Fungal infection of nails is common. The infection causes thickened and unsightly nails which sometimes become painful. Medication often works well to clear the infection, but you need to take medication for several weeks.
Between 3 and 8 out of 100 people in the UK will have a fungal nail infection at some stage of their lives. Toenails are more commonly affected than fingernails. It is more common in people aged over 55, and in younger people who share communal showers, such as swimmers or athletes.
Often the infection is just in one nail, but several may be affected. At first the infection is usually painless. The nail may look thickened and discoloured (often a greeny-yellow colour). Commonly, this is all that occurs and it often causes no other symptoms. However, it can look unsightly.
Sometimes the infection becomes worse. White or yellow patches may appear where the nail has come away from the skin under the nail (the nailbed). Sometimes the whole nail comes away. The nail may become soft and crumble. Bits of nail may fall off. The skin next to the nail may be inflamed or scaly. If left untreated, the infection may eventually destroy the nail and the nailbed, and may become painful. Walking may become uncomfortable if a toenail is affected.
The website www.dermnetnz.org/fungal/onychomycosis.html has pictures of fungal nail infections.
Other nail conditions can sometimes look like a fungal infection. Therefore, to confirm the diagnosis, a doctor will usually take a nail clipping and send it to the laboratory for testing.
This is an option if the infection is mild or causing no symptoms. For example, a single small toenail may be infected and remain painless and of little concern. Some people may prefer not to take treatment because:
The option to treat can be reviewed at a later date if the infection becomes worse or if you change your mind.
However, treatment is usually advised if:
Antifungal tablets will often clear a fungal nail infection. The medication will also clear any associated fungal skin infection, such as athlete's foot. Your doctor will usually recommend one of the following two medicines. The one chosen may depend on the type of fungus causing the infection. Both of these medicines cause side-effects in a small number of people, so read the packet that comes with the medicine for a full list of cautions and possible side-effects.
Studies suggest that in about 5 in 10 cases the nail will look fully normal again after treatment. In about a further 2 in 10 cases the fungus will be cleared from the nail after treatment, but the nail does not look fully normal again. Fingernails tend to respond better to treatment than toenails do. One reason for treatment to fail is because some people stop their medication too early.
A nail lacquer that contains the antifungal medicine amorolfine is an alternative for most (but not all) types of fungi that infect nails. You can buy amorolfine nail lacquer from pharmacies as well as getting it on prescription. However, this tends not to work as well as medication taken by mouth. Your doctor will advise if it is a suitable option for your type of infection. For example, it may be useful if the infection is just towards the end of the nail. This treatment does not tend to work so well if the infection is near the skin, or involves the skin around the nail.
The nail lacquer has to be put on exactly as prescribed for the best chance of success. You may need six months of nail lacquer treatment for fingernails, and up to a year for toenails.
Tioconazole is another solution that can be applied to the nail. It can also be bought from a pharmacy, although research trials suggest it does not work as well as amorolfine.
If other treatments have failed, an option is to have the nail removed by a small operation done under local anaesthetic. This is combined with treatment with antifungal medication.
Research is looking at newer methods of treating fungal nail infections. These include laser treatment and ultrasound. Initial results are positive but more evidence is needed about the long-term results of the treatments.
The fungi that are killed with treatment remain in the nail until the nail grows out. Fresh, healthy nail growing from the base of the nail is a sign that treatment is working. After you finish a course of treatment, it will take several months for the old infected part of the nail to grow out and be clipped off. The non-infected fresh new nail continues growing forward. When it reaches the end of the finger or toe, the nail will often look normal again.
Fingernails grow faster than toenails, so it may appear they are quicker to get back to normal. It may take up to a year after starting treatment before toenails look completely normal again and six months for fingernails to look completely normal.
Consult a doctor if there does not seem to be any healthy new nail beginning to grow after a few weeks of treatment. However, the infection can still respond to treatment even after you finish a course of medication. This is because the antifungal medication stays in the nail for about nine months after you stop taking medication.
Take medication as directed, and do not give up without discussing this with a doctor.
Side-effects are uncommon with modern medication, but tell a doctor if you notice any problems with treatment.
Tips on nail care if you have a nail infection, with or without taking medication, include the following.
Studies suggest that in about 1 in 4 cases where the infection has been cleared from the nail, the infection returns within three years. One way to help prevent a further bout of nail infection is to treat athlete's foot as early as possible to stop the infection spreading to the nail. Athlete's foot is common and may recur from time to time. It is easy to treat with an antifungal cream which you can buy from pharmacies, or get on prescription. The first sign of athlete's foot is itchy and scaling skin between the toes. See separate leaflet called Athlete's Foot (Tinea Pedis) for further detail. Also: