Nail fungus is a common infection of the nail. It begins as a white or yellow-brown spot under the tip of your fingernail or toenail. As the fungal infection goes deeper, the nail may discolor, thicken and crumble at the edge. Nail fungus can affect several nails.
If your condition is mild and not bothering you, you may not need treatment. If your nail fungus is painful and has caused thickened nails, self-care steps and medications may help. But even if treatment is successful, nail fungus often comes back.
Nail fungus is also called onychomycosis (on-ih-koh-my-KOH-sis). When fungus infects the areas between your toes and the skin of your feet, it's called athlete's foot (tinea pedis).
Symptoms
Symptoms of nail fungus include a nail or nails that are:
Thickened
Discolored
Brittle, crumbly or ragged
Misshapen
Separated from the nail bed
Smelly
Nail fungus can affect fingernails, but it's more common in toenails.
Treatment for toenail fungus isn't always needed. And sometimes self-care and nonprescription products clear up the infection. Talk with your health care provider if your condition doesn't improve. Treatment depends on the severity of your condition and the type of fungus causing it. It can take months to see results. And even if your nail condition improves, repeat infections are common.
Medications
Your health care provider may prescribe antifungal drugs that you take by mouth (orally) or apply to the nail.
Oral antifungal drugs. These drugs are often the first choice. One option is itraconazole (Sporanox). These drugs help a new nail grow free of infection, slowly replacing the infected part.
You typically take this type of drug daily for 6 to 12 weeks. But you won't see the end result of treatment until the nail grows back completely. It may take four months or longer to eliminate an infection. Treatment success rates with these drugs appear to be lower in adults over age 65.
Oral antifungal drugs may cause side effects such as rash and liver damage. Or they may interfere with other prescription drugs. You may need occasional blood tests to check on how you're doing with these types of drugs. Health care providers may not recommend oral antifungal drugs for people with liver disease or congestive heart failure or those taking certain medications.
Medicated nail polish. Your health care provider may prescribe an antifungal nail polish called ciclopirox (Penlac). You paint it on your infected nails and surrounding skin once a day. After seven days, you wipe the piled-on layers clean with alcohol and begin fresh applications. You may need to use this type of nail polish daily for almost a year.
Medicated nail cream. Your health care provider may prescribe an antifungal cream, such as efinaconazole (Jublia) and tavaborole (Kerydin). You rub this product into your infected nails after soaking. These creams may work better if you first thin the nails. This helps the medication get through the hard nail surface to the underlying fungus.
To thin nails, you apply a nonprescription lotion containing urea. Or your health care provider may thin the surface of the nail (debride) with a file or other tool.
Antifungal nail creams may cause side effects such as rash.
Surgery
Your health care provider might suggest temporary removal of the nail so that the antifungal drug can be applied directly to the infection under the nail.
The most effective but least used option is surgery to permanently remove the nail and its root.
Your health care provider will examine your nails and perhaps take some nail clippings or scrape debris from under your nail. These samples are sent to a lab to identify the cause of your symptoms.
Other conditions, such as psoriasis, can mimic a fungal infection of the nail. Microorganisms such as yeast and bacteria also can infect nails. Knowing the cause of your infection helps determine the best treatment.
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