Nail fungus is a common condition that begins as a white or yellow spot under the tip of your fingernail or toenail. As the fungal infection goes deeper, nail fungus may cause your nail to discolor, thicken and crumble at the edge. It can affect several nails but usually not all of them.
TREATMENTS & DRUGS
If self-care strategies and over-the-counter (nonprescription) products haven’t helped, your doctor may suggest a combination of prescription drugs and other approaches. But even if you find relief from your signs and symptoms, repeat infections are common.
- Oral antifungal drugs.Your doctor may prescribe an oral antifungal drug. Studies show the most effective treatments are terbinafine (Lamisil) and itraconazole (Sporanox). These drugs help a new nail grow free of infection, slowly replacing the infected part.
You typically take this type of drug for six to 12 weeks. But you won’t see the end result of treatment until the nail grows back completely. It may take four months or longer to eliminate an infection.
Treatment success rates with these drugs appear to be lower in adults over age 65. And treatment success seems to improve when you combine oral and topical antifungal therapies.
Oral antifungal drugs may cause side effects ranging from skin rash to liver damage. You may need occasional blood tests to check on how you’re doing with these types of drugs. Doctors may not recommend them for people with liver disease or congestive heart failure or those taking certain medications.
- Medicated nail polish.Your doctor may prescribe an antifungal nail polish called ciclopirox (Penlac). You paint it on your infected nails and surrounding skin once a day. After seven days, you wipe the piled-on layers clean with alcohol and begin fresh applications. You may need to use this type of nail polish daily for a year.
- Medicated nail cream.Your doctor may prescribe an antifungal cream, which you rub into your infected nails after soaking. These creams may work better if you first thin the nails. This helps the medication get through the hard nail surface to the underlying fungus.
To thin nails, you apply an over-the-counter (nonprescription) lotion containing urea. Or your doctor may thin the surface of the nail (debride) with a file or other tool.
Surgical or other procedures
- Nail removal.If your nail infection is severe or extremely painful, your doctor may suggest removing your nail. A new nail will usually grow in its place. But it will come in slowly and may take as long as a year to grow back completely. Sometimes surgery is used in combination with ciclopirox to treat the nail bed.
- Laser and light-based therapies.More study is needed, but these methods — alone or with medications — may help your nails improve. One study tested the effectiveness of carbon-dioxide laser therapy combined with antifungal nail cream. Most of the 24 people in the study benefited from the treatment.
Laser and light-based therapies are not available everywhere, are expensive, and often are not covered by insurance.
LIFESTYLES & HOME REMEDIES
Often, you can take care of a fungal nail infection at home:
- Try over-the-counter antifungal nail creams and ointments.Several products are available. If you notice white markings on the surface of the nail, file them off, soak your nails in water, dry them, and apply the medicated cream or lotion.
If you have athlete’s foot as well as nail fungus, treat the athlete’s foot with medicated powders or sprays and keep your feet clean and dry.
- Apply Vicks VapoRub.Many people have had success with Vicks VapoRub. One study of 18 patients showed that 56 percent had partial improvement of signs and symptoms, and 17 percent saw no improvement. To use this method, apply a small amount of the product daily with a cotton swab.
- Trim and thin the nails.This helps reduce pain by reducing pressure on the nails. Also, if you do this before applying an antifungal, the drug can reach deeper layers of the nail.
Before trimming or using a nail file to thin thick nails, soften them. You can do this with the following nightly routine: Apply urea cream to affected nails, cover them with a bandage, and wash off the urea with soap and water in the morning. Repeat until the nails soften. Protect the skin around your nails with petroleum jelly.
If you have a condition that causes poor blood flow to your feet and you can’t trim your nails, see a health care provider regularly to have your nails trimmed.
Some people have had success with alternative approaches to treating nail fungus:
- Snakeroot extract.This product comes from plants of the sunflower family. In a study of 110 people, it was about as effective as ciclopirox. It was applied every third day for the first month, twice a week for the second month and once a week for the third month.
Tea tree oil. This product, applied twice a day, is possibly effective in treating nail fungus, but more study is needed