Your physician may perform a simple test called a potassium hydroxide (KOH) preparation for microscopic fungal examination in the office or laboratory. This test can be used to confirm the presence of a fungal infection. This test is performed by using a microscope to examine small flakes of skin from the rash. Many dermatologists perform this test in their office with results available within minutes. Rarely, a small piece of skin may be removed and sent for biopsy or fungal culture to help confirm the diagnosis.
Topical treatment (polish or cream) isn’t likely to get rid of a fungal nail infection. Treatment with tablets is considerably more effective and takes less time. But some people can’t take tablets because of the very rare, yet serious risks. How you feel about the pros and cons of the different treatment options is a personal matter. You can also discuss the options with your doctor.
The causative pathogens of onychomycosis are all in the fungus kingdom and include dermatophytes, Candida (yeasts), and nondermatophytic molds. Dermatophytes are the fungi most commonly responsible for onychomycosis in the temperate western countries; while Candida and nondermatophytic molds are more frequently involved in the tropics and subtropics with a hot and humid climate.
If the fungal infection has spread to the toenails, the nails must also be treated to avoid reinfection of the feet. Often, the nails are initially ignored only to find the athlete's foot keeps recurring. It is important to treat all of the visible fungus at the same time. Effective nail fungus treatment may be more intensive and require prolonged courses (three to four months) of oral antifungal medications.
*All medications have both common (generic) and brand names. The brand name is what a specific manufacturer calls the product (e.g., Tylenol®). The common name is the medical name for the medication (e.g., acetaminophen). A medication may have many brand names, but only one common name. This article lists medications by their common names. For information on a given medication, check our Drug Information database. For more information on brand names, speak with your doctor or pharmacist.
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.
Conventional treatment typically involves thoroughly washing the feet daily or twice daily, followed by the application of a topical medication. Because the outer skin layers are damaged and susceptible to reinfection, topical treatment generally continues until all layers of the skin are replaced, about 2–6 weeks after symptoms disappear. Keeping feet dry and practicing good hygiene (as described in the above section on prevention) is crucial for killing the fungus and preventing reinfection.
Because athlete's foot may itch, it may also elicit the scratch reflex, causing the host to scratch the infected area before they realize it. Scratching can further damage the skin and worsen the condition by allowing the fungus to more easily spread and thrive. The itching sensation associated with athlete's foot can be so severe that it may cause hosts to scratch vigorously enough to inflict excoriations (open wounds), which are susceptible to bacterial infection. Further scratching may remove scabs, inhibiting the healing process.
Prescription oral antifungals such as terbinafine (Lamisil) or fluconazole (Diflucan) are traditionally used to treat toenail fungus. These treatments are often effective, but they may cause serious side effects ranging from upset stomach and dizziness to severe skin problems and jaundice. This may be why many people try home remedies instead. Here are 10 of these popular at-home treatments.
Cultured dairy or fermented foods (ideally organic and raw) — these are beneficial for replacing good bacteria in the gut since they provide probiotics. Probiotics help control yeast and also have numerous immune-enhancing effects. For other sources of probiotics, in addition to yogurt or kefir try cultured foods like kimchi, kombucha or sauerkraut.