Topical treatment is also usually recommended for children. One reason for this is that most oral medications aren’t suitable for children. Another reason is that children have thinner nails that grow more quickly, so it’s assumed that treatment with nail polish or creams is more likely to work in children than in adults. White superficial onychomycosis is also often treated with a nail polish or cream.


Toenail fungus often begins as an infection in the skin called tinea pedis (also known as athlete’s foot). The fungus often starts under the nail fold at the end of the nail. Over time, it grows underneath the nail and causes changes to its appearance, such as a yellow or brownish discoloration. It can also cause thickening and deformity of the toenail. 
In other words, the combination of urea and bifonazole got rid of nail fungus in an extra 10 participants. But there was no difference between the two groups six months after treatment. Also, the fungal infection returned in many participants, so it’s likely that neither of the two treatments can increase the chances of getting rid of the fungus in the long term.

A 2003 survey of diseases of the foot in 16 European countries found onychomycosis to be the most frequent fungal foot infection and estimates its prevalence at 27%.[32][33] Prevalence was observed to increase with age. In Canada, the prevalence was estimated to be 6.48%.[34] Onychomycosis affects approximately one-third of diabetics[35] and is 56% more frequent in people suffering from psoriasis.[36]


The possible side effects of itraconazole include headaches, dizziness, stomach and bowel problems, and rashes. Itraconazole can also interact with a number of other drugs. These include cholesterol-reducing and blood-sugar-lowering medications, as well as certain sleeping pills. It is therefore important to let your doctor know about any medication you take. Itraconazole is not an option for people with heart failure (cardiac insufficiency). It also isn’t suitable for women who are pregnant or breastfeeding.
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%[17] whereas a more recent source claims that fungus is present in 65 to 95 percent of cases.[18] 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.[17] 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.[18]
Medical treatment of onychomycosis is suggested in patients who are experiencing pain and discomfort due to the nail changes. Patients with higher risk factors for infections such as diabetes and a previous history of cellulitis (infection of the soft tissue) near the affected nails may also benefit from treatment. Poor cosmetic appearance is another reason for medical treatment.
No one knows where a specific person catches the fungus, as it is everywhere. However, since the fungus does thrive in warm moist areas (like sweaty feet), there are certain areas one should avoid or use with caution. Shower floors, locker rooms, and swimming pools are suspected of being sources of the fungus, although there are no studies proving this fact. Nail polish and acrylic nails also make the nail less "breathable" and make the nail more susceptible to fungal infection. Fungi are everywhere -- in the air, the dust, and the soil. Hygienic measures such as spraying socks and footgear sound sensible, and perhaps these measures can even help a little bit. However, avoiding tight, nonbreathing shoes or steering clear of athletic facility floors may very well be the best prevention available. Daily washing of the feet and drying between the toes can help to prevent nail fungus. The fungi carried on the coats of pets, like cats and dogs, don't often cause nail fungus. Wearing white socks does not help.
Many individuals with athlete's foot have no symptoms at all and do not even know they have an infection. Many may think they simply have dry skin on the soles of their feet. Common symptoms of athlete's foot typically include various degrees of itching, stinging, and burning. The skin may frequently peel, and in particularly severe cases, there may be some cracking, fissuring, pain, and itching in the toe webs. Occasionally, athlete's foot can blister.

Oral antifungal therapy has a high cure rate, depending on the medication. It can take nine to 12 months to see if it has worked or not, because that is how long it takes for the nail to grow out. Even when therapy works, the fungus may come back. Currently, an oral antifungal therapy is considered the best treatment for toenail fungus because of higher cure rates and shorter treatment duration compared to topical therapy.
Toenail fungus (onychomycosis) is caused by a group of fungi known as dermophytes. This group thrives on skin and on keratin, the main component of hair and nails. The fungus gets under the nail and begins to grow, damaging the nail so it discolors, becoming white, brown or yellow. Eventually, the nail might thicken, harden, become brittle and even fall off.
Some methods of prevention include avoiding walking barefoot in public showers, keeping the toenails short, wearing big enough shoes, and changing socks daily.[4][5] When infected, the feet should be kept dry and clean and wearing sandals may help.[3] Treatment can be either with antifungal medication applied to the skin such as clotrimazole or for persistent infections antifungal medication that are taken by mouth such as terbinafine.[2][4] The use of the cream is typically recommended for four weeks.[4]

To get rid of foot fungus like Athlete's Foot, start by applying an over-the-counter antifungal ointment, spray, powder, or cream to the affected area. You can also try taking an over-the-counter medication like butenafine or clotrimazole, but see your doctor for a prescription medication if your case is severe. If you're interested in a homeopathic solution, apply 100% tea tree oil to the affected area 2-3 times per day. To prevent the fungus from returning, wash your feet with antibacterial soap and dry them thoroughly, especially between your toes!

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]
Many individuals with athlete's foot have no symptoms at all and do not even know they have an infection. Many may think they simply have dry skin on the soles of their feet. Common symptoms of athlete's foot typically include various degrees of itching, stinging, and burning. The skin may frequently peel, and in particularly severe cases, there may be some cracking, fissuring, pain, and itching in the toe webs. Occasionally, athlete's foot can blister.
For fungus infection, there are plenty of options. Many medications are available, including miconazole (Micatin, Zeasorb powder), econazole (Spectazole), clotrimazole (Lotrimin), terbinafine (Lamisil), naftifine (Naftin), butenafine (Mentax), ciclopirox (Loprox), ketoconazole (Nizoral), efinaconazole (Jublia), luliconazole (Luzu), sertaconazole (Ertaczo), sulconazole (Exelderm), and tolnaftate (Tinactin). Ask your health care professional or pharmacist for a recommendation. It is difficult to know which of these drugs is most effective since they have not been tested against each other. Cost is probably the most significant differentiating factor, and many are available without a prescription. Treatment for athlete's foot should generally be continued for four weeks or at least one week after all of the skin symptoms have cleared.
Orange essential oil is another natural anti-fungal that can be applied daily to toenails in order to cure an infection.  Apply a drop of Plant Therapy Orange Oil on nails and between toes.  Let the oil soak in for at least one hour.  Orange oil may be too strong for people with sensitive skin.  If you find this is the case for you, dilute the oil with an all-natural carrier such as olive oil.  Also, because citrus allergies are somewhat common, it is recommended to test orange oil on a spot of healthy skin before applying it to infected nails.  (Many health and wellness stores have open ‘testers’ of their products for just such a purpose.)

If you have diabetes or a weakened immune system, treatment is especially important. After getting a fungal nail infection, people who have diabetes have an increased risk of developing sores that do not heal. Sores that do not heal can lead to a serious health problem. It’s important to see a dermatologist (or other doctor) at the first sign of a nail problem. A dermatologist can tell you whether you have a nail infection or something else.
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