Nail fungus, also known medically as “onychomycosis”, is an infection of the toenail or fingernail caused by a fungus. Toenail fungus is more common and the big toe nails are most often affected. Accepted risk factors for getting a fungalnail infection include the following:
- Frequent exposure to moist environments pools and saunas
- Wearing tight fitting shoes
- Athlete’s foot
- Damaged nails
- Advanced age
- Weakened immune system
- Living with family members who have nail fungus
Nail fungus can start as a white or yellow spot under your nail which then can enlarge as it spreads. It is common for fungal nails to discolor, thicken, change shape or lift up, break easily and hurt. Sometimes people ask about the appearance of white nail fungus or black nail fungus. Both appearances can be caused by a fungal nail infection. Nail fungal infections often turn the nail into a white or yellow-brown nail. Debris can also build up under the nail and cause it to look black. Any trauma to the nail can cause bleeding under the nail which can also cause it to look black.
A fungal nail infection also tends to change the shape of the nail and make the nail become brittle or cracked. Some people also report discomfort or pain with fungal nails, especially when wearing shoes or walking for a long time. It is also possible for the nail to separate from the nail bed.
Most fungal nail infections do not cause complications in otherwise healthy individuals. Whether to treat a fungal nail infection is your choice.
An untreated nail infection likely will not go away and may worsen or spread to other nails. If you have a condition such as diabetes or a weakened immune system that might complicate a nail infection, you should consult your doctor even if your fungal nail does not bother you. Treatment options include prescription oral antifungal medicines, prescription topical antifungal medicines, laser treatment, and surgery.
There are no over-the-counter products approved by the Food and Drug Administration to treat nail fungus. To determine what the best fungal nail treatment would be for you, you should see a doctor to discuss how to cure nail fungus.
It is important to know that a fungal nail infection can only be cured with a prescription antifungal medicine. Your doctor may prescribe a topical nail fungus treatment such as Jublia® (efinaconazole) or a medication you take by mouth such as Lamisil® (terbinafine) for treatment of fungal nails. Unfortunately, fungal nail infections can be difficult to cure and take months on a prescription treatment for a nail to look normal again.
- For example, in clinical testing, after 48 weeks of use, the complete cure (complete clearing of nail and fungus) rate for Jublia® was less than 20%.
- Oral antifungal medications are more effective with higher complete cure rates of over 50% depending on the medication but can have side effects that you should discuss with your doctor.
You should also check to see if your insurance will cover the expense of a topical prescription treatment. The effectiveness of newer potential approaches such as laser fungal nail treatment compared to standard medical therapy is still under debate.
Before starting any prescription treatment, you should know that it can take a long time to cure a fungal nail infection and see a change in the appearance of the nail. A prescription antifungal medicine kills the fungus, but it does not repair the nail once it is damaged. It takes about 12 months for a healthy toenail to fully grow in and replace the damaged nail. Trimming or thinning a nail to remove as much of the affected part as possible to allow any topical nail fungus treatment to penetrate is helpful.
Unfortunately, there is a chance that the treatment won’t work, the fungal nail infection might not get better, or the fungal infection will come back even after effective clearing with prescription nail treatments. Many factors contribute to recurrence of nail fungal infection. These include:
- Genetic predisposition
- Conditions which cause poor circulation
- A deficiency in the immune system
- An injury to the nail
There are things you can do to try to prevent recurrence such as keeping your feet cool and dry, avoiding going barefoot in public places and prompt treatment of any athlete’s foot if that is present. If you have recurring nail fungal infections, talk to your doctor about how best to manage your symptoms.
It is important to understand that there are no approved over-the-counter drug products available for treating or curing a fungal nail infection. There are cosmetic products available such as Kerasal® Fungal Nail Renewal™ that helps improve the appearance of fungal nails by reducing discoloration, normalizing thickness, and hydrating brittle nails. Talk to your doctor about using Kerasal® Fungal Nail Renewal™ with prescription oral antifungal treatment to help improve the appearance of the existing damaged fungal nail. Kerasal should not be used with other topical nail products.
Some over-the-counter products such as FungiNail®, FungiCure®, Proclearz® and Dr. Blaine’s® may appear to be a treatment for nail fungus, when in fact they are not shown to cure nail fungus or improve fungal nail appearance. These products are actually indicated for the treatment of athlete’s foot which is why the back panel of these products say, “This product is not effective on the scalp or nails.”
There are natural treatments that are available, but they have not been approved for the treatment or cure of nail fungus.