Fungus in the nails is a common problem, but it rarely causes serious harm. A doctor can prescribe a strong antifungal topical medication, such as efinaconazole or tavaborole (Kerydin), for you to apply at home. Or they can give you a prescription for an oral antifungal medicine, such as terbinafine (Lamisil). You will need to take this daily for months.
Symptoms
A fungal nail infection, or onychomycosis, can develop when fungi enter a crack in the nail or its surrounding skin. Fungi thrive in warm, damp environments and can be spread from person to person through shared shoes or socks. Infections are most common in the toenails but can occur in any fingernail. People are more likely to have fungal nails if they regularly walk barefoot in public places such as swimming pools, locker rooms, showers, or gyms; wear tight shoes or socks; or suffer from hyperhidrosis (excessive sweating).
Fungi can also infect the skin around the nail, which can be mistaken for dry skin. The fungi may cause one or more white spots in the nail or the surrounding skin. The affected nail may look thicker than usual or have a powdery texture. In severe cases, the nail may break off from the skin around it. The fungi can also spread to other toenails or even the skin of the feet and hands.
While many people do not consider nail fungus a serious health issue, it can be difficult to eradicate without the help of a doctor. At Pinnacle Dermatology, we advise people with nail fungus to seek the advice of a dermatologist or podiatrist to receive treatment before the infection spreads further.
Nail fungus can be treated with over-the-counter colorless nail polishes containing antifungal agents such as terbinafine or ciclopirox. These are applied to the nail, usually once or twice daily, for up to a year. Or, a doctor can prescribe oral or topical medications such as terbinafine or efinalac, which kill the fungi. These treatments are generally more effective than the over-the-counter products.
Although anyone can get a fungal nail infection, it is more common in older adults or those who have diabetes. Children rarely get this condition. People with a weakened immune system are also at higher risk for infection. Athlete’s foot, psoriasis, and poor circulation can also increase the likelihood of developing a fungal nail infection.
Diagnosis
Toenail fungus, also called onychomycosis, most often occurs in the toenails but can affect the fingernails as well. It can happen to anyone, but is more common in people over 60 and in those with diabetes. This condition can cause severe pain and damage the nails, especially if left untreated. You can prevent fungal nail infections by keeping your feet dry and wearing shoes that breathe. You should also trim and file your nails so they are not thick, soak them in a medicated nail polish remover and apply an antifungal cream or ointment like terbinafine (Lamisil).
The most common sign of nail fungus is yellowing of the nail that starts at the tip of the nail and spreads toward the center. The nail may also become thicker and crumbly or change shape. A foul odor may also develop. This fungus is very infectious and can spread to other nails and even the skin on your feet or hands. It is important to see a dermatologist as soon as you think you have nail fungus.
Your dermatologist will examine your nails and the surrounding skin for signs of infection. He or she may ask about your health history, symptoms and family history of fungus. Your doctor will likely prescribe an antifungal medication that goes on like nail polish or pills to treat the fungus. He or she may also recommend other treatments such as laser or light therapy, which are currently being studied.
If you have a serious case of nail fungus that has not responded to over-the-counter medications, your doctor may need to remove the affected nail. This procedure is performed under local anesthesia.
Fungus is more likely to invade your nails if you are in places where it thrives, such as in a public shower or pool deck, or if you wear sweaty shoes or socks for long periods of time. You are also more likely to get it if you have reduced circulation in your feet and toes or a suppressed immune system due to illness or medications. To help prevent a fungal nail infection, keep your feet clean and dry and wear shoes that breath, change your socks regularly, and use a nail brush to remove dirt and dead skin cells. You should also avoid sharing shoes, socks or nail-grooming tools and only go to a nail salon that disinfects their tools after each client.
Treatment
A fungal nail infection rarely goes away on its own and may worsen without treatment. It’s especially dangerous if you have diabetes or circulation problems that interfere with blood flow to your feet. Infections that aren’t treated can spread to other nails and the skin around your feet. They can also infect other people.
Nail fungus treatment options include nail polishes and creams that can be applied directly to your nails, tablets that you take by mouth, and treatments that remove your infected nails. All of these treatments work to stop the fungus from growing or killing your nails. They may also help your nails grow back healthier, but they’re not a cure. It can take a year or more for your nails to completely grow out.
If you choose to use a nail polish to treat your infection, choose one that says it’s antifungal. These are generally formulated with amorolfine or ciclopirox, two medications that help kill fungus. You should apply the nail polish daily to the affected nail or nails. Nail fungus treatments often require repeated applications, and some may be used for over a year to ensure they’re working.
Your dermatologist may also recommend you take oral antifungal medication. Medications such as terbinafine (Lamisil(r)) or itraconazole (Sporanox(r)) can be effective, but you’ll need to take them every day for several months to get the best results. These medications can damage your liver, so you’ll need a blood test to make sure you’re healthy enough to take them.
Surgical removal is sometimes recommended as a last resort for severe nail fungus. During this treatment, the doctor scrapes the infected nail and the fungus that’s beneath it. This can be painful, and it’s not always successful. It’s more likely to work if the infection is confined to a small area of the nail, and if it’s been treated with oral medication already.
There are some home remedies for nail fungus that can be effective, such as applying tea tree oil or other natural oils. But there isn’t good evidence that these or other home treatments actually work.
Prevention
The most effective way to treat fungal nail infections, or onychomycosis, is to prevent them from developing. You can do this by keeping your feet clean and dry, particularly when you shower or bathe, and by wearing shoes that allow your toes to breathe. You should also avoid sharing items such as nail clippers, shoes and towels with other people and ask your pedicurist about his or her process for sterilizing tools between clients. Some people also find that soaking their feet in a solution of equal parts apple cider vinegar and Listerine antiseptic mouthwash and applying Vick’s VapoRub to the nails is helpful over time.
A fungal nail infection usually appears as a white or yellow discoloration of the nails. It can affect one or more nails and may become brittle, thicker or change shape. In the most serious case, the affected nail may detach from the nail bed. Fungus-related nail infections are most often caused by a type of fungi called dermatophytes, though yeast and molds can also cause them.
If you get a nail fungal infection, it’s important to seek treatment right away because fungi can spread easily between people who share the same shoes or sweaty socks. It’s also harder to fight a fungal nail infection once it gets established, so prevention is essential.
Athlete’s foot, a skin infection that can spread to the nails, can be prevented by practicing good hygiene, including regularly washing and drying your feet. You can also use a moisturizing cream on your hands and feet and wear breathable socks that wick away moisture. In some cases, your doctor may prescribe medications to treat the fungus. These include antifungal nail polish, which contains ciclopirox (Penlac), and oral antifungals such as efinaconazole (Jublia) or tavaborole (Dermocil). In severe cases, surgery can be an option for removing the infected nail and then growing a new, healthy one. This may be necessary if other treatments are not successful or if you have a suppressed immune system because of illness or medication. This can be a painful procedure, but it offers the best chance of preventing an outbreak of nail fungus in the future.
