Get Rid of your Fungal Nail Infection
There is a cogent, succinct review of fungal nail infections on the CDC website and I will share that with you first. When it comes to treatment, though, I will expand on the standard recommendations for you.
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Fungal nail infections are common infections of the fingernails or toenails that can cause the nail to become discolored, thick, and more likely to crack and break. Infections are more common in toenails than fingernails. The technical name for a fungal nail infection is “onychomycosis.”
Symptoms
Nails with a fungal infection are often:
• Discolored (yellow, brown, or white)
• Thick
• Fragile or cracked
A fungal nail infection usually isn’t painful unless it becomes severe.
Some people who have fungal toenail infections also have a fungal skin infection on the foot, especially between the toes (commonly called athlete’s foot.)
How does someone get a fungal nail infection?
Fungal nail infections can be caused by many different types of fungi (yeasts or molds) that live in the environment. Small cracks in your nail or the surrounding skin can allow these germs to enter your nail and cause an infection.
Who gets fungal nail infections?
Anyone can get a fungal nail infection. Some people may be more likely than others to get a fungal nail infection, including older adults and people who have the following conditions:
• A nail injury or nail surgery
• Diabetes
• A weakened immune system
• Blood circulation problems
• Athlete’s foot
Prevention
• Keep your hands and feet clean and dry.
• Clip your fingernails and toenails short and keep them clean.
• Don’t walk barefoot in areas like locker rooms or public showers.
• Don’t share nail clippers with other people.
• When visiting a nail salon, choose a salon that is clean and licensed by your state’s cosmetology board. Make sure the salon sterilizes its instruments (nail clippers, scissors, etc.) after each use, or, you can bring your own.
Diagnosis
Your healthcare provider may diagnose a fungal nail infection by looking at the affected nail and asking questions about your symptoms. He or she may also take a nail clipping to look at under a microscope or send to a laboratory for a fungal culture.
Treatment
Fungal nail infections can be difficult to cure, and they typically don’t go away without antifungal treatment. The best treatment for a fungal nail infection is usually prescription antifungal pills taken by mouth. In severe cases, a doctor might remove the nail completely. It can take several months to a year for the infection to go away. Topical antifungal agents can be used but are often ineffective.
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So, if you have established onychomycosis, and you need to take an oral antifungal to eradicate the fungus (whether or not the nail is removed), which one is best?
I like fluconazole and I took it myself. If you search for fungal toenail treatments, other agents will be shown first; this is because FDA approval for this indication has never been sought for fluconazole. So, why do I favor fluconazole?: (1) it is the safest option; (2) it is now generic and less costly; (3) it has been uses since the early 1980’s, so we know it well; (4) convenient dosing; (5) it seems to work just fine.
Before I go into the details on fluconazole, let’s review the FDA-approved antibiotics for toenail fungus. Oral terbinafine is considered to be the first-line treatment for confirmed onychomycosis; the treatment course is generally 6 weeks for fingernails and 12 weeks for toenails. Terbinafine is rarely hepatotoxic, but this can include liver failure and liver blood tests should be monitored. It can also cause headache, nausea, vomiting, diarrhea, rash and low white blood cells, so the CBC should be monitored as well. It is taken as one pill daily.
The other approved drug for onychomycosis is itraconazole. It has been associated with nausea, diarrhea, vomiting, abdominal discomfort, allergic rash and edema and may also cause serious liver injury. Liver blood tests are monitored. Itraconazole is taken either 200 mg once daily for 3 months or 200 mg twice daily for 1 week per month for 4 rounds.
Fluconazole has also been associated with serious adverse events, just like each and every other antibiotic, but serious side effects from fluconazole are rare and are decidedly less common than from terbinafine or itraconazole. Flucaonazole has caused nausea, headache, skin rash, hair loss and very rarely serious liver injury. It is questionable whether you need liver blood test monitoring in the doses used for fungal nail infections, but it is not a bad idea. I recommend 400 mg once a week (for example, two pills each Sunday) until the nail grows out normally. This usually takes 6 months for fingernails and 12 months for toenails. This is not a meticulously researched or FDA-approved regimen, but it works for me!
Winkler G. Weinberg, MD
I have been an Infectious Disease physician for over 3 decades. I am the author of No Germs Allowed!. If you liked this article, check out the book on Amazon.
