Fungal Nail Infections - Treatment Overview

Treatment Overview

Treatment for a fungal nail infection includes using medications, taking steps to prevent the infection from returning, and possibly removing the affected nail. Treatment is generally successful; however, treatment does not work for 20% to 25% of people with the condition.⁶

You may decide not to treat a fungal nail infection if your nail is discolored or damaged but not painful. Antifungal medication does not guarantee a cure, and antifungal pills (oral medication) can be expensive and have potentially dangerous side effects.

Without treatment, fungal nail infections tend to get worse, infecting more of the nail or surrounding skin. Early treatment may shorten treatment time and increase your chances of being cured.

If you have a fungal nail infection that causes quality-of-life problems, such as discomfort, pain, or embarrassment, you may decide to treat it.

If you have a condition such as diabetes that might complicate a minor foot injury or infection, your health professional may suggest treating a fungal nail infection, even if it does not bother you.

For more information on deciding whether to use oral antifungal medications, see:

Should I take oral antifungal medication to treat a fungal nail infection?

Standard treatment for fungal nail infection includes one or a combination of the following:

• Antifungal pills (oral medication) offer the best chance of a cure. However, they require close monitoring for dangerous side effects and are generally reserved for moderate-to-severe or difficult-to-treat fungal nail infections. Pills include terbinafine (Lamisil), itraconazole (Sporanox), and fluconazole (Diflucan).
• Antifungal topical medication (creams, lotions, gels, and lacquers) are applied to the infected nail and surrounding areas of the skin. They may be used for mild-to-moderate infections and to help prevent an infection from returning or to prevent athlete's foot from spreading to the nails. Topical medications include terbinafine (Lamisil) and ciclopirox (Penlac). Topical medications may not be as effective as oral medications.
• Removal of an infected nail is used for severe or recurring fungal nail infections. Combining nail removal with antifungal creams or pills is likely to be more effective than using one of these treatments alone. Nail removal is rarely necessary.
  • In nonsurgical nail removal, a urea ointment is put on the nail, softening and dissolving it for easy removal.
  • In surgical nail removal, the infected nail and tissue is fully removed (avulsion) or partially removed (debridement).

A topical or oral antibiotic is necessary only when a bacterial infection has developed along with the fungal infection.

Recurring infections and prevention

Even after apparently successful treatment with antifungal pills, a fungal nail infection can return, either as a new infection or as regrowth of the original fungi. Severe toenail infections, particularly those involving a big toe, are difficult to treat and tend to recur.

After treatment, be sure to take steps to keep a fungal nail infection from developing again.

• Before bed, thoroughly wash and dry your feet or hands and apply a topical antifungal medication, such as terbinafine (Lamisil) or ciclopirox (Penlac), directly to your skin or nail. Use the topical medication for 1 year.⁷
• Keep your feet and hands dry. Dry skin and nails are less likely to become infected. Apply powder to your dry feet or hands after you take a shower or bath.
• Wear dry cotton socks and change them 2 or 3 times a day if necessary.
• Wear dry shoes that allow air to circulate around your feet. Avoid tight, enclosed shoes. Injury to the tips of the toes because of tight shoes may be the biggest single factor that leads to recurrence of a fungal nail infection.⁷
• Wear shower sandals or shower shoes when using a public pool or shower; allow them to dry between uses.
• Don't share shoes, socks, nail clippers, or nail files with others.
• Avoid injuring your nail. Cutting nails too short is a common cause of nail injury. If you decide to get artificial nails or have a manicure, go to a salon that uses sterile instruments. Nail manicure and certain nail products can damage the nail or cuticle, making the nail more susceptible to infection.
• Control chronic conditions such as diabetes.
• Stop smoking.

What To Think About

If you have a mild fungal infection or are concerned about the risks of oral antifungal medication, consider using a topical treatment, such as Lamisil or Penlac.

Fungal nail infections can be treated successfully; however, some types are more easily treated than others. One type, distal subungual onychomycosis, can be a lifelong infection and hard to treat. Another type, white superficial onychomycosis, can be easily treated.

Even after treatment, your nails may continue to look irregular in shape and appearance. It can take a year or longer before they return to normal.