Toenail fungus, medically known as onychomycosis, is a very common condition. It can cause your nail to become brittle and crumbly, appearing with white, brown, or yellow spots. Over time, the nail might thicken and even start to lift from your toe. This condition does not resolve on its own and, if left untreated, can worsen, potentially causing pain when walking, spreading to other nails, or affecting other parts of your body.
Fungal nail infections are typically caused by fungi called dermatophytes that infect the skin beneath the nail; yeast is another common culprit. Toenails are particularly susceptible to infection when bare feet come into contact with damp surfaces, such as those found in showers, swimming pools, and locker rooms. Nail fungi thrive in warm, moist environments, making these areas prime locations for contraction. You can also acquire it from sweating in shoes all day.
Diagnosis of Toenail Fungus
Your healthcare provider will examine your nails and may take nail clippings or scrape debris from under your nail for testing. This is important because other conditions, such as psoriasis, can mimic a fungal infection. Microorganisms like yeast and bacteria can also infect nails.
Treatment Options for Toenail Fungus
Treatment for toenail fungus is not always immediately necessary, and sometimes self-care and nonprescription products can clear the infection. However, if your condition does not improve, it's advisable to consult your healthcare provider.
Prescription Treatments
For more persistent or severe infections, prescription treatments are often recommended. These can include oral antifungal medications, medicated nail polishes, and medicated creams.
Oral Antifungal Drugs
Oral antifungal drugs are frequently the first choice for treatment. Medications like itraconazole (Sporanox) and terbinafine (Lamisil) are highly effective. These drugs help a new nail grow free of infection, gradually replacing the infected part. Typically, you will take these medications daily for 6 to 12 weeks. However, the full results of the treatment may not be apparent until the nail has completely grown back, which can take four months or longer.
It is important to note that oral antifungal drugs can have side effects, including headaches, an itchy rash, stomach ache, nausea, and diarrhea. Terbinafine can affect the liver, and itraconazole can interact negatively with other medications. Therefore, your doctor will likely monitor you with occasional blood tests to ensure your liver is functioning properly, both before and during treatment. These medications may not be suitable for individuals with certain conditions, such as liver or kidney disease, or for those who are pregnant or breastfeeding.
Medicated Nail Polish
Your doctor might prescribe an antifungal nail polish, such as ciclopirox (Penlac). This medication is applied to the infected nails and surrounding skin daily. After seven days of application, the accumulated layers are wiped clean with alcohol, and fresh applications begin. This treatment can take 6 months or more before your nails start to look better. Studies indicate that antifungal nail polish is less effective than oral medications, so your doctor may recommend using it in conjunction with pills for a better outcome.
Medicated Creams and Gels
Prescription creams and gels, such as efinaconazole (Jublia) and tavaborole (Kerydin), are also available. These topical treatments are best for surface fungus as they may not penetrate the nail bed deeply. It may take up to a year of daily use to see the fungus disappear. To enhance penetration, your foot doctor (podiatrist) may trim your nail and file away dead layers. These products are rubbed into the infected nails after soaking and may work better if the nails are first thinned using a nonprescription lotion containing urea.
Over-the-Counter (OTC) Treatments
Antifungal creams, gels, sprays, and patches are available at drugstores or online without a prescription. These include clotrimazole (Lotrimin) and terbinafine (Lamisil) cream. OTC products are most effective for mild toenail fungus and may require several months to show results. When using these products, it is recommended to file or cut off any white markings on your nails, soak your nails in water, dry them thoroughly, and then apply the medicated cream. It is important to recognize that most OTC products are not potent enough to cure moderate or severe cases of toenail fungus; prescription drugs are necessary for these instances.
Nail Removal
In cases of deep infection or long-standing conditions, your doctor may suggest removing all or part of the infected nail. This can be done surgically or nonsurgically. For nonsurgical treatment, urea ointment is applied to soften the nail bed, allowing the infected nail or diseased part to be removed. Surgical removal involves numbing the area and then carefully detaching the nail. A new nail typically grows back, though this process can take about a year. During this time, your doctor will likely provide a cream or other treatment to apply to the nail bed to prevent recurrence.
Laser Treatment
Due to potential side effects from oral medications, some individuals opt for laser treatment. This procedure involves heating the nail layers to destroy the fungus. Treatments usually take about 30 minutes and require at least two sessions spaced 5-6 weeks apart. While results may take around 2 months to become visible, studies on the effectiveness of laser treatment are mixed, and further research is needed to confirm its safety and efficacy.
Home and Natural Remedies
Several home remedies are popular for toenail fungus, although scientific evidence for their effectiveness varies.
- Tea Tree Oil: Derived from the tea tree plant, this oil has been traditionally used as an antiseptic. Some studies suggest it may be as effective as clotrimazole cream for toenail fungus when applied twice daily for 6 months, while other studies have shown no significant improvement.
- Vicks VapoRub: Containing camphor, eucalyptus oil, and menthol, Vicks VapoRub is thought to have antifungal properties. A small study indicated that daily application resulted in complete or partial cure in a significant percentage of participants after 48 weeks.
- Apple Cider Vinegar: While vinegar is known to fight fungus, specific studies on its efficacy for toenail fungus are lacking. A common method involves soaking feet in a mixture of one part apple cider vinegar to three parts warm water for 10-40 minutes.
- Baking Soda: A small study found that baking soda inhibited fungal growth in nearly 80% of treated nail samples after 7 days, suggesting it may be more effective at preventing than killing fungus. It can be used in foot soaks or as a paste.
- Listerine Mouthwash and Snakeroot Extract: Listerine contains thymol, which has antifungal properties, but it has not been specifically studied for toenail fungus. Snakeroot extract, from the sunflower family, showed similar efficacy to ciclopirox in one study when applied as a nail polish over 6 months.
The advantage of home remedies is their lack of side effects. However, many may only address symptoms rather than the underlying infection. It is recommended to discuss these options with your doctor.
Preventing Toenail Fungus Recurrence
Toenail fungus can be stubborn, and recurrence is possible. Taking preventive measures can help:
- Keep your feet clean and dry.
- Wear shower shoes or flip-flops in public places like locker rooms, gyms, and swimming pool decks.
- Change your shoes and socks daily. Opt for breathable footwear and moisture-wicking socks (acrylic socks are often better than cotton).
- Ensure nail salons sanitize their tools properly and clean your home nail clippers regularly.
- Soften nails in warm water or trim them immediately after a shower.
- Trim your toenails short, straight across, and shorter than the tips of your toes.
- Avoid tearing your nails, as this can create entry points for fungus.
- If a family member has toenail fungus, consider using separate showers or wearing flip-flops in shared bathing areas.
Understanding When Fungus is Dying
While your nails may not look perfect during treatment, a key indicator that the toenail fungus is clearing up is the regrowth of healthy nail at the base of your toe. This new nail will be its natural color and texture, distinct from the unhealthy, thickened nail. It's crucial to complete the full course of prescribed medication, even if your nails start to improve, to prevent the fungus from returning. If you suspect a recurrence, characterized by changes in nail color or texture, swelling, or itching, consult your doctor.
It's important to be patient, as toenail fungus can take a long time to fully resolve. It can take anywhere from 6 months to 18 months for a toenail to return to normal. Prescription medications, like terbinafine, are generally faster acting than home remedies, though they still require consistent use over several weeks.