Trim infected nails. Using large toenail clippers and/or nail nippers, keep your toenails well-trimmed by cutting them straight across to the toe line. Thin thickened nails by gently scraping away the crumbly debris under the nail with a file. This will get rid of some fungus and help reduce pain by alleviating pressure on the nail bed and toes. Soak your toes first to soften the nails or trim after a shower.


Prevent future occurrences. There are many situations that make you more at risk for infection. You are at a higher risk if you are older, have diabetes, have an impaired immune system, or have poor circulation. If you are at high risk, you should take extra care to prevent infection. Preventative measures include wearing shoes or sandals when you are at damp public areas such as swimming pools or gyms, keeping your toenails clipped and clean, making sure your feet are dry, and drying your feet after you shower.
When the skin is injured damaged, the natural protective skin barrier is broken. Bacteria and yeasts can then invade the broken skin. Bacteria can cause a bad smell. Bacterial infection of the skin and resulting inflammation is known as cellulitis. This is especially likely to occur in individuals with diabetes, chronic leg swelling, who have had veins removed (such as for heart bypass surgery), or in the elderly. Bacterial skin infections also occur more frequently in patients with impaired immune systems.
Green nails can be caused by Pseudomonas bacteria, which grow under a nail that has partially separated from the nail bed. This infection may cause a foul odor of the nails. The treatment is to trim the nail short every four weeks, don't clean it, polish if you want to hide the color, and wait two to three months. It is also advised to avoid soaking the nail in any sort of water (even if inside gloves) and to thoroughly dry the nail after bathing. If the problem continues, there are prescription treatments that your doctor may try.

For more severe cases, oral antifungal medications might be required. These include fluconazole (an antifungal agent also commonly used to treat thrush), terbinafine (a broad-spectrum antifungal) and griseofulvin (usually used for skin infections). The latter is a very old drug and carries the risk of causing damage to the liver. Terbinafine is most effective and therefore is the preferred oral treatment. A 12-week course cures 70-80% of cases by causing the fungi’s cells to leak and die. It can, however, cause gastrointestinal side effects and depression.
Fungal nail infections and the resultant nail destruction can promote other sources of infection like cellulitis (a bacterial skin infection) and other forms of tinea, and aggravate foot problems resulting from other illnesses such as diabetes. Diagnosis is usually confirmed by looking at nail clippings through a microscope or other tests before starting treatment.

Tinea pedis, also known as athlete's foot or foot fungus, can cause recurrence of fungal nails. Therefore, it is important to manage this condition. One can apply over-the-counter (OTC) antifungal medicines such as clotrimazole (Lotrimin) or terbinafine (Lamisil) cream as directed to affected skin. Keeping footwear and socks clean can be helpful. You can also use portable UV light sanitizers to disinfect shoes.
Medications in tablet form are much more effective at fighting nail fungus than topical treatments are, but they aren’t guaranteed to work and also have more side effects, long treatment durations and possible interactions. (7) Another downside is that they are like putting a Band-Aid on the problem — they’re not addressing why the fungus developed in the first place.

Sometimes people with a fungal nail infection are offered laser treatment. This involves shining infrared or ultraviolet (UV) light on the nail in order to kill the fungi. Laser treatments haven’t been proven to work in good quality studies. Because statutory health insurers in Germany don’t cover the costs of this treatment, people have to pay for it themselves.

Starts at the ends of the nails and raises the nail up: This is called "distal subungual onychomycosis." It is the most common type of fungal infection of the nails in both adults and children. It is more common in the toes than the fingers, and the great toe is usually the first one to be affected. Risk factors include older age, swimming, athlete's foot, psoriasis, diabetes, family members with the infection, or a suppressed immune system. It usually starts as a discolored area at a corner of the big toe and slowly spreads toward the cuticle. Eventually, the toenails will become thickened and flaky. Sometimes, you can also see signs of athlete's foot in between the toes or skin peeling on the sole of the foot. It is often accompanied by onycholysis. The most common cause is T. rubrum.
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Oral medications include terbinafine (76% effective), itraconazole (60% effective) and fluconazole (48% effective).[2] They share characteristics that enhance their effectiveness: prompt penetration of the nail and nail bed,[23] and persistence in the nail for months after discontinuation of therapy.[24] Ketoconazole by mouth is not recommended due to side effects.[25] Oral terbinafine is better tolerated than itraconazole.[26] For superficial white onychomycosis, systemic rather than topical antifungal therapy is advised.[27]
Onychomycosis patients may need to learn new, healthier habits to stop the fungus growing back. These could include protecting toes from sources of infection, wearing correctly fitting footwear, laundering socks in hot water with disinfectant, wearing protective footwear at the pool and gym, keeping nails short, using open-toed footwear and wearing shoes made of breathable material.
Topical antifungal agents can be used but are often ineffective. Oral terbinafine is considered to be the first-line treatment for confirmed onychomycosis; the treatment course is generally 6 weeks for fingernails and 12 weeks for toenails.9 Azoles can also be used. Surgical debridement or removal of the affected nail is also a consideration for cases that are resistant to antifungals, and laser treatments for onychomycosis appear to be a promising area for future study.10
When athlete's foot fungus or infested skin particles spread to one's environment (such as to clothes, shoes, bathroom, etc.) whether through scratching, falling, or rubbing off, not only can they infect other people, they can also reinfect (or further infect) the host they came from. For example, infected feet infest one's socks and shoes which further expose the feet to the fungus and its spores when worn again.
Following effective treatment, recurrence is common (10–50%).[2] Nail fungus can be painful and cause permanent damage to nails. It may lead to other serious infections if the immune system is suppressed due to medication, diabetes or other conditions. The risk is most serious for people with diabetes and with immune systems weakened by leukemia or AIDS, or medication after organ transplant. Diabetics have vascular and nerve impairment, and are at risk of cellulitis, a potentially serious bacterial infection; any relatively minor injury to feet, including a nail fungal infection, can lead to more serious complications.[31] Infection of the bone is another rare complication.[6]

You may use other antifungal treatments, such as antifungal nail lacquer or topical solutions. These treatments are brushed onto the nail in the same way that you would apply nail polish. Depending on the type of fungus causing the infection, as well as the extent of the infection, you may have to use these medications for several months. Topical solutions are not generally effective in curing toenail fungal infections.
You can help prevent the return of toenail fungus by adopting some basic habits. Replace old shoes and socks regularly. Wear clean socks each day, and consider using a medicated shoe spray after every use. Wearing shower shoes in hotels, gyms, public pools, and showers is also very important to prevent reinfection.  Going to a nail salon that uses plastic liners in the whirlpool, bringing your own tools and disposing of files, buffers is also highly recommended.
Keeping socks and shoes clean (using bleach in the wash) is one way to prevent fungi from taking hold and spreading. Avoiding the sharing of boots and shoes is another way to prevent transmission. Athlete's foot can be transmitted by sharing footwear with an infected person. Hand-me-downs and purchasing used shoes are other forms of shoe-sharing. Not sharing also applies to towels, because, though less common, fungi can be passed along on towels, especially damp ones.
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