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.
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As both an antiseptic and fungicidal remedy, tea tree oil is a great remedy for onychomycosis. First clean areas on and around the infection with rubbing alcohol then apply undiluted 100% pure tea tree oil (such as this Plant Therapy Tea Tree Oil) directly to the affected nails and let it soak in. After about ten minutes, gently scrub the nail with a soft bristle toothbrush. When applying tea tree oil directly to skin, consider mixing the oil one-to-one with an all-natural carrier, like olive or almond oil. Repeat daily until the new healthy nail grows out completely, then continue treatment for two to three more weeks to prevent regrowth.
Multiple fungi species can infect the nail. Fungus grows well in warm, moist environments such as showers. Fungus infection is one of the few foot problems that affect more men than women, perhaps because more men walk barefoot in locker rooms. Age is a factor, too. Half the sufferers are people older than 70. Other risk factors include having certain medical conditions such as diabetes, vascular insufficiency and malnutrition.
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.
Globally, fungal infections affect about 15% of the population and affects one out of five adults. Athlete's foot is common in individuals who wear unventilated (occlusive) footwear, such as rubber boots or vinyl shoes. Countries and regions where going barefoot is more common experience much lower rates of athlete's foot than do populations which habitually wear shoes; as a result, the disease has been called "a penalty of civilization". Studies have demonstrated that men are infected 2–4 times more often than women.
Creams and other topical medications have traditionally been less effective against nail fungus than oral medications. This is because nails are too hard for external applications to penetrate. It is also cumbersome to adhere to topical medication regimens. Oftentimes, these medications require daily applications for a period of time up to one year to see results. One of the major advantages of topical treatment is the minimal risk for serious side effects and drug interactions compared to oral therapy.
Efinaconazole (Jublia) is a medication that was approved in 2014. It is a topical (applied to the skin) antifungal used for the local treatment of toenail fungus due to two most common fungal species affecting nails (Trichophyton rubrum and Trichophyton mentagrophytes). Once-daily application is required for 48 weeks. The most common side effects of Jublia are ingrown toenails and application site dermatitis and pain.
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.
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.