Topical agents such as amorolfine (Loceryl 5% nail lacquer; applied once or twice a week) and ciclopirox (Penlac 8% nail lacquer; applied daily) are usually prescribed for mild forms of the disease, but the treatment periods are long and their efficacy is somewhat limited due to poor nail plate penetration. These medications kill fungi by interfering with their cell membranes, which leads to their death.
Over-the-counter antifungal treatments. Antifungal creams and ointments treat toenail infections while helping to keep new fungus out so new nails can grow. Some treatments must be applied every day, others are applied once a week. It’s a good idea to apply topical treatments to both the foot and nail simultaneously to prevent foot fungus from spreading to the toes. If you trim your toenails well (see above) before applying an antifungal, the medicine can reach deeper into the nailbed.
Ozonized oils such as olive oil and sunflower oil are “injected” with ozone gas. According to a 2011 study, this type of ozone exposure in low concentrations for a short duration can then inactivate many organisms such as fungi, yeast, and bacteria. Another study found ozonized sunflower oil was more effective in treating toenail fungus than the prescription topical antifungal, ketoconazole (Xolegel).
Cultured dairy or fermented foods (ideally organic and raw) — these are beneficial for replacing good bacteria in the gut since they provide probiotics. Probiotics help control yeast and also have numerous immune-enhancing effects. For other sources of probiotics, in addition to yogurt or kefir try cultured foods like kimchi, kombucha or sauerkraut.
Physical exam alone has been shown to be an unreliable method of diagnosing fungal nails. There are many conditions that can make nails look damaged, so even doctors have a difficult time. In fact, studies have found that only about 50% of cases of abnormal nail appearance were caused by fungus. Therefore, laboratory testing is almost always indicated. Some insurance companies may even ask for a laboratory test confirmation of the diagnosis in order for antifungal medicine to be covered. A nail sample is obtained either by clipping the toenail or by drilling a hole in the nail. That piece of nail is sent to a lab where it can by stained, cultured, or tested by PCR (to identify the genetic material of the organisms) to identify the presence of fungus. Staining and culturing can take up to six weeks to get a result, but PCR to identify the fungal genetic material, if available, can be done in about one day. However, this test is not widely used due to its high cost. If a negative biopsy result is accompanied by high clinical suspicion, such as nails that are ragged, discolored, thickened, and crumbly, it warrants a repeat test due to the prevalence of false-negative results in these tests.
Some methods of prevention include avoiding walking barefoot in public showers, keeping the toenails short, wearing big enough shoes, and changing socks daily. When infected, the feet should be kept dry and clean and wearing sandals may help. Treatment can be either with antifungal medication applied to the skin such as clotrimazole or for persistent infections antifungal medication that are taken by mouth such as terbinafine. The use of the cream is typically recommended for four weeks.
Patience is key, as treatment duration varies from 2-3 months for oral treatments to up to 12 months for topical treatment. Because the nails take a long time to grow (6 months for fingernails and 12-18 months for toenails), it will take some time for the infection to resolve and the nail appearance to improve, regardless of the type of treatment used. Sometimes treatment may not be successful and your doctor may prescribe a different medication.