Nail Fungus

Diagnosis

During the examination, a doctor will inspect your nails and may collect nail clippings or scrape debris from beneath them. These samples will be sent to a laboratory for analysis to determine the underlying cause of your symptoms. It’s important to note that conditions like psoriasis can mimic a fungal nail infection, and microorganisms such as yeast and bacteria can also be responsible. Identifying the specific cause of the infection is crucial for determining the most effective course of treatment.

Treatment

Not all cases of toenail fungus necessitate treatment, as self-care measures and over-the-counter products can sometimes resolve the infection. However, if your condition persists, it’s advisable to consult your healthcare provider. The chosen treatment depends on the severity of the condition and the specific fungus involved. It’s essential to recognize that visible improvements may take months, and recurrence of infections is common even if there’s improvement in the nail condition.

Medications

Your doctor may recommend antifungal medications administered either orally or topically to address toenail fungus.

• Oral antifungal drugs: Typically, the initial choice, drugs like itraconazole aid in the growth of a new, infection-free nail, gradually replacing the affected part. This treatment involves daily intake for 6 to 12 weeks, with visible results only after the complete regrowth of the nail. Complete elimination of the infection may take four months or longer, and success rates tend to be lower in adults over 65. However, oral antifungal drugs may induce side effects such as rash and liver damage or interact with other medications. Regular blood tests may be necessary, and these drugs might not be recommended for individuals with liver disease, congestive heart failure, or certain medications.
• Medicated nail polish: Your healthcare provider might prescribe ciclopirox, an antifungal nail polish. Application involves painting it on infected nails and surrounding skin daily. After seven days, accumulated layers are wiped clean with alcohol, and the process is repeated. This treatment may be required daily for nearly a year.
• Medicated nail cream: Antifungal creams like efinaconazole and tavaborole may be recommended. These are applied after soaking, and better results may be achieved by first thinning the nails. To facilitate this, you can use a nonprescription lotion containing urea, or your healthcare provider may perform nail surface thinning (debridement) with a file or another tool. Antifungal nail creams may induce side effects such as rash.

Surgery

Your doctor might suggest temporarily removing the nail to enable the direct application of antifungal medication to the infection beneath the nail. Alternatively, a less common but highly effective option involves surgery to permanently remove the nail and its root.