Onychomycosis? Never heard of it? You probably know it by its more common name: nail fungus. Nail fungus is a common infection that can affect your fingernails and toenails, though it’s more common in toenails. Nail fungus can impact your quality of life, too, making you feel self-conscious or even causing pain.
Nail fungus is more prevalent than you might think. Some estimates place the number of adults in North America with nail fungus as high as 13.8%. It’s less common in children, with an estimated prevalence of less than 1%.
If you think you might have nail fungus, it’s important to understand the causes, how it’s diagnosed, and what treatments are available to you. This article will provide a comprehensive overview of nail fungus, including how common it is, how it develops, how it’s diagnosed, and how it can be treated with oral medications, topical treatments, surgery, and alternative therapies. We’ll also cover what you can expect as the fungus clears up and how you can prevent it from coming back.
So, let’s dig into some nail fungus reviews.
How nail fungus spreads
Like any other infection, nail fungus has to start somewhere. It’s helpful to understand how nail fungus spreads and how it thrives.
Onychomycosis: Prevalence and risk factors
Onychomycosis, the medical term for nail fungus, is more common as people get older. That’s because nails become more brittle with age, and cracks in the nails give fungus a place to settle in.
Other things that increase your risk of getting nail fungus include:
- Diabetes
- Peripheral vascular disease
- A weakened immune system
Common culprits
Most of the time, nail fungus is caused by dermatophytes. In the United States, dermatophytes are responsible for about 70% of nail fungus infections. Other causes include yeasts and molds that aren’t dermatophytes.
Sometimes, a person has a mixed infection, where both dermatophytes and other molds or yeasts are present.
How nail fungus invades
Nail fungus often starts with athlete’s foot (tinea pedis). From there, the fungus can get into the nail bed and nail plate.
What helps fungus grow
Fungus loves a warm, moist environment. That’s why it’s so important to dry your feet thoroughly after you shower or swim. Toenail fungus is more common than fingernail fungus because socks and shoes create a warm, moist environment for feet all day long.
A nail injury can also create an opening for fungus to enter. Avoid trauma to your nail!
How to know if you have nail fungus
If you think you have nail fungus, it’s good to get a diagnosis. That’s because about half the time, nail problems are not caused by fungus. Psoriasis, lichen planus, and chronic dermatitis can cause changes that look a lot like nail fungus.
Here are some things you might notice if you have nail fungus:
- Your nails are thicker than usual.
- Your nails are discolored.
- Your nails are brittle.
- Your nails are distorted or misshapen.
- Your nail is separating from the nail bed (called onycholysis).
- Debris builds up under your nail (called subungual hyperkeratosis).
It’s important to get the right diagnosis so you can avoid taking medicine you don’t need.
Here are some of the tests doctors use to check for nail fungus:
- KOH preparation with microscopy. This test is often used for the first diagnosis. It’s accurate about 55% to 80% of the time.
- Fungal culture. This test is accurate about 23% to 85% of the time.
- Nail biopsy with PAS staining. This test is accurate about 81% to 92% of the time.
- PCR testing. This test is about 83% accurate.
Each test has pros and cons, so talk with your doctor about which one is right for you.
Oral Therapy
Oral antifungal medications are another possible treatment for nail fungus. Here are some things to know.
First-Line Oral Antifungal Medications
These are some of the most common medications that doctors prescribe for nail fungus.
- Terbinafine. This is usually the go-to oral treatment for most cases of nail fungus. It clears up fingernail fungus about 75% of the time. For toenail fungus, the cure rate is 38% to 76%. Terbinafine is cost-effective and usually works well. It also has lower relapse rates compared to another medication called itraconazole.
- Itraconazole. This medication has a fingernail cure rate of 78%. For toenails, the cure rate is 14% to 62.6%. It’s important to talk to your doctor about potential interactions with other drugs you’re taking.
- Fluconazole. This medication has a fingernail cure rate of 76% and a toenail cure rate of 31.2%.
Things to consider before starting oral therapy
These are some of the factors that you and your doctor will need to discuss before deciding if oral antifungal medication is right for you.
- When to consider oral medications. Oral medications are usually considered for moderate to severe infections or when topical treatments haven’t worked.
- Potential side effects and contraindications. Oral medications can have side effects, such as liver toxicity and interactions with other drugs. It’s important for your doctor to monitor your liver function while you’re taking these medications.
- Treatment duration. How long you’ll need to take the medication depends on the type and location of the infection. Your doctor can help you understand what to expect in terms of nail regrowth time.
Effectiveness in Older Adults
It’s important to note that oral drugs may not work as well in adults over age 65. If you’re an older adult, talk to your doctor about any special considerations or precautions you should take.
Treatment Options: Topical Therapy
If you’re looking for a nail fungus treatment, topical medications are available in creams, gels, and lacquers.
Topical Antifungal Medications
- Ciclopirox: This is a nail polish you brush on once a day. You may need to use it for almost a year. The cure rate for fingernails is about 5.5 percent, and for toenails, it’s 6 to 9 percent.
- Efinaconazole: The cure rate for toenails is about 15 to 18 percent. It’s more effective than using no treatment at all.
- Tavaborole: The cure rate for toenails is about 7 to 9 percent. It’s more effective than ciclopirox.
- Amorolfine: This 5 percent lacquer shows a good rate of mycologic cure.
Is Topical Therapy Right for You?
When should you consider topical medications?
- for superficial or early infections
- as an addition to oral medications
To get the best results from topical medications, you’ll need to prepare your nails first. Trim, file, and soften them, and use the right clippers for thick nails. Urea-containing creams can help soften your nails.
Keep in mind that topical medications don’t cure fungal infections as often as oral medications do. You’ll need to follow the directions carefully, and you’ll need to keep up with the treatment for a long time.
Other treatment options
If over-the-counter treatments aren’t effective, your doctor or podiatrist may recommend one of these options.
Surgical therapy
In severe cases, when medications haven’t worked, nail removal may be an option. This is called nail avulsion. Typically, nail avulsion will be combined with a topical antifungal treatment applied to the nail bed.
Nail avulsion has risks and benefits that your doctor can discuss with you.
Laser and light therapy
Several types of laser and light therapy are available. Some of the lasers used to treat nail fungus are:
- Nd:YAG laser
- CO2 laser
- photodynamic therapy
Some studies show that photodynamic therapy has a higher response rate than fluconazole (an oral medication) for nail fungus.
Laser and light therapies have limitations and considerations that you should discuss with your doctor.
Integrative medicine
Some people look to integrative medicine for help with nail fungus, including exploring options like herbal nail fungus soaks. Here are some things you should know:
- Tea tree oil. Research indicates that tea tree oil has antifungal effects.
- Other essential oils. Some essential oils show promise in treating nail fungus, but more research is needed.
- Biotin. Some research suggests that biotin may help strengthen weak or brittle fingernails.
Always consult with a healthcare professional before trying integrative medicine treatments.
New treatment options
Researchers are continually working on new ways to treat nail fungus. Some of the new options are:
- Plasma therapy. One pilot study showed a 53.8% clinical cure rate.
- Novel drug delivery systems. Researchers are looking at new ways to deliver antifungal medications to the nail.
- Ongoing research and clinical trials. You can find clinical trials near you through the National Institutes of Health.
Prevention and what to expect
Nail fungus is stubborn, and it is possible to get it again even after you’ve successfully treated it. If you’re looking to get rid of nail fungus, it’s important to understand prevention methods. Here are some tips for prevention and what to expect.
How to prevent nail fungus
- Practice good hygiene. Don’t walk barefoot in public places, and keep your nails trimmed and clean. It’s a good idea to disinfect your shoes regularly, too.
- Manage underlying conditions. Treat athlete’s foot promptly, and work with your doctor to control any diabetes or other conditions that could contribute to nail fungus.
- Take good care of your nails. Avoid trauma to your nails, such as stubbing your toe or wearing shoes that squeeze your toes. Also, avoid excessive moisture, which can create a breeding ground for fungus.
What to expect and how to avoid recurrence
Even after successful treatment, nail fungus can come back. It’s important to understand the factors that contribute to recurrence so you can take steps to prevent it.
You may need regular monitoring and maintenance therapy to keep the fungus at bay. Talk to your doctor about a plan for follow-up care.
Frequently Asked Questions
Can you buy tolnaftate over the counter?
Yes, tolnaftate is an antifungal medication available over-the-counter (OTC) in various forms, such as creams, powders, and sprays. It’s often used to treat athlete’s foot, ringworm, and other fungal skin infections. It can be used on nail fungus, but is typically less effective than other treatments.
Can you scrape out toenail fungus?
While filing down the surface of the nail can help topical treatments penetrate better, you cannot “scrape out” toenail fungus. The infection is usually deep within the nail bed and under the nail plate. Aggressive scraping can damage the nail and surrounding tissue, potentially worsening the infection or leading to secondary infections.
What is the strongest antifungal over the counter?
In terms of OTC options, medications containing ingredients like terbinafine or clotrimazole are often considered stronger and more effective for many fungal infections than older options like tolnaftate. However, for nail fungus, prescription oral medications are generally the most powerful treatment options, but come with potential side effects.
What is the active ingredient that kills nail fungus?
Various active ingredients kill nail fungus, depending on the treatment. Common ones include terbinafine (oral and topical), itraconazole (oral), fluconazole (oral), and ciclopirox (topical nail lacquer). Different ingredients work in different ways to disrupt the fungus’s cell walls or inhibit its growth.
Does Kerasal really work?
Kerasal Nail is a topical treatment that doesn’t contain an antifungal medication. Instead, it uses ingredients like urea to soften and thin the nail, which can improve the appearance of the nail and may help other antifungal treatments penetrate better. Some users report seeing improvements in nail appearance, but it’s not a cure for the underlying fungal infection and its efficacy can vary.
Summary
Nail fungus is a common problem that needs a correct diagnosis to be treated effectively. There are a few different ways to treat it, from pills you swallow to creams you put on your nails. Each treatment has pros and cons to consider. It’s also important to take steps to prevent nail fungus from coming back.
The best way to deal with nail fungus is to talk to a doctor. They can help you figure out the best treatment based on your situation. It’s important to work with your doctor to make a decision that you both agree on.