If you’re in the market for a nail fungus treatment, it is important that you consider the range of options you have before you make your decision.
There are many different products on the market and the goal of this site is to help you determine which is right for you. Nail fungus infections are difficult to treat and some advertised treatments are ineffective and make false claims. When deciding on a treatment approach it is important to understand whether it addresses the root cause of the infection or only masks its symptoms over the short term.
Toenails in particular require several months of consistent therapy. Toenails are slower growing than fingernails, only growing by around 1mm per month, so it’s important to prepare yourself mentally for long treatment times. The disorder is relentlessly progressive which means it is very unlikely to clear up on its own without treatment, and eventually may cause the complete loss of the nail.
Onychomycosis: The clinical presentation of nail fungus
Nail fungus infection (or Onychomycosis) is caused by a dermatophyte fungus (primarily Trichophyton rubrum and Trichophyton interdigitale) that feed on keratin protein in the skin and nails. Prevalence rates are very high with an estimated 35 million people in the US affected according to the US Department of Health and Human Services. Other estimates suggest that 6-8% of the adult population has a fungus nail infection making it the most common form of nail abnormality. Although Onychomycosis is the most common medical term, and “nail fungus infection” the most used colloquial one, the condition is also referred to as ringworm of the nails or tinea unguium.
Bear in mind that while the infection may appear dormant for periods of time, for example in the summer months where increased light and exposure can slow the progression of the fungus across the nail, the fungus will generally start growing again once conditions allow. In all cases the earlier the treatment is started the more effective it will be. In particular it is advisable to address the disorder before the fungus has spread to the “lanula” – the white half moon section of nail near the cuticle.
The Different Forms Of Onychomycosis Explained
There are three distinct manifestations of the disease. (Four, if you include a rare nail disorder caused by the Candida yeast species which, to confuse matters further, is also a type of fungus. For more information we have a whole section of this website dedicated to Candida, how to get rid of a yeast infection and options for yeast infection treatment).
By far the most common fungal nail infection is Distal Lateral Subungal Onychomycosis, where the fungus invades from the distal edge of the nail (the tip) and spreads laterally down the side of the nail in the direction of the cuticle. The fungus resides in a subungal position between the nail plate and the nail bed.
The first sign is commonly a painless white or yellow spot on the nail. Unfortunately this can be hard to spot, particularly if you are using nail polish or if the fungus has begun on the underside of the nail. As the fungus spreads so too does the yellowish coloration. The nail typically starts to lose texture and become brittle. Small particles of debris can collect under the nail as it distorts and begins to detach from the nail bed.
Do You Have These Nail Fungus Symptoms?
- Yellow nails or a yellow-green or dark yellow-brown discoloration on the nail surface.
- Thickened nail with loss of luster, changes in texture and cloudy appearance.
- Abnormal grooves and ribbed lines or other distortion to nail shape.
- Brittle, crumbling or flaky nail, especially at the free edges.
- A build-up of debris under the nail. The debris is the result of an overgrowth of dry, flaky skin (hyperkeratotic debris).
- Mild discomfort or itchiness of the flesh around the nails, especially when walking (for toenail fungus) or using your hands (for fingernails).
- In severe cases of nail fungus the discoloration becomes quite dark and the nail can begin to detach from the surrounding skin (or cuticle) and nail bed, crumble away and even fall off completely.
- Not to be confused with Athlete’s foot or foot fungus, where the skin surrounding the nails and between the toes is infected (rather than the nails). Still unsure? See these foot fungus pictures for clarification.
These symptoms of nail fungus can be confirmed by a doctor by inspection, via a KOH test and/or by sending a sample of the fungal debris or nail scraping for laboratory analysis.
The two other forms of the disease are known as Proximal Subungal Onychomycosis and White Superficial Onychomycosis. The former is also subungal in character but the spread of the fungus is from the proximal fold (near the cuticle) towards the nail tip. The latter is more superficial and is characterized by the formation of white opaque looking spots on the nail surface. The complete destruction of the nail is less common with this form of the disease. See more information on the different forms of Onychomycosis.
Are You At Risk Of Developing A Nail Fungus Infection?
Onychomycosis is a very common nail disorder accounting for as much as 50% of all nail problems. Incidence rates are not even across the population and certain risk factors have been identified. Fungal infections are transmitted by direct contact with an infected host or indirectly by contact with exfoliated skin, nails and fungal debris. Infected particles may be present in clothing, towels, shoes, on nail files or on shower floors for example.
Specifically you are more likely to develop fungus nails if:
- You are an older person. It is thought that older people are more at risk due to poorer circulation to the extremities, more opportunity for exposure and a weaker immune system.
- You are prone to excessive sweating. Like all fungi, the dermatophyte group of fungus responsible for nail fungus infections thrives in warm, dark and moist environments.
- You frequent public spaces which are typically damp and where people walk around barefoot. Public gyms and locker rooms are common places where toe nail fungus infections are passed from person to person.
- You share your nail instruments with other people who may have a fungi nail infection.
- You do not check sterilization and safety procedures before choosing a nail salon for a manicure or pedicure. Contact with non-sterilized foot and nail-care equipment (e.g foot baths, nail files or artificial nails used during a pedicure) is a leading cause of infection.
- You wear tight-fitting shoes that push against your toes. Any kind of nail trauma, including from picking or biting at the nails, can provide an easy entry point for fungi to invade the nails as well as weaken the local immune response.
- You have a pre-existing injury to the skin or nail such as a cut (even if very small), scar, burn, rash or other trauma.
- You are a diabetic, have poor circulation or a compromised immune system. There may also be genetic factors at play when it comes to resistance from infections.
- You are suffering from Athlete’s foot, a condition affecting the skin between the toes that is caused by the same fungus. Cross infections from the skin to the nails are common if Athlete’s foot is not cleared up quickly.
- You suffer from other skin fungus infections (known by the generic terms ringworm or tinea) – see these skin fungus pictures for more details.
- You do not change out of sweaty shoes and socks immediately after exercising. Wearing non-ventilating shoes and socks made from synthetic fibers that don’t absorb perspiration can provide the right environment for fungi to breed and grow.
- You don’t wash your socks on the hot cycle.
- You wear the same closed in shoes day in, day out and do not allow your feet to breathe for a few hours each day.
- You wear nail polish without interruption for long periods; months or years. (Nail polish and artificial nails reduce the ability of nails to breathe and the skin beneath them to perspire, creating conditions that are more conducive to fungal growth)
- Your occupation requires you to keep your hands or feet wet for long periods of time.
The study of nail fungus infections is an evolving field. Incidence rates are high and new approaches to treatment are emerging all the time.
The effectiveness of different nail fungus treatment options will depend on the severity of your fungal infection, the part of the nail that is affected, the number of nails affected and the rate of growth of the infection. Nail fungus is a progressive disease, so whatever the severity, it is important to take action as early as possible.
Generally speaking, you have more options for the treatment of nail fungus if the affected area is confined to the tip and sides of the toenail than when the cuticle area or the proximal fold become infected. As the table below indicates, we recommend using home remedies for nail fungus only if you have a mild infection, or for prevention. Mild infections do not cover the entire nail, but typically affect only the tip or the side of one toenail. Moderate to severe infections can cover the entire nail, including the crescent shaped lighter area at the base of the nail, causing considerable brittleness, flakiness and discoloration. If the nail is becoming detached from the nail bed, parts of it are crumbing away, and you have more than one nail that is infected, your condition will usually be considered a severe one.
The most popular nail fungus cure is to apply a topical antifungal nail lacquer externally to the affected nail(s). This because, unlike oral antifungal medications available on prescription, topical treatments have not been associated with any serious side effects. But they do require a disciplined approach to treatment. While laser treatment for nail fungus appears promising, longer term clinical trials are still needed to determine its effectiveness.
Nail Fungus Treatment Effectiveness
Depending on severity, it typically requires several weeks, or even months, of consistent topical application in order to get rid of the infection. This is because the medication contained in the treatment (the most common topical antifungals are Undecylenic acid, Tea tree oil, Amorolfine, Ciclopirox or Benzalkonium Chloride) will only work when in direct contact with the fungus. And it simply takes time to soak through the nail layers to reach the fungus. This is particularly the case with Distal Lateral Subungal Onychomycosis – the most common form of the disease – where the fungus lies beneath the nail plate. The best nail fungus treatment lacquers such as Funginix and Zetaclear combine the antifungals with thin carrier oils in special formulations designed for rapid penetration.
How To Apply A Topical Nail Fungus Treatment For Best Results
This video provides a best best practice guide to applying a topical nail fungus treatment product.
Applying the treatment regularly (most nail fungus cures require at least a daily application), has the effect of replenishing the “reservoir” of antifungal medication on the surface of the nail from where it can penetrate into the nail (see diagram below). Always clean and dry nails thoroughly before each application. “Debriding” or scraping away nail layers above the fungus before each application will help to open up the fungus to treatment. It is also important to continue to treat the nail until a new, healthy nail has completely grown in order to be sure you have completely eliminated the fungus and to reduce the risk of re-infection.
Although some nail fungus treatments are more effective than others – see our reviews for the best options in the sidebar – it is your ability to stick to a regular treatment routine that is the most important factor in determining how successful you will be at eliminating the fungus quickly. That’s why we have created tracking sheet downloads and other resources to help keep you motivated during treatment and increase your chances of success.
Our nail fungus treatment reviews highlight the pros and cons of the different products available on the market and our information articles are designed to equip you with the knowledge to move forward with confidence. Ultimately, our goal is to assist you in making a better decision for the treatment of fungus nail disorders.