How to treat fungal nail infections

What is nail fungal and what causes it?

Onychomycosis is an infection of fingernails and/or toenails caused by a small micro-organism called a fungus. There are different species of fungi, such as dermatophytes, yeasts and moulds. The fungus settles under the nail and once present in the nail bed begins to multiply and spread. The fungus in fungal nail infections are difficult to reach as the nail itself protects it.

Fungal nail infections are more common in our toenails because we wear socks and shoes that keep our toenails warm and moist, a perfect environment for the fungus to grow. Foot injuries and tight, uncomfortable shoes also increase the possibility of getting fungal nail infections.

What are the symptoms of fungal nail infections?

Our nails may change colour – white, yellow or brown.  They can become flaky, thicker and even at times painful. If left untreated, we can expect these symptoms to worsen over time, so it’s important we know how to recognise the early signs and symptoms.

Who gets fungal nail infections and why?

Anyone can contract a fungal nail infections at any time. However, there are several people that may find themselves at higher risk than others, such as the elderly, those that uses public pools, bathrooms and changing rooms and anyone who has had athletes foot (see our blog on athletes foot here). If you regularly receive manicures and pedicures you are at a higher risk of fungal nail infections, as well as those with medical problems, such as trauma, diabetes, bone and joint disease, obesity, foot trauma during sports and vascular disease or immunodeficiency.

Are fungal nail infections contagious? 

Fungal nail infections are difficult to transmit from person to person. In order to be contagious, these micro-organisms require a warm or humid medium, such as those found in shower stalls, pools and areas in manicure salons.

The fungus can be passed along on a nail file, a hand/foot bath or a pool deck. Over time, these infections can also spread from one nail to another.

How can we prevent fungal nail infections?

  • Keep our feet clean and dry. Make sure we dry between the toes.
  • Use socks made of natural materials (cotton or wool) to permit air circulation.
  • Change our socks daily.
  • Avoid wearing tight or synthetic material shoes.
  • Use sandals when walking in public pools, showers, changing rooms etc.
  • Avoid manicure/pedicure salons with unsterilised instruments.
  • Cut our nails short (but not too short!)

What are the treatment choices for fungal nail infections?

Fungal nail infections may be treated with antifungal drugs that kill the fungi and prevent their embedded spores to grow and multiply. These treatments may be in the form of either a topical treatment or a tablet that you have to take.

Topical treatments 

These treatments are applied directly on the infected nail(s).

The drug penetrates through the nail to the site of infection in the nail bed. Effective drug concentrations are achieved within days. They can be used as long as needed for the infected section of the nail to grow and be cut off. Topical antifungals may be employed for all kinds of nail infections. They may be used alone for mild cases or used in combination with antifungal tablets or capsules for more severe infections.

Oral antifungal treatments 

These tablets or capsules are swallowed and the antifungal drug reaches the site of infection (the nail bed) via the bloodstream. To be effective, these drugs need to accumulate in the nail bed in sufficient quantity. Oral antifungals are suited for treating severe nail infections (when the matrix/root of the nail is also infected) and the combined use of a topical treatment may give a higher chance of successfully getting rid of the infection

How long does the treatment last?

Treatment length varies depending on what type of infection we have, whether it affects our finger or toenails, how many nails are affected etc. Even after the fungus and spores have been killed (mycological cure), it will take about 6 months for fingernails and 12 months for toenails to be normal in appearance. This is the time needed for our nails to grow out.

When can a nail be considered cured?

Cure for onychomycosis is only achieved when both the fungi and their spores are eliminated. Fungi are usually killed within weeks. Spores are much more resistant and can survive several months embedded in the previously infected section of the nail. This is why a nail can only be considered cured when the previously infected section of the nail has grown out and is cut off. This can take several months depending on the location of the infection,

Why do treated nails often get re-infected?

Nails often get re-infected because although the fungus has been killed, the spores survive within the remaining affected nail. For this reason, we have to wait until the nail grows out and the affected nail portion can be cut off, before stopping treatment. It is also possible that there may be another associated fungal infection (such as, athlete’s foot), which may lead to re-infection of the nail. It is therefore important that any associated fungal infection be treated as well.

Why it’s important to see a Podiatrist for advice and treatment? 

Before starting any treatment against fungal nail infections, you need to see a health professional to:

  1. Confirm the diagnosis of fungal nail infections.
  2. Avoid the spreading of fungal nail infections to other nails.
  3. Obtain a prescription for an effective treatment.

If you wish to speak to one of our Podiatrists for advice, you can use our FREE online service and message us directly.