Nail fungal infections, also known as onychomycosis, are a common condition that can affect toenails or fingernails. The infection is caused by fungi such as dermatophytes, yeasts, and molds that thrive in warm, moist environments like shoes and socks. If left untreated, the infection can spread and cause permanent nail damage. Thankfully, there are several effective treatment options available. This article will provide a brief overview of nail fungal infections and discuss the pros and cons of the various treatment methods to help you determine the best course of action if faced with this stubborn condition.
What causes nail fungal infections?
Fungi are present everywhere in our environment. Some common sources of infection include:
- Public places like pools, showers, and locker rooms
- Soil
- Existing nail infections that can spread to other nails
When fungi come into contact with a nail, they can take hold if conditions are right. Risk factors that make someone more susceptible to developing a fungal nail infection include:
- Sweaty feet
- Injuries to the nail or cuticle
- Walking barefoot in damp public areas
- Poor circulation
- A weakened immune system
- Diabetes
- Use of artificial nails
- Smoking
What are the symptoms of a nail fungal infection?
Signs and symptoms of a fungal nail infection include:
- Thickened, discolored, or brittle nails
- Distorted nail shape
- Debris building up under the nail
- White or yellow nail discoloration
- Nails that separate from the nail bed
- Foul nail odor
- Pain or discomfort in the affected nail
Toenail infections are much more common than fingernail infections. Symptoms tend to develop slowly and worsen over time if the fungus is not treated.
When to see a doctor
It’s advisable to see a podiatrist or dermatologist if you suspect you have a fungal nail infection. Trying to treat the condition at home without knowing the cause could lead to permanent nail damage. A doctor can confirm the diagnosis, identify the specific fungus, and recommend the most effective treatment options.
See a foot doctor right away if you have diabetes and notice nail changes. Individuals with diabetes are at higher risk for developing secondary bacterial infections in the feet and nails, which can become serious if left untreated.
Treatment options for nail fungal infections
Several treatment methods are available for combating stubborn fungal nail infections. Typical options include:
- Oral antifungal medications
- Topical antifungal medications
- Laser therapy
- Photodynamic therapy
- Removal of the infected nail
The pros and cons of each approach are outlined below.
Oral antifungal medications
Oral antifungal drugs, also called systemic antifungals, are usually the first line of defense prescribed by doctors to treat nail fungus. Oral medications include:
- Terbinafine (Lamisil)
- Itraconazole (Sporanox)
- Fluconazole (Diflucan)
Pros:
- High cure rate – oral drugs are more effective than topical treatments
- Treat the entire infection – medicine circulates through blood to treat nails and skin
- Shorter treatment duration – take medication for 6-12 weeks
- New clear nail grows out – replaces damaged nail
Cons:
- May cause side effects like headache, upset stomach, rash
- Prescription required
- Can interact with other medications
- Not recommended for liver disease patients
- Slow results – can take 3-6 months to see improvement
- Infection may return once medication is stopped
Topical antifungal medications
Topical antifungal treatments applied directly on the nails come in cream, gel, liquid, and lacquer form. Common prescription topicals contain:
- Ciclopirox (Penlac)
- Efinaconazole (Jublia)
- Tavaborole (Kerydin)
Over-the-counter options typically include clotrimazole, miconazole, and tolnaftate.
Pros:
- Minimal side effects
- Lower risk of drug interactions
- Easy to use at home
Cons:
- Slow to work – takes about 1 year
- Less effective than oral medication
- Frequent applications required
- Only treats affected area, not whole infection
- Frequent reinfection
Laser therapy
Laser treatment utilizes highly concentrated beams of light to target and destroy fungal overgrowth on the nails. It’s a quick in-office procedure performed under local anesthesia.
Pros:
- No pain or discomfort during procedure
- Improves nail appearance – makes them clearer and thinner
- Higher cure rates than topical treatment
- Short therapy duration – several sessions over a few weeks
Cons:
- Multiple treatments usually required
- Doesn’t always fully eliminate infection – combination therapy sometimes needed
- Risk of nail fracture or shedding
- Doesn’t prevent reinfection
- Can be expensive – not covered by all insurance plans
Photodynamic therapy (PDT)
Photodynamic therapy uses a combination of light waves and a photosensitizing agent applied to nails to eliminate fungus. It works by activating the agent once exposed to light.
Pros:
- Improves appearance – leaves nails looking healthier
- Minimally invasive – no pain or anesthesia required
- Short treatment period – several sessions over 4-6 weeks
Cons:
- Not as effective for severe infections
- Possible redness, swelling, and itching after procedure
- Higher reinfection rates
- Multiple required treatments
- May not be covered by insurance – can be expensive
Removal of infected nail
In severe cases where the nail is extensively damaged, permanent removal of part or all of the nail may be recommended. Options include:
- Partial nail avulsion – removing part of the infected nail
- Full nail avulsion – removing the entire nail
This is typically performed under local anesthesia in a podiatrist’s office.
Pros:
- Rids the nail of fungus
- Allows new, healthy nail to grow in
- Samples can be tested to identify fungus
- Quick procedure
Cons:
- Can be painful during and after procedure
- Increased risk of permanent nail deformities
- Numbness or discomfort may persist
- Fungus can still reoccur with new nail
- Regular removal can weaken nail over time
Home care tips
In addition to medical treatment, good nail and foot hygiene habits at home can help prevent fungal infection recurrence and speed recovery. Tips include:
- Keep feet clean and dry
- Wear socks that wick moisture and change them frequently if feet sweat
- Avoid tight-fitting shoes
- Wear shower shoes in public locker rooms
- Disinfect home pedicure tools after each use
- Apply antifungal or tea tree oil regularly to nails
- File down thick nails
- Avoid picking at nails
- Throw out old shoes where fungi may have developed
Which treatment is best for nail fungus?
The most effective approach depends on the severity of infection and underlying cause. Mild to moderate cases often respond well to oral antifungal medication, which offers high cure rates. Topical treatments may suffice for superficial white fungus limited to the nail surface.
For more extensive infections causing thickening, discoloration, and crumbling of the nail, combination therapy is usually required. This may involve oral medication plus removal of part or all of the nail to allow new growth. Laser or photodynamic therapy can also be beneficial additions to clear nail debris and destroy remaining fungal overgrowth.
Work closely with your doctor to determine the best course of treatment. Be patient, as it takes time for damaged nails to grow out and new, fungus-free nails to replace them. Stick with your treatment regimen and practice good foot hygiene to finally be rid of troublesome nail fungus for good.
Conclusion
Nail fungus is a common issue that can be challenging to treat. Thankfully, modern medicine offers several effective options beyond folk remedies to eradicate these stubborn infections. Oral and topical antifungal medications, laser therapy, and nail removal procedures all provide pros and cons to weigh with your doctor. Combination treatment is often key, along with diligent home care and foot hygiene. While it requires patience waiting out nail growth cycles, following your prescribed regimen can successfully cure fungal nail infections and restore health and appearance to your nails.