Fungal nail infection treatment

Fungal nail infections are a very common problem which can be unsightly and embarrassing. Here we look at some potential fungal nail infection treatments.

What is toenail fungus?

The medical term is onychomycosis – a fungal infection of the nails, caused most often by dermatophytes – a fungus which feed on keratin and cause ringworm (tinea). It can affect either fingernails or toenails, but the latter is more common.

Symptoms/signs of toenail fungus?

  • Yellow nails – An early symptom is a small yellow or white spot which grows in size, while the rest of the nail becomes cloudy.
  • Thick nails – Nails eventually become thickened and can also become rough and crumbly.
  • Black nails – nails can turn black and the nail can separate from its base. They tend not to be particularly painful, but are unsightly and can be embarrassing in public places.

However, there are other conditions which have similar symptoms, so you should see your doctor in the first place, for a correct diagnosis. People who complain that a particular treatment doesn’t work may be treating the wrong fungus. Diagnosis should be done as early as possible as fungal infections can be difficult to treat so the sooner you start the better.

toenail fungus
toenail fungus

What causes toenail fungus?

Usually, the nails provide a protection against infection, but a break in the nail, (for example, due to trauma to the nail) can, under certain conditions, allow a fungus to take hold. Those conditions include warm and wet conditions such as public swimming pools or gym changing rooms, i.e. similar to those under which athlete’s foot or verrucas can be contracted. The greater exposure of the feet to such conditions explains why toenails are more susceptible to the fungus than fingernails. You can also get it from direct contact with another person who has the fungus, so if your husband/wife/partner/etc. has it, care should be taken. Therefore, to avoid potentially getting these conditions (and prevention is always better than cure), there are some precautions you can take:

  • Good foot hygeine
  • Wear sandal -type footwear rather than bare feet in communal wet areas
  • If you wear socks, wear those which allow air to the feet. e.g. cotton or wool.

Other factors: There may be a greater risk for people in the following groups:

  • People over 55;
  • People with poor health generally,
  • Those with certain diseases, such as psoriasis or diabetes;
  • Depleted immune system
  • Those in a warm / humid climate
  • Smokers

Is there a danger of getting toenail fungus from from fish pedicures?

According to the Health Protection Agency, there is a low risk from the increasingly popular fish pedicures. However, it can depend on the hygiene precautions taken by the particular establishment. For more details see here: Guidance on the management of the public health risks from fish pedicures (PDF, 531 KB)

How to treat nail fungus?

Medical treatments can be very expensive and there there is no 100% guaranteed cure, as there is always a danger that the fungus can return.

Toenail fungus Laser treatment

Arguably the most reliable form of treatment and safer than drugs. However, it is expensive and, as mentioned above, it is not guaranteed to be permanent. Advice should be given as to precautions to help prevent re-occurrence.

Medications

The most popular medication for toenail fungus is Lamicil (terbinafine), taken as pills. Another pill-based treatment is Itraconazole. However, as with other anti-fungal medications, there are some potentially risky side-effects. Lamisilaims to prevent growth of a fungus by inhibiting the ability of a particular enzyme in making the fungal cell wall. It is most effective against two of the dermatophytes but unable to kill some other fungi so it is important that the correct fungus is identified before treatment.

What are the potential side-effects of Lamisil?

The more serious side-effect is the potential to cause liver problems, and Liver failure due to the use of Lamisilhas been known in rare cases. Because of this patients are likely undergo liver function tests before being prescribed this drug. If you have kidney problems or an auto-immune disorder, you should also inform your doctor (if, for some reason, he or she doesn’t already know). The complete list of possible side-effects is so long that any unusual symptoms should be reported to your doctor. These can include:

  • rashes or other skin reactions
  • any pains or swelling of joints or glands
  • mood or behaviour changes
  • dyspepsia (indigestion)
  • headaches

Itraconazole also has some possible side-effects. They are not particularly common and generally disappear when treatment is over. As with Lamisil, however, there are some potential more serious side effects which can affect the liver or the heart.

Nail removal

This is an option prior to treatment of the fungus on the skin but would not necessarily remove the fungus without additional treatment of the nail bed.

Other treatments

Due to the potential risks and expense of other treatments without a guarantee of success, many people prefer to turn to relatively safe and inexpensive home remedies. So what are the options?

Topical treatments for nail fungus

There are several commercial treatments, several of which are based on natural ingredients, such as essential oils,

These include:

Simon & Tom Yoffee Clear, which contains Argan, Tea Tree, Clove, Rosemary and Pomegranate Oils and other natural extracts to protect and nourish new nail growth

Zetaclear – a popular treatment which includes Tea Tree oil

ClearZal BAC Fungal Nail Treatment – not a completely natural solution but includes aloe vera for extra moisturising.

Toenail fungus home remedies

Due to the potential risks and expense of other treatments without a guarantee of success, many people prefer to turn to relatively safe and inexpensive home remedies. So what are the options?

Systemic treatments

You could try the herbs that are known as good immune boosters or anti-fungal treatments including – some of these can also be applied externally.

  • Garlic
  • Extract of Olive
  • Oil of Oregano (don’t take if you are pregnant)
  • Coconut oil
  • Echinacea
  • Grapefruit seed extract

There is quite a large number of home treatments but due to the nature of such things, most of the ‘evidence’ of success tends to be anecdotal. It is usually thought helpful to cut back the nail as far as possible and file down the surface of the nail before applying the treatment, either be soaking the feet in solution or by applying directly with a cotton bud/Qtip.

  •  The Swiss naturopath, Alfred Vogel recommends treating with Camomile cream during the day. At night leave the toe in some absorbant cotton soaked in the whey product Molkosan. The following night the same treatment but with Spilanthes repacing Molkosan. The treatment continues, alternating Spilanthes and Molkosan every other night. Mr Vogel also recommends eating foods rich in calcium and silica, to strengthen nails.
  • Essential Oils
    • Tea Tree oil – The main active ingredient of some of the commercial treatments. Apply a 100% solution. [Beware that tea tree oil can be toxic to dogs and cats]
    • Lemon
    • Thyme
    • Lavender
    • Eucalyptus
  • Listerine – Soak fingernails or toenails. Popular mouthwash is thought to have anti-fungal properties; however it may be more successful with the candida-type infection than dermatophyte-type infection.
  • Vinegar / Apple Cider Vinegar – good results are reported by many by soaking in a 1:3 solution of vinegar to water for about 20 minutes a day or direct application of neat vinegar to the affected area. I can’t find any advantage of apple cider vinegar over normal vinegar, as the main active ingredient seems to be the acetic acid.
  • Vicks Vapo Rub – contains camphor, menthol, spirits of turpentine, eucalyptus oil and cedar leaf oil. Users report slow but noticeable progress.
  • Bleach – soaking in a diluted solution for 10 – 20 minutes or direct application of neat bleach to the nail have both produced positive reports, although there is a possibility that it is improving the appearance without actually killing the fungus, so another product may be used in conjunction.
  • Hydrogen Peroxide – usually used in combination with one or more of the other solutions

There are almost innumerable reports of every possible combination of the treatments mentioned above, including topical home treatments in conjunction with Lamisil. Treating fungal infections is notoriously difficult and long term, often taking at least 12 weeks and treatments from 6 months to over a year are not uncommon, so patience and persistence is definitely required.

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