Toenail Fungus (Onychomycosis)

Treatment is available but can take several months, depending on the type of treatment. Your doctor can advise on the best options for you.

What Is Toenail Fungus?

Types of Toenail Fungus

• Dermatophytes This skin fungus is responsible for 75 to 90 percent of toenail fungal infections.
• Molds Aspergillus and other molds account for around 10 percent of cases.
• Yeasts Yeasts, most commonly Candida albicans, can also cause onychomycosis.

• Brittle
• Crumbly
• White, yellow-brown or otherwise discolored
• Thick or misshapen
• Detached from the nail bed

• Wear tight or closed shoes
• Are an older adult, as the risk increases with age
• Have other fungal infections, such as athlete’s foot
• Live in an urban environment
• Have obesity
• Have a history of toenail infections
• Sweat a lot
• Participate in sports or fitness activities
• Injure the nail
• Don’t keep your nails clean and trim
• Use public swimming pools or bathing facilities
• Share a household with someone who has onychomycosis
• Have certain genetic factors that increase your risk
• Smoke
• Have a compromised immune system
• Have Down syndrome
• Have certain health conditions, such as:
• Diabetes mellitus
• Psoriasis
• Circulatory problems affecting your feet, such as peripheral vascular disease
• Hallux vagus
• Asymmetric gait nail syndrome

• Assess any visible nail symptoms
• Use a tool known as a dermoscope to differentiate a fungal infection from other causes
• Take a sample, such as a clipping or a nail scrape, to study under a microscope

Laboratory testing can help differentiate onychomycosis from other causes of similar symptoms, such as psoriasis, lichen planus, or melanoma.

There are various treatment options, and some are more effective than others.

• The extent and severity of the infection
• Your age, as oral medication is not suitable for children
• The cost of treatment and if your insurance covers it
• How you react to the side effects of any drugs
• Other health conditions you may have

Medicated Nail Polishes

You apply amorolfine once or twice a week.

You apply ciclopirox every second day for the first month, at least twice a week in the second month, and weekly thereafter.

With both treatments, you’ll need to:

1. Remove the old polish with an alcohol swab.
2. Trim and file down the nail as far as possible.
3. Apply a new layer of antifungal polish.

Some ciclopirox polishes are water soluble. You’ll need to wash them off and reapply daily.

Creams

• A cream containing urea, which softens the nail.
• An antifungal cream containing bifonazole
• A nail scraper or spatula

To use this treatment, you’ll need to:

1. Soak the toe in warm water for 10 minutes.
2. Dry thoroughly.
3. Apply the urea-based cream.
4. Cover with an adhesive bandage for 24 hours.
5. Remove the dressing and soak the nail in warm water until soft.
6. Scrape the surface of the nail with the spatula.
7. Reapply the urea-based cream and cover with a new bandage for another 24 hours.
8. Repeat the above procedure for 14 days, until the infected part of the nail has disappeared.
9. Apply bifozanole cream for another four weeks.

But they are less likely to have adverse effects or interact with other drugs, compared with oral medication. Infections can go away in around 6 weeks with the use of creams.

Medical Nail Avulsion (Removal)

Medical nail avulsion involves the use of chemicals to remove all or part of an infected nail.

1. Your healthcare provider covers the healthy skin around the nail with cloth adhesive tape.
2. They apply urea ointment on the nail surface and cover it with plastic and tape.
3. Over the next 7 to 10 days you’ll keep the dressing and nail dry while the ointment softens the nail.
4. At the next appointment, the doctor will gently lift the nail away from the nailbed or cut out the infected part.

Oral Medication

Combination Treatments

Complementary and Integrative Therapies

• Tea tree oil (ensure that you are not allergic)
• Snakeroot extract
• Propolis, an extract found in beehives
• Oregano extract

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• Vitamin E
• Bitter orange oil
• Products containing camphor or menthol, such as Vicks Vaporub

Light Therapies

• Wear shower shoes in public locker rooms, baths, and pools.
• Wash your feet and dry them thoroughly before putting on socks and shoes.
• Wear properly fitting shoes that allow your feet to breathe.
• Moisturize dry skin after bathing to prevent cracking, as pathogens can enter through cracks.
• Sprinkle your shoes with an over-the-counter antifungal product to prevent a new infection.
• Alternate your shoes to allow them to dry out fully.
• Check your feet and toenails regularly for changes in appearance or texture.
• In case of a fungal infection in your feet or toenails, seek medical advice and follow up any treatment plan your doctor recommends.
• After treating an infection, throw away old shoes as they might still harbor the fungus.
• Ensuring household members also check for fungal infections, as they can spread easily.
• Sanitize your nail clippers and other pedicure tools between uses.
• Ensure your pedicurist follows appropriate safety and hygiene standards, including sanitizing equipment.
• Trim your toenails straight across.

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• Avoid nail polish and artificial nails, as they can trap moisture, increasing the risk of infection.

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With treatment, depending on the type, toenail fungus can go away anywhere between several weeks to a year.

How long it takes to treat toenail fungus and the success of treatment will depend on factors such as:

• The extent and severity of the infection
• Other health conditions
• Measures taken to follow the treatment plan and prevent a new infection

• Increase the risk of bacterial infections, such as cellulitis and paronychia
• Cause pain, discomfort, and tingling
• Make standing and walking difficult
• Lead to nail deformities that make it hard to find suitable shoes
• Cause difficulty with keeping nails trim
• Affect your quality of life and self esteem

In North America and Europe, studies suggest it is present in around 4.3 percent of people but 8.9 percent of those in a hospital.

• New broad-spectrum antifungal agents
• New topical treatments
• New ways of enabling medications to penetrate the nails
• A redox gas solution that treats the nail while you insert it in a special chamber
• Black peel (cosmetic peel typically used to treat acne)
• Plasma therapies

• Living and working conditions, which can increase exposure to pathogens
• Limited access to healthcare, which can delay diagnosis
• Limited access to insurance, which can affect the affordability of treatment
• Lower quality nutrition due to a low income and inaccessibility of nutritious food options
• Higher rates of diabetes and other conditions that increase the risk of an infection and its complications

• Lichen planus
• Psoriasis
• Chronic dermatitis
• Alopecia areata
• Chronic paronychia
• Lupus
• Scabies
• Rheumatoid arthritis
• Warts under the nail
• Pemphigus vulgaris
• Various benign and malignant tumors

• Fungal toenail infections, also known as onychomycosis, are a common problem that can cause toenails to thicken, change color, and break down.
• Fungal toenail infections are often unsightly and uncomfortable. In some cases, they can lead to severe complications, such as the bacterial infection cellulitis.
• Treatment is available for fungal toenail infections, but it can take time to work.
• The sooner you seek treatment, the easier it is to get rid of a fungal toenail infection.