Fungal nail infections can be embarassing, and very difficult to treat. Even the best treatments don’t always work and some have nasty side effects. This encourages sufferers to look for alternatives, but some offerings are overpriced and questionably effective!
Any treatment is more effective when the infection is less severe. Since nail infections are not painful, however, sometimes they are ignored until they become well established and disfiguring. Once an infection becomes extensive, involving the full nail bed, it is more difficult to treat, so best to treat at the first sign of an infection.
The appearance of a fungal nail infection can vary from pitting or flaky white patches in the surface of the nail, to yellow or white streaks in the nail bed, and even to complete nail destruction. Scaling and debris can collect under the nail, causing it to lift and separate from the nail bed. Infections can be caused by several different fungal, yeast or mould agents, but the most common is a fungal dermatophyte infection. Check with your doctor for a proper diagnosis. Clippings of the nail may be taken to confirm the type of infection.
Here are some of the available treatments you may consider…
Anti-fungal tablets and capsules (Lamisil, Sporanox) – Prescription only.
These are the most effective type of treatment. They need to be taken until the nail completely grows out – usually 6 weeks for fingernails and 12 weeks for toenails, which grow more slowly.
Side effects, however, can be serious: liver damage, severe rashes, and effects on blood cell production and pancreas, as well as less serious effects like headache, diarrhea, nausea/vomiting, sun sensitivity and taste or vision changes. Some doctors hesitate to prescribe these medications for what is sometimes considered a cosmetic problem, and many people can't tolerate the side effects.
Anti-fungal creams and solutions – Prescription and non-prescription
These work well for fungal skin infections, like Athlete’s Foot, but can’t penetrate the nail. This means they may help for a surface nail infection at an early stage or to prevent an infection between the toes from spreading to the nail, but they can’t treat an infection that is growing under the nail.
Creams can be helpful to reduce the chance of reinfection.
Nail paints and polishes – Prescription and non-prescription
There are two basic types: antifungal and acid containing (acidity inhibits fungus growth). A few products contain both types of ingredients.
Some also contain penetration-enhancing ingredients, such as menthol, DMSO, propylene glycol or others to increase penetration into the nail.
Strangely, pricing seems to have no relationship to the cost of the ingredients, with prices from under $10 up to $90 for prescription lacquers.
Success with this types of product requires perseverance and consistency. Use precisely as directed every day until the infected nail has completely grown out. It will take months of treatment for success.
Laser therapy – Does not require a prescription
Lasers are thought to kill fungi by producing heat. One to 3 treatments are recommended. Success has been reported in small numbers of patients, but no large studies have yet been completed.
Each laser treatment can cost upwards of $1000 and, given this cost plus lack of solid proof of effectiveness, this treatment is not highly recommended. However, I did see a small unit on Amazon for under $300 (still expensive!) that might be worth investigating if you wanted to try this therapy.
Surgery and non-surgical nail removal
Surgically removing the nail, to allow anti-fungal creams to reach the infected nail bed, is a more extreme treatment. However, it is sometimes considered in more severe infections that have not responded to less invasive treatment.
An infected nail can also be removed non-surgically by applying 30-40% Urea cream (commercially available or prepared by a pharmacist). This preparation softens the nail over multiple applications, gradually destroying the integrity of the nail and allowing anti-fungal agents to penetrate. Sometimes the nail falls completely out, and antifungal cream should be applied while the new nail grows in.
Home remedies – Non-prescription
Tea tree oil
Antifungal and antibacterial actions.
Menthol/eucalyptus (Vicks Vaporub or can be compounded)
These have antifungal activity, plus menthol enhances penetration.
Vinegar (acetic acid) 25% (1 part vinegar mixed with 3 parts water)
An idea to incorporate all 3 of these approaches: Vicks Vaporub (or generic) with perhaps 10% tea tree oil plus a vinegar soak before application.
Your neighbourhood pharmacist could likely prepare something along these lines for you…he may even be able to add 1% clotrimazole antifungal powder too!
Prevention - Prevent reinfection or avoid getting it in the first place!
Keep feet dry. Fungus grows more easily in a moist environment.
Wear socks - look for ones with a moisture-wicking fiber. Change when damp.
Wear open shoes whenever possible.
Wear shower sandals at public pools or showers. Let dry between uses.
Don’t share shoes, socks, nail clippers or files. Clean clippers and files regularly with alcohol.
Avoid nail injury, for example, clipping nails too short.
Ensure any nail salon you use sterilizes all instruments.
If you have diabetes, you could be more susceptible due to poorer circulation. Learn proper daily foot care for people with diabetes.
