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.
The most common symptom of a fungal nail infection is the nail becoming thickened and discoloured: white, black, yellow or green. As the infection progresses the nail can become brittle, with pieces breaking off or coming away from the toe or finger completely. If left untreated, the skin underneath and around the nail can become inflamed and painful. There may also be white or yellow patches on the nailbed or scaly skin next to the nail, and a foul smell. There is usually no pain or other bodily symptoms, unless the disease is severe. People with onychomycosis may experience significant psychosocial problems due to the appearance of the nail, particularly when fingers – which are always visible – rather than toenails are affected.
Fungal nail infections don’t usually lead to serious long-term problems when properly treated, but they may be more serious in certain individuals. This can include people with diabetes or who have a weakened immune system and have trouble fighting off an infection. Even if there is no pain associated with the infection, it is important that you promptly visit your doctor for assessment if you see any abnormal nail changes.
Satchell, A. C., Saurajen, A., Bell, C., & Barnetson, R. StC. (2002, July 19). Treatment of interdigital tinea pedis with 25% and 50% tea tree oil solution: A randomized, placebo-controlled, blinded study [Abstract]. Australasian Journal of Dermatology, 43(3), 175–178. Retrieved from http://onlinelibrary.wiley.com/doi/10.1046/j.1440-0960.2002.00590.x/full
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
The definition of over-the-counter (OTC) products means that they are available by ordinary retail purchase, not requiring a prescription or a license. Although there are few OTC medications aimed to treat fungal nails, many of these medications have not been tested and therefore are not approved by the U.S. Food and Drug Administration (FDA) for the treatment of onychomycosis. Most OTC agents are aimed at treating fungal infection of the skin rather than the nail. Some medications list undecylenic acid and/or propylene glycol as main ingredients. These ingredients inhibit fungal growth; however, they may not adequately penetrate the nail to be effective in treating fungal nails.