Diagnosis

Your doctor will examine your nails. He or she may also take some nail clippings or scrape debris from under your nail and send the sample to a lab to identify the type of fungus causing the infection.

Other conditions, such as psoriasis, can mimic a fungal infection of the nail. Microorganisms such as yeast and bacteria also can infect nails. Knowing the cause of your infection helps determine the best course of treatment.

Treatment

Fungal nail infections can be difficult to treat. Talk with your doctor if self-care strategies and over-the-counter (nonprescription) products haven't helped. Treatment depends on the severity of your condition and the type of fungus causing it. It can take months to see results. And even if your nail condition improves, repeat infections are common.

Medications

Your doctor may prescribe antifungal drugs that you take orally or apply to the nail. In some situations, it helps to combine oral and topical antifungal therapies.

  • Oral antifungal drugs. These drugs are often the first choice because they clear the infection more quickly than do topical drugs. Options include terbinafine (Lamisil) and itraconazole (Sporanox). These drugs help a new nail grow free of infection, slowly replacing the infected part.

    You typically take this type of drug for six to 12 weeks. But you won't see the end result of treatment until the nail grows back completely. It may take four months or longer to eliminate an infection. Treatment success rates with these drugs appear to be lower in adults over age 65.

    Oral antifungal drugs may cause side effects ranging from skin rash to liver damage. You may need occasional blood tests to check on how you're doing with these types of drugs. Doctors may not recommend them for people with liver disease or congestive heart failure or those taking certain medications.

  • Medicated nail polish. Your doctor may prescribe an antifungal nail polish called ciclopirox (Penlac). You paint it on your infected nails and surrounding skin once a day. After seven days, you wipe the piled-on layers clean with alcohol and begin fresh applications. You may need to use this type of nail polish daily for almost a year.
  • Medicated nail cream. Your doctor may prescribe an antifungal cream, which you rub into your infected nails after soaking. These creams may work better if you first thin the nails. This helps the medication get through the hard nail surface to the underlying fungus.

    To thin nails, you apply a nonprescription lotion containing urea. Or your doctor may thin the surface of the nail (debride) with a file or other tool.

Surgery

Your doctor might suggest temporary removal of the nail so that he or she can apply the antifungal drug directly to the infection under the nail.

Some fungal nail infections don't respond to medicines. Your doctor might suggest permanent nail removal if the infection is severe or extremely painful.

Lifestyle and home remedies

Often, you can take care of a fungal nail infection at home:

  • Try over-the-counter antifungal nail creams and ointments. Several products are available. If you notice white markings on the surfaces of the nails, file them off, soak your nails in water, dry them, and apply the medicated cream or lotion.
  • Trim and thin the nails. This helps reduce pain by reducing pressure on the nails. Also, if you do this before applying an antifungal, the drug can reach deeper layers of the nail.

Before trimming or using a nail file to thin thick nails, soften them with urea-containing creams. If you have a condition that causes poor blood flow to your feet and you can't trim your nails, see a health care provider regularly to have your nails trimmed.

Preparing for your appointment

You're likely to start by seeing your family doctor or a general practitioner. In some cases when you call to set up an appointment, you may be referred immediately to either a doctor who specializes in skin conditions (dermatologist) or one who specializes in foot conditions (podiatrist).

To make the most of your time with your doctor, it's good to prepare for your appointment.

What you can do

  • List your symptoms, including any that may seem unrelated to nail fungus.
  • List key personal information, including any major stresses or recent life changes.
  • List all the medications, vitamins and supplements you're taking.
  • List questions to ask your doctor.

For nail fungus, your questions might include:

  • What is likely causing my symptoms or condition?
  • What are other possible causes for my symptoms or condition?
  • What tests do I need?
  • What is the best course of action?
  • What are the alternatives to the primary approach you're suggesting?
  • I have other health conditions. How can I best manage them together?
  • Is a generic alternative available for the medicine you're prescribing?
  • Do you have any brochures or other printed material that I can take home? Do you recommend any websites on nail fungus?

Don't hesitate to ask any other questions you have.

July 26, 2017
References
  1. Onychomycosis. Merck Manual Professional Version. https://www.merckmanuals.com/professional/dermatologic-disorders/nail-disorders/onychomycosis. Accessed May 15, 2017.
  2. Goldstein AO, et al. Onychomycosis: Management. https://www.uptodate.com/contents/search. Accessed May 15, 2017.
  3. Toenail fungus. American Podiatric Medical Association. http://www.apma.org/Learn/FootHealth.cfm?ItemNumber=1523. Accessed May 15, 2017.
  4. Varade RS, et al. Cutaneous fungal infections in the elderly. Clinics in Geriatric Medicine. 2013;29:461.
  5. Gupta AK, et al. Improved efficacy in onychomycosis therapy. Clinics in Dermatology. 2013;31:555.
  6. Westerberg DP, et al. Onychomycosis: Current trends in diagnosis and treatment. American Family Physician. 2013;88:762.
  7. AskMayoExpert. Fungal nail infection (onychomycosis). Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2017.
  8. Nail care. Natural Medicines. https://naturalmedicines.therapeuticresearch.com/databases/medical-conditions/n/nail-care.aspx. Accessed May 17, 2017.
  9. Gibson LE (expert opinion). Mayo Clinic, Rochester, Minn. June 6, 2017.