The causes, symptoms and best treatments for fungal toenail infections.
Medically reviewed by Dr Louise Wiseman MBBS, BSc (Hons), DRCOG, MRCGP
Reluctant to show your feet in public? If your toenails are plagued by unsightly white patches and they’ve become brittle and started to split, it sounds like you might have a fungal toenail infection. So which treatment works to get rid of the fungus properly?
While it’s tempting to stick a pair of socks on and hide your feet away, treating fungal nail infections is a straightforward process. We look at toenail fungal infection causes, symptoms and treatments, so you can start shopping for sandals:
What is a fungal nail infection?
Fungal nail infections (medically known as onychomycosis or tinea unguium) are common. They occur when a fungus that would normally be found on the body overgrows in the fingernails or toenails that then starts affecting the structure of the nail. The nail may thicken, change in colour and become more likely to crack and break.
Fungal infections affect toenails more than fingernails and everyone can get them, but the following groups of people are at higher risk:
- The elderly
- People with an impaired immune system
- People with diabetes
- People with poor peripheral circulation
Warm, moist environment helps fungi to grow and cause infection. This means that trainers, showers, bathrooms and changing rooms are ideal places for these fungi to grow.
Fungal nail infection symptoms
While fungal nail infection symptoms vary, an infection usually includes one or more of the following:
- Thickening and discolouration of the nail.
- White patches appear where the nail has come away from the skin.
- In some cases the nail may fall off.
- Your nail may become brittle and split.
- Your nail may look dull and lose its natural shine.
- You may notice white or yellowish spots in the middle of the nail.
- Wearing shoes may cause discomfort and pain in the nail that is infected.
Fungal nail infection causes
What causes a fungal nail infection? Fungal nail infections can occur directly within the nail itself, or from an untreated fungal infection of the foot.
The nail changes are caused by dermatophyte fungi, this is the same type that causes athlete’s foot – a common infection of the skin of the feet, especially between the toes.
With athlete’s foot the dermatophyte fungus lives in the outer layer of the skin only. When spores of the fungus get between the toenail and the nail bed beneath a fungal nail infection can develop.
Fungal nail infection diagnosis
Doctors often use clinical examination alone to make a diagnosis of a fungal nail infection. Sometimes nail clippings or scrapings may be taken for microscopic examination and culture in the lab to identify the type of fungus causing the symptoms. Results can take two to three weeks.
There are other conditions such as psoriasis, bacterial infections or an injury that may affect the appearance of nails. Your doctor or pharmacist may ask you additional questions to work out what may be affecting your nails.
Fungal nail infection treatment
The treatment of a fungal nail infection will depend on how severe the fungal infection is, and the number of nails involved. Not all nail infections will need treatment, but a fungal nail infection will not clear up without treatment.
If a fungal nail infection is not bothering you, then you may not feel the need to treat it. You should however, keep an eye on it and try not to spread the infection to others. If however it is causing you discomfort or you find it embarrassing, the following treatments are used to treat fungal nail infections:
✔️ Antifungal nail lacquers
Antifungal nail lacquers such as Loceryl, Trosyl are most effective if the infection is treated at an early stage. Fungal treatment nail lacquers need to be used for 4-12 months for any significant improvements are seen. These treatments are safe to use but may cause some redness and irritation around the nail.
✔️ Oral antifungal treatments
Oral antifungal treatments such as terbinafine tablets need to be take daily for at least six months for the treatment of toe nail infections. They are not suitable for some people and can cause liver damage. You will need to have blood tests to check your liver function if you start on a course of antifungal tablets. Antifungal medicines can also interact with other medications so are only prescribed carefully after a consultation with a doctor.
✔️ Excilor and Nailner
Fungal nail treatments containing Ethyl acetate or acetic acid, such as Excilor or Nailner work by changing the pH levels inside the nail, creating an environment that inhibits further growth of the fungi causing the nail infection. These products are also formulated to help the active ingredients penetrate nail more effectively, so targeting the fungi causing the infection.
✔️ Laser treatment
Laser treatment kills off the fungi causing the infections. There is limited evidence and research to show that laser treatment is effective for clearing fungal infections of nails.
Seeing a chiropodist who can trim and file the nail to remove infected parts of a nail. Removing any thickened or yellow parts of the nail with infection will also help to clear up the infection more quickly if an antifungal nail lacquer or tablets are prescribed afterward.
Fungal nail infection complications
Fungal nail infections are common even in healthy people. However, if fungal infections do not respond to treatment or a person has many different areas of the body affected at once, it might be necessary to do further tests to exclude problems with the immune system and other conditions. If you have any concerns, ask your GP for advice.
Fungal nail infection prevention
To prevent spreading the infection to your other toes or to other people, try the following:
- Keep your nails short, dry and clean.
- Use a separate nail clipper for the infected nails.
- Wear well-fitting shoes – avoid narrow shoes with narrow toes.
- Consider replacing old trainers/shoes or giving them a good wash as they could be contaminated with fungus spore
- Maintain good foot hygiene and use an antifungal creamto treat athletes’ foot.
- Use an antifungal spray or powder such as Daktarin foot sprayin your shoes to kill off any spores in the shoes.
- Wear sandals or slip-flops when in communal showers, locker rooms or gyms.