Toenail Fungus Treatments
Hints on medications, nail infections, fungal conditions, &
Toe fungus spores can invade your skin through tiny invisible cuts or through a small
separation between your toenail and nail bed.
You may have a toenail fungal infection — also called onychomycosis (on-i-ko-mi-KO-sis)
— if one or more of your nails are:
Brittle, crumbly or ragged
Distorted in shape
Dull, with no lustre or shine
A dark color, caused by debris building up under your nail
Infected nails also may separate from the toenail bed, a condition called onycholysis.
Fingernail infections tend to clear up quicker than toenail infections.
Other factors that can increase your risk of developing nail fungus
Walking barefoot in damp public places, such as swimming pools, gyms and
Having athlete's foot (tinea pedis)
Working in a humid or moist environment
Having a minor skin or nail injury, a damaged nail or another infection
Having diabetes, circulation problems or a weakened immune system
Having the skin condition psoriasis
Wearing socks and shoes that hinder ventilation and don't absorb
Toenail fungal infections can be painful and may cause permanent damage to
You're also at greater risk for cellulitis, a potentially serious
bacterial skin infection.
Tests and diagnosis - Your doctor will examine your nails first.
Proximal subungual onychomycosis
Fungal penetration of the newly formed nail plate through the proximal
There is evidence that topical ciclopiroxolamine has poor cure rates and
that amorolfine might be substantially more effective.
White superficial onychomycosis
Caused by fungal invasion of the superficial layers of the nail plate to
form "white islands" on the plate.
They cause problems only if your nails are continually exposed to warmth
and moisture — conditions perfect for the growth and spread of fungi.
Other causative pathogens include Candida and non-dermatophytic moulds,
in particular members of the mould generation Scytalidium (name recently
changed to Neoscytalidium), Scopulariopsis, and Aspergillus.
But you may have to be patient.
It has completed Phase II trials.
Although it may be tempting to hide toenail fungal infections under a coat
of pretty pink polish, this can trap unwanted moisture and worsen the
Two remedies purported to help toenail fungus infections are vinegar and
Mentagrophytes is now restricted to the agent of favus skin infection of
the mouse; though this fungus may be transmitted from mice and their
danders to humans, it generally infects skin and not nails.
Over-the-counter antifungal nail creams and ointments are available.
A laboratory test should be performed to confirm; nail fungal infections are typically caused by a fungus that belongs to
a group of fungi called dermatophytes.
When to see a doctor- well, it is up to you of course.
If your skin becomes irritated, try soaking only two to three times
a week, or increase the amount of water in the mixture.
As with many diseases, there are also some scientifically unverified
folk or alternative medicine remedies.
Topical medications usually don't provide a cure, but may be used in
conjunction with oral medications.
There may also be leads to other serious infections that can spread beyond
your feet if you have a suppressed immune system due to medication,
diabetes or other conditions.
Sometimes surgery is used in combination with ciclopirox to treat the
Other moulds more commonly affect people older than 60 years, and their
presence in the nail reflects a slight weakening in the nail's ability
to defend itself against fungal invasion.
Hint: Alternate closed-toe shoes with open-toed shoes.
Accounts for only 10 percent of onychomycosis cases.
Trim nails straight across and file down thickened areas.
Nail Fungus Home Remedies - Do They Actually Work?
The oral prescription treatments for onychomycosis (toenail fungus or
toenail fungus) are associated with several and potentially severe side
effects (Liver Damage), so home remedies are often followed.
There's no consensus on how often to apply some products, so check with
your doctor before using it on your nails.
A 2002 study compared the efficacy and safety of terbinafine in
comparison with placebo, itraconazole and griseofulvin in treating
fungal infections of the nails.
Other conditions, such as psoriasis, can mimic a fungal infection of the
Drug pipelines are a source of info; most drug development activities are focused on
the discovery of new antifungals, and
novel delivery methods to promote access of existing antifungal drugs
into the infected nail plate.
Active clinical trials investigating Onychomycosis have been done.
A medicinal nail lacquer, NM100060 from NexMed, contains terbinafine as
the active ingredient and a permeation enhancer which facilitates the
delivery of the drug into the toenail bed where the fungus resides.
Treatment of onychomycosis is challenging because the infection is
embedded within the nail and is difficult to reach.
A comparison of delivery methods for Itraconzole is useful.
Topical medications can be useful.
Jot down all the questions for your doctor regarding your condition,
from the most to least important.
Spray or sprinkle your feet and the insides of your shoes.
An infection with nail fungus may be difficult to treat, and infections
Fungi are microscopic organisms that don't need sunlight to survive.
What you can do
Write down any symptoms you're experiencing, including any that may seem
unrelated to the reason for which you scheduled the appointment.
Use an antifungal spray or powder.
Watch for the form of a rash or itch in an area of the body that
is not infected with the fungus.
A promising new laser treatment for toenail fungus has been cleared by
the Food and Drug Administration for the PinPointe FootLaser system,
which has been available in the U.S.
It is the least common form of tinea unguium in healthy people but found
more commonly when the patient is immunocompromised.
Watch for the prior damage of the toenail by infection or
Medications are available to help clear up nail fungus.
There is also evidence for combining systemic and topical treatments.
See your doctor at the first sign of nail fungus, which is often a tiny
white or yellow spot under the tip of your toenail. However, in some
cases when you call to set up an appointment, you may be referred
immediately to either a dermatologist or podiatrist.
You paint some treatments onto your infected nails and surrounding skin once
or twice a day.
If your nail infection is severe or extremely painful, your doctor may
suggest removing your nail. Ouch.
Dermatophytids are fungus-free skin lesions that sometimes form as a
result of a fungus infection in another part of the body.
Write down questions to ask your doctor.
Risk factors for nail fungus include increased age, male gender,
diabetes, nail trauma, hyperhydrosis, peripheral vascular disease,
athlete’s foot, immunodeficiency, poor hygiene, and chronic exposure of
the nails to water.
As the toenail fungus spreads deeper into your nail, it may cause your
to discolour, thicken and develop crumbling edges — an unsightly and
potentially painful problem.
Hint: before seeing your doctor, write down key personal information, including any major stresses or
recent life changes.
Make a list of all medications, as well as any vitamins or supplements,
that you're taking.
There is a cosmetic condition that most often affects the toenails.
Multiple studies indicate that the universal antimicrobial activity is
due to contamination with synthetic preservatives that were unlikely to
be made from the seeds of the grapefruit.
Candida species invade fingernails usually occurring in persons who
frequently immerse their hands in water.
Between uses, turn the rubber gloves inside out to dry.
An infection of nail fungus occurs when fungi infect one or more of your
Patients with onychomycosis may experience significant psychosocial
problems due to the appearance of the nail.
Sometimes, because current treatments can take a long time to work and
aren't always effective, people turn to home remedies.
Nails may grow more slowly and thicken with age, making them more
susceptible to infection.
Candida mainly cause fingernail onychomycosis in people whose hands are
often submerged in water.
Daily use of Penlac for about one year has been shown to help clear some
nail fungal infections.
There is usually no pain or other bodily symptoms, unless the disease is
Take your shoes off occasionally during the day and after exercise.
If you have athlete's foot as well as toenail fungus, you should treat the
athlete's foot with topical medication and keep your feet clean and dry.
See your doctor immediately if you suspect nail fungus.
The main findings have some showings: that for reduced fungus terbinafine was found to
be significantly better than itraconazole and griseofulvin, and
terbinafine was better tolerated than itraconazole.
Vinegar is a home remedy.
The nails can become rough and crumbly, or can separate from the nail
For toenail fungus, questions might include:
What is likely causing my symptoms or condition?
Are there other possible causes for my symptoms or condition?
Wear appropriate socks, not ones that make your feet sweat.
Relative effectiveness of treatments: in July 2007, a meta-study reported on clinical trials for topical
treatments of fungal nail infections.
Therefore, any relatively minor injury to your feet — including a nail
fungal infection — can lead to a more serious complication, requiring
timely medical care.
A common outdated name that may still be reported by medical
laboratories is Trichophyton mentagrophytes.
A nail fungal infection may begin as a white or yellow spot under the
tip of your fingernail or toenail.
You may need to take medication for only six weeks for a fingernail
Knowing the cause of your infection helps determine the best course of
You're likely to start by seeing your family doctor or a general
Your doctor may file the surface of your nail (debridement) to lessen
the amount of infected toenail to treat and possibly make the topical
medication more effective.
It is also well-established that heightening oxygen circulation through
the cells will increase nail growth.
If your toenail infection doesn’t bother you, you may wish to leave it
Some prescription medication can sometimes damage your liver (though
this is rare) and you may have a test to check if your liver is healthy
before starting a nail fungus treatment.
If you suspect you have a nail fungal infection, you should know the
symptoms of nail fungus and make sure that your physician
performs the proper diagnostic tests.
A Noveon-type laser that is already in use by physicians for some types
of cataract surgery has proved very effective and painless.
Make sure your hair salon sterilizes all its instruments.
Nail ablation with urea paste
A topical treatment, AN-2690, is being developed by Schering-Plough Corp
and Anacor Pharmaceuticals.
Germs may have access to your skin and nails if you get a bad bump.
If you have a mild to moderate infection of toenail fungus, your doctor may
prefer to prescribe an antifungal nail polish called ciclopirox (Penlac).
Which Treatments Work For Nail Fungus Infections?
With the right treatment, you should be able to get rid of a nail
infection caused by fungus, even if you’ve had it for years or it’s very
To avoid misdiagnosis as nail psoriasis, lichen planus, contact
dermatitis, trauma, toenail bed tumor or yellow nail syndrome, laboratory
confirmation may be necessary.
Ask your doctor:
"How can I best manage my infections? "
Is there a generic alternative to the medicine you're prescribing me?
Are there brochures or other printed material that I can take home with
Are there Web sites you recommend?
In addition to the questions that you've prepared to ask your doctor,
don't hesitate to ask questions during your appointment at any time that
you don't understand.
What tests do I need?
What is the best course of action?
What are the alternatives to the primary approach that you're
I have other health conditions.
To make the most of your time with your doctor, it's a good idea to
prepare for your appointment.
Studies have shown the most effective treatments to be terbinafine
(Lamisil) and itraconazole (Sporanox).
Fungal infections of the nail pose the most serious health risk for
people with diabetes and for those with weakened immune systems, such as
people with leukemia, AIDS or those who've had an organ transplant.
Once a toenail fungal infection begins, it can persist indefinitely if not
Dermatophytes are the fungi most commonly responsible for onychomycosis
in the temperate western countries; meanwhile, Candida and non-dermatophytic
molds are more frequently involved in the tropics and subtropics with a
hot and humid climate.
To reliably identify nondermatophyte moulds several samples may be
Other dermatophytes that may be involved are Trichophyton interdigitale,
Epidermophyton floccosum, Trichophyton violaceum, Microsporum gypseum,
Trichophyton tonsurans, Trichophyton soudanense.
Nail fungus can spread from nail to nail.
So when some treatments increases the oxygen levels to kill the fungus,
it simultaneously helps the nail to grow back more quickly.
Your doctor can verify if it is indeed a fungal infection by examining
nail scrapings and clippings under a microscope and submitting these
samples to a lab to be cultured.
Don't go barefoot in public places.
It may take four months or longer to eliminate an infection.
It is important to see your health care provider to ensure that it is
truly a fungal infection you are dealing with before any treatment
Doctors may not recommend some medication treatments for people with liver disease or
congestive heart failure or for those taking certain medications.
Further research into the effectiveness of antifungal agents for toenail
infections is required.
Some meds are active against Trichophyton species.
Antifungal drugs may cause side effects ranging from skin rashes to
Infection with nail fungus occurs more in toenails than in fingernails
because toenails are often confined in a dark, warm, moist environment
inside your shoes — where fungi can thrive.
Most treatments are either systemic antifungal medications such as
terbinafine and itraconazole, or topical such as nail paints containing
ciclopirox or amorolfine.
To treat nail fungus, your doctor may prescribe an oral antifungal
Wash your hands after touching an infected nail.
Choose a reputable manicure and pedicure salon.
All of these microscopic organisms live in warm, moist environments,
including swimming pools and showers.
It is the most common disease of the nails and constitutes about a half
of all toenail abnormalities.
Nail fungus tends to affect men more often than it does women,
particularly those with a family history of this infection.
To help prevent nail fungus and reduce recurrent infections, practice
good hand and foot hygiene by following these steps:
Keep your nails short, dry and clean.
Some fungi have beneficial uses, while others cause illness and
Grapefruit seed extract as a natural antimicrobial is not demonstrated.
Microorganisms, including yeast and bacteria, also can infect nails.
Wear shoes around public pools, showers and locker rooms.
A study of 504 patients in 2007 found that aggressive debridement of the
nail combined with oral terbinafine significantly reduced symptom
frequency over terbinafine alone.
Change your socks and shoes often, especially if your feet sweat excessively.
Recent results indicate that the most sensitive diagnostic approaches
are direct smear combined with histological examination, and toenail plate
biopsy using periodic acid-Schiff stain.
You may be advised to use these creams with an over-the-counter lotion
containing urea to help speed up absorption.
If you have diabetes, your blood circulation and the nerve supply to
your feet can become impaired.
You can soak your feet in a solution daily.
Recurrent infections are possible, especially if you continue to expose
your nails to warm, moist conditions.
While there's no direct evidence that a vinegar soak can cure nail
fungus, some studies have shown that it can inhibit the growth of
Nail fungus is more common among older adults for several reasons,
including diminished blood circulation and more years of exposure to
Key points about treating fungal nail infections
To get rid of a fungal toenail infection, you will probably have to take a
treatment, sometimes for up to six months.
Be concerned about the safety and tolerability of topical Terbinafine.
There are several treatment options available to cure nail fungus.
After seven days, you wipe the piled-on layers clean with alcohol and
begin fresh applications.
You may feel pain in your toes or fingertips and detect a slightly foul
Nail fungus can be difficult to treat, and repeated infections are
Hint: Thoroughly dry your hands and feet, including between your toes, after
bathing. This protects your skin from overexposure to water.
Proper diagnosis is important because treatment can take a long time,
can be expensive, and may be associated with certain side effects.
Your doctor is likely to recommend oral medication if you:
experiencing pain or discomfort from your nail infection
Have a history
Want treatment because the infection is unsightly
Have diabetes or other risk factors for cellulitis
Some medications help a new toenail grow free of infection, slowly
replacing the infected portion of your nail.
You typically take medications for six to 12 weeks, but you won't
see the end result of treatment until the nail grows back completely.
Do any of these remedies work? If so, which ones? Are they safe?
Nail Fungus Symptoms - How Do I Know If I Have a Nail Fungus Infection?
The answer to this question is not as straightforward as you might think
and even doctors get it wrong sometimes.
Get a scientific evaluation through your doctor.
The debris can be examined under a microscope or cultured in a lab to
identify what's causing the infection.
Toenail fungus may affect toenails or fingernails, but toenail
infections are particularly common.
Normally doctors recommend pills for toenail fungus conditions, but there are also
treatments you can put on an infected toenail.
The causative pathogens of onychomycosis include
dermatophytes, Candida, and non-dermatophytic molds.
In the past, treatment options were limited and often not very
Snakeroot leaf extract has been shown to cure superficially. Onychomycosis
without side effects, that is what you want.
Risk factors for onychomycosis include family history, increasing age,
poor health, prior trauma, warm climate, participation in fitness
activities, immuno-suppression (e.g., HIV, drug induced), communal bathing,
and occlusive footwear.
Treating nail fungus with photodynamic therapy, in which a laser is used
to irradiate the nail after it's been treated with an acid, may also be
There are other disorders (such as: Psoriasis, Lichen planus, contact
dermatitis, and certain bacterial infections) that can cause similar
looking toenail problems.
Dermatophytids can be thought of as an allergic reaction to the fungus.
Hint: Don't trim or pick at the skin around your nails.
Yeasts and moulds also can be responsible for nail fungal infections.
Some treatments' effectiveness are scientifically unverified.
There is some evidence that ciclopiroxolamine and butenafine are both
effective but both need to be applied daily for prolonged periods (at
least 1 year).
Australian tea tree oil has some claims of being effective.
The diminished blood circulation to the toes as
compared with the fingers, makes it harder for your body's immune
system to detect and eliminate the infections.
See the internet pages on how it works and medical studies for a more
As with vinegar, there have been no controlled clinical trials to assess
the effectiveness of Vicks VapoRub on nail fungus, but there have been
numerous anecdotal reports that it works.
Synthetic socks that wick away moisture may keep your feet dryer than do
cotton or wool socks (you can also wear synthetic socks underneath other
Onychomycosis (also known as "Dermatophytic onychomycosis," "Ringworm of
the toenail," and "Tinea unguium") means fungal infection of the nail.
Recently a remarkable discovery was made by scientists: fungus are
If your infection is severe or keeps coming back, your doctor might
recommend removing part or all of your nail.
Newer treatments include use of laser light sources which kill the
fungus in the nail bed.
Other treatment options
Your doctor may also suggest these toenail fungus treatments:
Antifungal lacquer - it could take months to clear up.
Posaconazole, taken orally.
As a result many people turn to natural, alternative, home remedies to
treat their onychomycosis.
Surgery is an option.
But this treatment is rarely used.
Your doctor may also opt for other topical antifungal medications.
As a result full removal of symptoms is very slow and may take a year or
Scytalidium mainly affects people in the tropics, though it persists if
they later move to areas of temperate climate.
Commercial sale of some products has been stopped.
Often in nail infections several types of fungus will be present at the
same time. Get it checked by your doctor.
In some cases, WSO is a misdiagnosis of "Keratin Granulations" which are
not a fungus, but a reaction to nail polish that can cause the nails to
have a chalky white appearance.
Trichophyton rubrum is the most common dermatophyte involved in
There are four classic types of onychomycosis.
Distal subungual onychomycosis.
The most common form of tinea unguium usually caused by Trichophyton
rubrum, which invades the toenail bed and the underside of the nail plate.
A new toenail will usually grow back, in its place, though it will come in slowly
and may take as long as a year to grow back completely.
Diagnosis involves microscopic examination and culture of nail scrapings
All toenail fungus infections result in thickened, discoloured, and
Hint: Wear rubber gloves.
Hint: Give up nail polish and artificial nails.
Hint: If the problem is mild, you might be given a nail varnish or use tea
tree oil that kills the fungal infection.
Experts suggest soaking your feet for 15 to 20 minutes in a mixture of 1
part vinegar to 2 parts warm water.
A 2007 randomised clinical trial with 249 patients show that a
combination of amorolfine nail lacquer and oral terbinafine enhances
clinical efficacy and is more cost-effective than terbinafine alone.
A topical treatment, NB-002, is being developed by NanoBio Corporation.
A study included 6 randomised controlled trials dating up to March
For superficial white onychomycosis systemic rather than topical
antifungal therapy is advised.
To test for fungi, your doctor may scrape some debris from under your
nail for analysis.
A small study in 2004 showed that ciclopirox nail paint was more
effective when combined with topical urea cream.
Hint: Be sure to rinse well and pat your feet dry when you're
Some products flood the area with oxygen molecules and
kills the toenail fungus.
This is based on the idea that they can only survive in low oxygen environments and, if
oxygen levels significantly increase, the fungus die.
The prevalence of onychomycosis is about 6-8% in the adult population.
The nail plates can have a thickened, yellow, or cloudy appearance.
Nail Fungus Treatments
Nail fungus, otherwise known as Onychomycosis, has been recognized as
being a very difficult type of fungal infection to treat.
Thyme oil has been shown to have a potential to be effective against the
fungus that commonly infects toenails.
The three main approaches are potassium hydroxide smear, culture and
There are many species of fungus that can infect the nail. Be sure to
have your toenail fungus checked by your doctor for accurate treatments.
www.MayoClinic.com - Nail Fungus,