prevent a fungal nail infection, you should maintain rigorous foot hygiene, including keeping your feet clean and dry, washing your feet daily, and drying thoroughly between your toes. You should also invest in breathable footwear and use antifungal powders or sprays to maintain an environment less conducive to fungal development.
Signs of a fungal nail infection include thickened, discolored, or brittle nails that are easy to break. If you think you have a fungal nail infection, you should speak to a pharmacist or doctor for advice and treatment options.
