Nail fungus: causes, symptoms and treatment

Fungal nail infections (onychomycosis) are a common nail problem. It is estimated that 10% of the population is affected by nail fungus.

Nail fungus causes discoloration, thickening of the nails, as well as cracking and breaking of the nails. It happens when an overgrowth of fungus enters your nail and causes an infection.

This article explains the causes, symptoms, treatment, potential complications, and prevention steps for toenail fungus.

Causes of nail fungus

Microscopic organisms cause nail fungus. You can come into contact with fungi that can cause infection in a variety of ways, including:

• Skin contact with someone who has a fungal infection (such as athlete’s foot or ringworm)
• Skin contact with moist areas where fungi grow (swimming pool edges, locker rooms)
• Sharing personal care items (nail clippers, towels)
• Wear sweaty socks and shoes
• Skin or nail cracks

While anyone can get nail fungus, some people are more susceptible, including:

• The elderly
• Those who live in a hot and humid climate
• People with poor circulation
• People with an injured nail or an existing fungal infection
• Those with chronic health conditions, such as cancer, diabetes, psoriasis, HIV, or other immunocompromised individuals
• Those who have recently had an organ transplant

Symptoms of nail fungus

Symptoms of nail fungus are usually easy to spot. They understand:

• Discolored nails (usually yellow, brown or white)
• Nail thickening
• Hardened or brittle, cracked nails

Nail fungus treatment

There are several approaches to treating nail fungus, including oral, topical, and laser treatments. Often the treatment you receive will depend on the severity of your infection.

Topical treatments

Topical nail fungus treatments are antifungal medications that you apply directly to the nail. These drugs are not the most effective method of treatment; however, they may be a good option if the case is mild. The U.S. Food and Drug Administration (FDA) has approved the following topical treatments:

• Amorolfine
• Ciclopirox
• Efinaconazole
• Tavaborole

Amorolfine and ciclopirox are the most common topical treatments for nail fungus. You apply them daily like nail polish for a year. However, since topical medications are less effective, especially in milder and more severe cases, healthcare providers sometimes combine them with another method of treatment, such as oral medications.

Topical treatments prevent new fungi from growing as the nail grows. Therefore, this treatment can take some time, sometimes up to a year or more.

Oral treatments

Oral medications are the first line treatment for nail fungus as they are the most effective. Plus, they work faster, often in just a few months. Here are the FDA-approved oral nail fungus medications:

• Fluconazole
• Griseofulvin
• Itraconazole
• Terbinafine

Although these drugs are effective, they can produce serious side effects, including liver and heart problems. Therefore, while you are receiving oral therapy, your health care provider will periodically monitor you by checking blood work with a CBC and LFT (liver function test). As long as your numbers are within normal limits, the drug is safe to take.

Nail debridement

Nail debridement (removal) may be needed if you are unresponsive or unable to take other treatments. A healthcare provider may surgically remove your nail or apply a chemical to the nail to encourage it to fall out on its own.

Laser treatment

Laser therapy can be a good option for people who are intolerant to medication and don’t want to lose their nails. With laser therapy, a healthcare provider uses a laser to apply heat to the nail to kill the fungus and inhibit fungal growth.

One study looked at the effectiveness and safety of laser treatment for nail fungus. The researchers assessed 35 articles, including 1,723 participants. The overall cure rate was 63%, but was higher with a CO2 laser, which had a 74% cure rate.

Researchers have found that laser treatments are safe and effective. However, they can lead to pain and bleeding. Laser therapy can be an out-of-pocket expense for most people, as it is usually not covered by insurance.

Complications

When you don’t treat toenail fungus early, it can turn into a more serious infection, which can lead to removal of the fungus, loss of the nail, or pain.

Additionally, the drugs used to treat nail fungus can lead to complications, including heart and liver problems and anaphylaxisa severe allergic reaction.

When taking medication, watch for signs of serious problems, including:

• Jaundice (yellowing of the skin or the whites of the eyes)
• Pale stools or dark urine
• bruises easily
• Rapid or irregular heartbeat

Prevention

There are simple steps you can take to reduce your risk of getting a fungal nail infection. They understand:

• Wear flip flops in public places (rather than going barefoot)
• Wear well-fitting, breathable shoes and clean socks
• Allow wet shoes to dry before wearing them again
• Use antifungal powder in your shoes
• Keep nails cut short
• Disinfect nail clippers
• Keep feet clean and dry
• Keep your feet hydrated
• Treat Athlete’s Foot Immediately

If you notice a fungal infection, make an appointment with a health care provider.

Summary

Nail fungus is caused by microscopic organisms that enter your nail and cause an infection. Anyone can get nail fungus, but it’s more common in older people and people with chronic health conditions. Symptoms include discolored, thick, and brittle nails. You can prevent nail fungus by making sure your feet and shoes are dry, wearing flip flops in public locker rooms and showers, disinfecting nail clippers, etc.

A word from Verywell

If your nails are flaking, thick or yellow, don’t ignore them: a fungal infection may be brewing. Remember that the sooner you start treatment, the better the results. Tell a health care provider if you have any allergies, heart disease, kidney or liver problems, blood disorders, or are taking any medications as this may affect your medications.