Nail fungus, or onychomycosis, is a common skin condition where a fungus infects a part of the nail including the bed, matrix, or plate.[1] Nail fungus can result in cosmetic concerns, pain, and discomfort as well as end up affecting your everyday activities. If it is a severe infection, it may cause permanent damage to your nails or may spread beyond your nails.[2] If you know you have toenail fungus, you can follow a few simple steps to get rid of it and return your toenail to its former health.
Over-the-counter toenail fungus treatments can cure existing infections, but only products which include 1% Tolnaftate can prevent a recurrence of the condition. Tolnaftate is the only ingredient approved by the US Food and Drug Administration for the prevention of fungal infections. Treating toe nail area fungus is only part of the solution. Preventing further outbreaks using a product with 1% Tolnaftate will keep you looking and feeling your best.
The ease with which the fungus spreads to other areas of the body (on one's fingers) poses another complication. When the fungus is spread to other parts of the body, it can easily be spread back to the feet after the feet have been treated. And because the condition is called something else in each place it takes hold (e.g., tinea corporis (ringworm) or tinea cruris (jock itch), persons infected may not be aware it is the same disease.
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.
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.
Research suggests that fungi are sensitive to heat, typically 40–60 °C (104–140 °F). The basis of laser treatment is to try to heat the nail bed to these temperatures in order to disrupt fungal growth.[37] As of 2013 research into laser treatment seems promising.[2] There is also ongoing development in photodynamic therapy, which uses laser or LED light to activate photosensitisers that eradicate fungi.[38]
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]
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
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.
Athlete’s foot appears as a scaly red rash on the bottoms or sides of the feet often accompanied by itching, dry or cracked skin, stinging, and odor. You can also have moist, raw skin between your toes. Though athlete’s foot is fairly easy to treat with over-the-counter anti-fungal creams or sprays, this foot fungus is quite contagious and may easily spread to your toenails.
Athlete’s foot infections can be mild or severe. Some clear up quickly, and others last a long time. Athlete’s foot infections generally respond well to antifungal treatment. However, sometimes fungal infections are difficult to eliminate. Long-term treatment with antifungal medications may be necessary to keep athlete’s foot infections from returning.
Treatment: Nail fungus is a difficult condition to properly treat due to the average time before seeing results and the general lack of understanding regarding topical treatments. Fungus grows underneath the nail bed, making it extremely difficult to target. Certain nail fungus products, like topical ointments, contain nail penetrating ingredients that treat fungal nail infections underneath the nail bed where it grows.

There are many possible causes of foot rashes. Additional causes include irritant or contact dermatitis, allergic rashes from shoes or other creams, pompholyx (dyshidrotic eczema), psoriasis, yeast infections, and bacterial infections (gram negative toe web infection and erythrasma). Since these conditions are often indistinguishable on superficial visual examination, it is important for your doctor to do his best to identify the precise cause. Since fungal infections are potentially curable, it is important not to miss this diagnosis.

For this treatment, the affected toe or finger first has to be soaked in warm water for ten minutes and then dried. After that, the urea-based cream is applied to the nail, and the nail is covered with an adhesive bandage. After 24 hours, the bandage is removed and the toe or finger is held in warm water again. The softened layer of the nail is then scraped off using a spatula, the cream is applied again and the nail is covered with a new bandage. This treatment is carried out over 14 days. Once the infected part of the nail has been scraped away completely, the skin beneath is treated for another four weeks with a bifonazole cream.
Trichophyton rubrum is the most common dermatophyte involved in onychomycosis. Other dermatophytes that may be involved are T. interdigitale, Epidermophyton floccosum, T. violaceum, Microsporum gypseum, T. tonsurans, and T. soudanense. A common outdated name that may still be reported by medical laboratories is Trichophyton mentagrophytes for T. interdigitale. The name T. mentagrophytes is now restricted to the agent of favus skin infection of the mouse; though this fungus may be transmitted from mice and their danders to humans, it generally infects skin and not nails.
The ease with which the fungus spreads to other areas of the body (on one's fingers) poses another complication. When the fungus is spread to other parts of the body, it can easily be spread back to the feet after the feet have been treated. And because the condition is called something else in each place it takes hold (e.g., tinea corporis (ringworm) or tinea cruris (jock itch), persons infected may not be aware it is the same disease.

You can also try itraconazole (Sporanox), which is usually prescribed with a dose of 200 mg a day for 12 weeks. Side effects can include nausea, rash, or liver enzyme abnormalities. It should not be used if you have liver issues. Sporanox also has interactions with over 170 different drugs such as Vicodin and Prograf. Check with your doctor to ensure any medication you are taking does not interfere with it.[7]


Yeast onychomycosis: This type is caused by a yeast called Candida and not by the Trichophyton fungus named above. It is more common in fingernails and is a common cause of fungal fingernails. Patients may have associated paronychia (infection of the cuticle). Candida can cause yellow, brown, white, or thickened nails. Some people who have this infection also have yeast in their mouth or have a chronic paronychia (see above) that is also infected with yeast.
Griseofulvin (Gris-Peg, Grifulvin V, Griseofulvin Ultramicrosize) is an antibiotic prescribed to treat fungal infections such as ringworm of the body, athlete's foot, barber's itch, and fungal or ringworm of the nails. Side effects, drug interactions, dosing, storage, and pregnancy and breastfeeding information should be reviewed prior to taking this medication.
When visiting a doctor, the basic diagnosis procedure applies. This includes checking the patient's medical history and medical record for risk factors,[11] a medical interview during which the doctor asks questions (such as about itching and scratching), and a physical examination.[11] Athlete's foot can usually be diagnosed by visual inspection of the skin and by identifying less obvious symptoms such as itching of the affected area.
What you need to know about fungal infections Some fungi occur naturally in the body, and they can be helpful or harmful. An infection occurs when an invasive fungus becomes too much for the immune system to handle. We describe the most common types, including yeast infection, jock itch, and ringworm. Here, learn about risk factors and the range of treatments. Read now
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