In some cases of suspected nail fungus there is actually no fungal infection, but only nail deformity. A 2003 source gives a figure of 50% whereas a more recent source claims that fungus is present in 65 to 95 percent of cases. Avoiding use of oral antifungal therapy (e.g. terbinafine) in persons without a confirmed infection is a particular concern because of the possible side effects of that treatment. However, according to a 2015 study, the cost in the United States of testing with the periodic acid–Schiff stain (PAS) was about $148. Even if the cheaper KOH test is used first and the PAS test is used only if the KOH test is negative, there is a good chance that the PAS will be done (because of either a true or a false negative with the KOH test). But the terbinafine treatment only cost $10 (plus an additional $43 for liver function tests). In conclusion the authors say that terbinafine has a relatively benign adverse effect profile, with liver damage very rare, so it makes more sense cost-wise for the dermatologist to prescribe the treatment without doing the PAS test. (Another option would be to prescribe the treatment only if the potassium hydroxide test is positive, but it gives a false negative in about 20% of cases of fungal infection.) On the other hand, as of 2015 the price of topical (non-oral) treatment with efinaconazole was $2307 per nail, so testing is recommended before prescribing it.
Onychomycosis – commonly known as toenail fungus – is characterized by inflammation, pain, and swelling of the toe, as well as yellowing, thickening, and crumbling of the nail itself. Toenail fungus can be the result of abnormal pH of the skin, continuous exposure to moisture, wearing synthetic socks, compromised immune system, sweat build-up in shoes, poor foot hygiene, or weak circulation such as that caused by diabetes.
Do the research before trying this product. I sure wish I had. Any "natural" product insures results with regular use but warns that the process takes weeks and even months, due to slow nail growth. These natural remedy sites also warn that you should never reuse the mixture when reapplying because any contamination with the fungus can "inhibit or create more fungus growth." This cancels out the 2nd step altogether given the redipping of the nail brush. Perhaps this product does work for some people after repeated use for many months. I'd just love to see that truth written in more reviews.
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Since some people are simply more prone to fungal infections, they are also prone to repeated infection. Preventive measures include keeping your feet clean and dry, avoiding prolonged moist environments, using socks in airport security lines, removing shoes, and allowing the feet skin to "breathe," avoiding walking barefoot, especially in public areas like swimming pools and gyms, avoiding contact with known infected people, and avoiding soaking and contaminated tool usage at nail salons. Weekly applications of a topical antifungal foot cream or sprinkling of antifungal foot powder (Zeasorb Foot Powder) into shoes may also be helpful.