Nail Fungus

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Question

What is nail fungus?

Answer

Nail fungus is a fungal infection of the fingernails or toenails. Another name for a nail fungus infection is onychomycosis. Mild infections of nail fungus may produce few or no symptoms. More severe infections may cause the nail to turn whitish, thicken, become brittle, and even detach from the nailbed. Some people have blisters and painful swelling around the infected nail. Fungal infection of the toenails is more common than fingernails. You can get a toenail infection by walking barefoot in public places or as part of an athlete's foot infection.

Alternative, over-the-counter and prescription treatments can help kill the fungus on the skin surrounding the nail. For fungal infections of the nailbed, prescription medicines taken by mouth are the most effective treatment. Before prescribing a medicine, your doctor can take a small sample from the nail to find out which fungus is causing the infection.

Over-the-counter treatments

There are several over-the-counter treatments available to treat nail fungus in the form of liquids, solutions, and creams. You apply these products directly to the nail and surrounding skin to treat cases of nail fungus infection. Common topical antifungals include clotrimazole (Lotrimin AF®) and terbinafine (Lamisil®). Because they do not penetrate the nail, they work best in infections of the skin or nail surface, as in athlete's foot. When the fungus has invaded the nailbed, over-the-counter treatments may not be strong enough to treat extreme cases of nail fungus. In these more extreme cases, prescription medicines have the best chance of treating the infection.

Antifungal prescriptions

Prescription medicines include griseofulvin (Fulvicin®), itraconazole (Sporanox®), and terbinafine (Lamisil®). Of these medications, itraconazole and terbinafine are the most effective. They cure 70 to 80% of infections with one course of treatment. Griseofulvin  cures 30 to 70% of infections with one course. Doctors sometimes prescribe another drug, fluconazole (Diflucan®), but it has not been studied as thoroughly as the other antifungal drugs.

Another product available is ciclopirox (Penlac®) nail lacquer for nail fungus. You apply it like a nail polish once daily to the affected nail(s). While it appears less effective than antifungals taken by mouth, it may be an option for people who want to avoid the risk of side effects from oral antifungals.

Even with prescription medicine, fungal infections are sometimes difficult to cure, and may return after treatment is complete.

Alternative therapies for nail fungus

The herb tea tree oil has been studied as an alternative therapy in the treatment of onychomycosis. When applied topically, tea tree oil may improve the appearance of the nail, but there is not enough evidence to suggest that it is effective in curing nail infections. When the fungus has invaded the nail bed, prescription medicines have the best chance of treating the infection.

Treatment duration

Nail fungus drug treatments usually take three months. The medicine gets into the nail and remains there as the nail grows out. It can take up to six months to cure a fingernail infection and up to 18 months for toenail infections because this is how long it can take for the healthy nail to grow out. For comfort, keep affected nails short.

Avoiding future infections

Follow these tips to help avoid fungal infections of your nails: Keep your feet clean and dry. Use a towel to dry your feet, including between the toes, after a bath or shower. Wear cotton socks and change them frequently, if needed. Wear gloves if your hands are frequently immersed in water. Choose a salon with good sterilization procedures for manicures and pedicures.

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