You may first notice a fungal toenail infection as a small white or yellow spot on the tip of your toenail, especially the big toe. As the infection progresses, the toenail can become yellow, brittle—even crumbly—and thick and uneven-looking. In the worst fungal infections, the toenail separates from the nail bed. This is called onycholysis. As fungal infections worsen, the nail beds can be tender to the touch and quite painful. Sometimes women try to pretend the pain is “normal” and ignore it altogether.
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.
Infected nails are usually thicker than normal and could be warped or oddly shaped. They can break easily. Nails with fungus might look yellow. Sometimes a white dot shows up on the nail and then gets bigger. When fungus builds up under your nail, it can loosen and even separate the nail from the bed. The fungus can also spread to the skin around your nail.