Fungal nail infection, medically known as Onychomycosis or tinea unguium, is a chronic and potentially persistent condition that affects millions of people worldwide. While the condition is usually caused by the same fungi associated with athlete’s foot (dermatophytes), a variety of non-dermatophytic molds and Candida may result in an infection of the nails as well.
When a fungal nail infection occurs, it starts off as a yellow or white spot just under the tip of a fingernail or toenail. Mild cases usually clear away on their own, especially if the afflicted person has a strong immune system.
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Complications: What If The Infection Is Left Untreated?
If the nail fungus spreads deeper into the nail bed, it will cause the nail to thicken and turn green, yellow, brown, or black. As the infection progresses, the infected nail becomes brittle and pieces of it will start to break off from the toe or finger completely. Should the condition be left untreated, it can spread to other nails or cause skin around the infected nail to become inflamed. In more advanced stages, a foul smell may develop and white or yellow patches may be seen on the exposed nail bed. Over time, severe fungal nail infections can cause permanent damage to the nail root or nail bed.
It can be quite embarrassing to have this condition since this is an infection that’s hard to hide. People with Onychomycosis may also find it difficult or painful to wear shoes, walk, or stand for long periods of time if their toenails have been infected severely.
Ways to Treat Nail Fungus
Fortunately, there several ways to get rid of nail fungus. Most treatments aim to eradicate the causative organism and restore the normal appearance of healthy nails. Treatment options range from self-care remedies, to medications recommended by a general practitioner, to ointments bought over-the-counter without a prescription.
It’s important to note that repeat infections are common even with treatment. What’s more, remedies are not all equally effective with some even causing possible side effects.
With that in mind, here are some of the top ways to treat and get rid of nail fungus at home.
#1: Oral Prescription Drugs
Commonly prescribed oral treatments for nail fungus include:
Alternatively known as Lotrimin, this anti-fungal medicine is prescribed if the fungal nail infection has been caused by Candida or dermatophyte fungi that are associated with athlete’s foot and ringworms.
Once processed in the liver and delivered by blood to the infected area, Clotrimazole acts by breaking and dissolving the cell walls of the disease-causing fungi. Despite being highly effective, this oral drug can instigate side effects such hives, itchiness, redness, swelling, and cause blisters in some people.
- Terbinafine (Lamisil)
This drug is prescribed if the dermatophytes responsible for infection result in either white superficial or distal subungual onychomycosis. Like Clotrimazole, Terbinafine is not devoid of side effects. In addition to headaches and gastrointestinal issues such as stomach upsets and nausea, Terbinanfine can also cause hives and itchy rashes.
Before commencing treatment with this oral drug, blood samples will be taken and sent to the laboratory for liver function tests.
Terbinafine is available as a cream or lotion for patients who prefer not to take the drug orally.
- Itraconazole (Sporanox)
Also sold under the brand names of Sporanox and Onmel, Itraconazole is an antifungal agent that’s used to treat infections caused by molds or yeast (Candida). It has been chemically formulated to inhibit synthesis of ergosterol, a cell membrane sterol that’s essential to the survival of fungi and protozoa.
While Itraconazole can be quite effective, some patients may develop side effects such as cold-like symptoms, mild itching, diarrhea, and joint pain.
This drug is primarily fungistatic, meaning that it inhibits fungal growth. While Fluconazole is a medicine for Candida infections, it can also be used against dermatophyte related nail fungus.
Some of the side effects that might occur when medicating on Fluconazole include rash, elevated liver enzymes, nausea, abdominal pain, diarrhea, and dizziness.
It’s important to point out that although many oral antifungal medications are associated with side effects, negative reactions only occur in less than 1% of patients. Nonetheless, it’s always advisable to consult a physician and discuss about risks before starting treatment with any antifungal medication mentioned above.
Efficacy and Doses for Oral Antifungal Drugs
Among all available prescription drugs for nail fungus, anti-fungal pills are the most effective since they deliver medication via the bloodstream. With that said, cure rates vary heavily on the chosen oral drug. Some nail fungus treatment via oral tablets can last for several months and the dose duration will further depend on the chosen oral medication.
- Terbinafine Tablets
Terbinafine tablets are taken on a pulse-dosing schedule, which simply means that the medicine is taken daily throughout the entire treatment duration. For toenail infections, the tablets need to be taken once a day for 12 weeks. For fingernail infections, a patient will require medication for up to 6 weeks.
- Oral Azoles
Oral azoles are also taken daily, with doses lasting for 3 to 18 months depending on the medicine. Unlike the daily schedule required for Terbinafine, this class of antifungal drugs is used according to a weekly pulse-dosing schedule. As a result, some people may find it cheaper to treat fungal nail infections with this medicine.
No matter which prescriptive drug you ultimately decide to use, remember that it’s important to complete doses even if symptoms clear up after a few weeks. Stopping the medication too early can cause an infection to return.
Precautions and Contraindications for Oral Drugs
Oral Onychomycosis antifungal medications are not suitable for every individual. While pharmaceutical drugs can get rid of nail fungus, they can also cause unwanted side effects and serious drug-to-drug interactions. As a result, physicians do not normally prescribe these drugs to people who are already using certain medications.
- May Interfere With Other Medications
Oral antifungal pills can interfere with other drugs that help to treat or manage conditions such as diabetes, HIV, cancer, Cellulitis, and psoriasis. Individuals with liver disease or cognitive heart failure are also advised to keep away from oral nail fungus prescriptions.
- May Harm the Liver
Since most oral antifungal tablets must be processed in the liver, several rare hepatic side effects can occur. Due to this risk, liver enzymes may be checked before starting Onychomycosis treatment even if the patient has no history of liver disease.
In some treatments, liver function may be inspected again after four weeks. It’s important to keep track of any signs of liver disease like jaundice (yellow skin or white eyes), fatigue, dark urine, malaise, upper body pain, or pale colored stool, and report these signs to your doctor immediately when using any prescription medications to treat nail fungus.
- May Not Be Suitable For Breastfeeding Mothers
Some studies have found that traces of oral medications like Terbinafine and azoles can find their way into the milk of nursing mothers. The effects of such drugs on babies and unborn fetuses remain largely unknown. As such, a majority of oral Onychomycosis antifungal medications are contraindicated for nursing or pregnant women.
- Does Not Interact Well With Alcohol
Patients deemed fit to take oral medications for nail fungus should also ensure not to take alcohol during treatment. The reason for this is that damage to the liver is increased when these drugs are taken with alcohol.
#2: Topical Applications
Topical anti-fungal medications usually come in the forms of paint-on lacquer, cream, or ointment, and they’re rubbed onto the infected nail and surrounding skin several times a day.
Depending on how advanced the infection is, topical applications may take up to one year to clear a nail fungus infection since these creams have to penetrate deep into the nail bed in order to kill underlying fungi.
Most of the time, nails will get in the way of these topical treatments, which explains the long treatment duration. However, nail filler or a non-prescription lotion containing urea may be used to thin the nails and thus increase the efficacy of topical medications.
Topical nail fungus creams and ointments drugs tend to work better when paired with oral anti-fungal tablets. Common topical agents used to treat nail fungus include:
- Ciclopirox (Penlac)
If a fungal nail infection proves difficult to cure with modern treatments or becomes too painful, surgery may be considered as a treatment option. Surgical nail removal is also ideal for removing ingrown nails resulting from severe or recurring fungal nail infections.
This approach involves surgically removing the infected nail so that a new one can grow back in its place. Depending on how advanced the infection is part of the nail (debridement) or the entire nail (avulsion) can be removed. Surgical nail removal is rarely required if treatment for nail fungal infection is started early.
This is what a typical surgery process looks like:
- A surgeon carrying out this minor operation will first inject the infected finger or toe with local anesthesia to prevent pain.
- Once the diseased nail is removed, an antibiotic ointment is then applied to the exposed nail bed.
- The wound is finally covered with gauze and tape.
Potential Surgery Risks
Some of the risks associated with this procedure include post-surgery pain, infection, and abnormal nail growth. And although surgery can eradicate the underlying fungi completely, it can take up to one year for a new nail to grow back fully, which is a very long time.
#4: Laser Treatment
Laser treatment is another option that’s available for treating nail fungus infections. During treatment sessions, a specialist will use special equipment that focuses tiny pulses of light through the infected fingernail or toenail. The treatment is fast and effective, usually taking no more than 30 to 45 minutes to complete.
How Onychomycosis Laser Treatment Works
Research indicates that most fungi are sensitive to heat and the basic premise of a laser treatment is to heat the nail bed to temperatures that disrupt fungal growth. However, a number of laser systems do more than simply stunt growth of the underlying nail fungi. For example:
- 1046 YAG Laser Treatment
The 1064 YAG laser kills fungus using a specific wavelength through selective photothermolysis. This simply means that the laser beam increases temperature on the nail bed to a point where the fungi die off due to intolerable heat.
- Noveon NaiLaser Treatment
Noveon NaiLaser is yet another alternative FDA-approved laser treatment therapy for nail fungus that uses cooler temperatures than the 1064 YAG system. However, both laser systems ensure that the healthy tissue around the nail remains unharmed while only targeting the fungus.
- Lunula Laser Therapy
The Lunula Laser therapy is a third FDA and CE certified therapy for treating fungal nail infections. This laser therapy works by stimulating the body’s immune system to fight off the disease causing fungus.
New light-based therapies for fungal nail infection treatment are always being invented as laser technology continues to evolve. While these procedures are painless, they’re not widely available and can be expensive. Additionally, not everyone can qualify for laser fungal nail infection treatment. For example, people with compromised immune systems or extremely poor circulation may be advised not to have the procedure.
When it comes to efficacy, research findings show that laser and light-based therapies are very effective at treating fungal nail infections. In fact, some studies report a success rate of up to 95.4% in just two months of treatment.