Fungal Nails

  • Medical Author:
    Kyoung Min Han, DPM, AACFAS

    Dr. Kyoung Min Han is a podiatrist (foot and ankle specialist) practicing in Southern California. Dr. Han completed her undergraduate education at the University of California, San Diego, and went on to the New York College of Podiatric Medicine to pursue her medical training. She returned to her native Southern California to complete a three-year foot and ankle surgical residency, followed by subspecialty training in a sports medicine fellowship.

  • Medical Editor: Melissa Conrad Stöppler, MD
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

Quick GuideNail Color and Texture: What Nails Say About Your Health

Nail Color and Texture: What Nails Say About Your Health

What is the treatment for fungal nails?

Keeping nails trimmed and filed can help to reduce the amount of fungus in the nails and is highly recommended. A podiatrist or dermatologist may shave the top layer of the nail off or even remove part of the nail.

Creams and other topical medications have traditionally been less effective against nail fungus than oral medications. This is because nails are too hard for external applications to penetrate.

Prescription topical medications for fungal nails include the following:

Ciclopirox (Penlac) topical solution 8% is a medical nail lacquer that has been approved to treat finger or toenail fungus that does not involve the white portion of the nail (lunula) in people with normal immune systems. It only works about 7% of the time. The medication is applied to affected nails once daily for up to one year. The lacquer must be wiped clean with alcohol once a week. There is some evidence that using an antifungal nail lacquer containing amorolfine can prevent reinfection after a cure, with a success rate of about 70%. However, this drug is currently unavailable in the United States.

Efinaconazole (Jublia) is a medication approved in 2014. It is a topical (applied to the skin) antifungal used for the local treatment of toenail fungus due to two most common fungal species affecting nails (Trichophyton rubrum and Trichophyton mentagrophytes). Once-daily application is required for 48 weeks.

Tavaborole (Kerydin) is another new medication that is indicated for onychomycosis of the toenails. This medicine has the same indication as efinaconazole. It also requires application once daily for 48 weeks. Continue Reading

Reviewed on 3/8/2016
References
REFERENCES:

Averill, R.W., and R.K. Scher. "Simplified Nail Taping With Urea Ointment for Nonsurgical Nail Avulsion." Cutis 38 (1986): 231.

Baran, R., R.J. Hay, and J.I. Garduno. "Review of Antifungal Therapy, Part II: Treatment Rationale, Including Specific Patient Populations." J Dermatolog Treat 19.3 (2008): 168-175.

Brillowska-Dabrowska, A., S.S. Nielsen, H.V. Nielsen, and M.C. Arendrup. "Optimized 5-Hour Multiplex PCR Test for the Detection of Tinea Unguium: Performance in a Routine PCR Laboratory." Med Mycol. 48.6 Sept. 2010: 828-831.

Bristow, I.R., and M.C. Spruce. "Fungal Foot Infection, Cellulitis and Diabetes: A Review." Diabet Med 26 (2009): 548.

de Berker, D. "Clinical Practice. Fungal Nail Disease." N Engl J Med. 360.20 May 14, 2009: 2108-2116.

Derby, R., P. Rohal, C. Jackson, et al. "Novel Treatment of Onychomycosis Using Over-the-Counter Mentholated Ointment: A Clinical Case Series." J Am Board Fam Med 24 (2011): 69.

Elewski, B.E. "The Effect of Toenail Onychomycosis on Patient Quality of Life." Int J Dermatol 36 (1997): 7.

Gaburri, D., J.M. Chebli, A. Zanine, A.C. Gamonal, and P.D. Gaburri. "Onychomycosis in Inflammatory Bowel Diseases." J Eur Acad Dermatol Venereol. 22.7 JulY 2008: 807-812.

Garcia-Doval, I., et al. "Clinical Diagnosis of Toenail Onychomycosis Is Possible in Some Patients: Cross-sectional Diagnostic Study and Development of a Diagnostic Rule." Br J Dermatol. 163.4 Oct. 2010: 743-751.

Ginarte, M., Garcia-Doval, I., et al. "Observer Agreement in Toenail Disorders: Implications for Diagnosis and Clinical Research." Br J Dermatol. 160.6 June 2009: 1315-1317.

Grover, C., S. Bansal, S. Nanda, et al. "Combination of Surgical Avulsion and Topical Therapy for Single Nail Onychomycosis: A Randomized Controlled Trial." Br J Dermatol 157 (2007): 364.

Gupta, A.K., H.C. Jain, C.W. Lynde, P. Macdonald, E.A. Cooper, and R.C. Summerbell. "Prevalence and Epidemiology of Onychomycosis in Patients Visiting Physician's Offices: A Multicenter Canadian Survey of 15,000 Patients." J Am Acad Dermatol 43 (2 Pt 1) (2000): 244.

Gupta, A.K., L.E. Lynch, N. Kogan, and E.A. Cooper. "The Use of an Intermittent Terbinafine Regimen for the Treatment of Dermatophyte Toenail Onychomycosis." J Eur Acad Dermatol Venereol. 23.3 Mar. 2009: 256-262.

Kondori, N., A.L. Abrahamsson, N. Ataollahy, and C. Wennerås. "Comparison of a New Commercial Test, Dermatophyte-PCR Kit, With Conventional Methods for Rapid Detection and Identification of Trichophyton rubrum in Nail Specimens." Med Mycol. 48.7 Nov. 2010: 1005-1008.

Litz, C.E., and R.Z. Cavagnolo. "Polymerase Chain Reaction in the Diagnosis of Onychomycosis: A Large, Single-Institute Study." Br J Dermatol. 163.3 Sept. 2010: 511-514.

Montgomery, B.J. "Urea Plasters Alternative to Surgery for Nail Removal." JAMA 241 (1979): 1559, 1563.

Nair, A.B., S.R. Vaka, S.M. Sammeta, H.D. Kim, P.M. Friden, B. Chakraborty, and S.N. Murthy. "Trans-ungual Iontophoretic Delivery of Terbinafine." J Pharm Sci. 98.5 May 2009: 1788-1796.

Roujeau, J.C., B. Sigurgeirsson, H.C. Korting, et al. "Chronic Dermatomycoses of the Foot as Risk Factors for Acute Bacterial Cellulitis of the Leg: A Case-Control Study." Dermatology 209 (2004): 301.

Shemer, A., B. Davidovici, M.H. Grunwald, H. Trau, and B. Amichai. "Comparative Study of Nail Sampling Techniques in Onychomycosis." J Dermatol. 36.7 Jul7 2009: 410-414.

Shemer, A., H. Trau, B. Davidovici, M.H. Grunwald, and B. Amichai. "Onychomycosis in Psoriatic Patients - Rationalization of Systemic Treatment." Mycoses. 53.4 July 2010: 340-343.

Sigurgeirsson, B., J.H. Olafsson, J.T. Steinsson, N. Kerrouche, and F. Sidou. "Efficacy of Amorolfine Nail Lacquer for the Prophylaxis of Onychomycosis Over 3 Years." J Eur Acad Dermatol Venereol. 24.8 Aug. 2010: 910-915.

Sigurgeirsson, B., and O. Steingrímsson. "Risk Factors Associated With Onychomycosis." J Eur Acad Dermatol Venereol 18 (2004): 48.

Smijs, T.G., and S. Pavel. "The Susceptibility of Dermatophytes to Photodynamic Treatment With Special Focus on Trichophyton rubrum." Photochem Photobiol. 87.1 Jan.-Feb. 2011: 2-13.

Sotiriou, E., T. Koussidou-Eremonti, G. Chaidemenos, Z. Apalla, and D. Ioannides. "Photodynamic Therapy for Distal and Lateral Subungual Toenail Onychomycosis Caused by Trichophyton rubrum: Preliminary Results of a Single-Centre Open Trial." Acta Derm Venereol. 90.2 Mar. 2010: 216-217.

Szepietowski, J.C., A. Reich, E. Garlowska, et al. "Factors Influencing Coexistence of Toenail Onychomycosis With Tinea Pedis and Other Dermatomycoses: A Survey of 2761 Patients." Arch Dermatol 142 (2006): 1279.

Takahata, Y., M. Hiruma, Y. Shiraki, Y. Tokuhisa, T. Sugita, and M. Muto. "Treatment of Dermatophyte Onychomycosis With Three Pulses of Terbinafine (500 mg Day for a Week)." Mycoses. 52.1 Jan. 2009: 72-76.

Thomas, J., et al. "Toenail Onychomycosis: An Important Global Disease Burden." J Clin Pharm Ther. 35.5 Oct. 2010: 497-519.

Tosti, A., B.M. Piraccini, C. Stinchi, and M.D. Colombo. "Relapses of Onychomycosis After Successful Treatment With Systemic Antifungals: A Three-Year Follow-up." Dermatology 197 (1998): 162.

Walling, H.W. "Subclinical Onychomycosis Is Associated With Tinea Pedis." Br J Dermatol. 161.4 Oct. 2009: 746-749.

IMAGES:

1.iStock/CDC

2.iStock

3.iStock/CDC

4.iStock

5.Medscape – Dr. Antonella Tosti

6.Sanna Lindberg / PhotoAlto Agency RF Collections

7.Getty Images

8.iStock

9.iStock

10.iStock

11.Medscape/iStock/Fitzpatrick's Color Atlas & Synopsis of Clinical Dermatology Klaus Wolff, Richard Allen Johnson, Dick Suurmond Copyright 2009, 2005, 2001, 1997, 1993 by The McGraw-Hill Companies. All Rights reserved./"Infectionofcutical" by James Heilman, MD

12.iStock

13.Getty Images

14.iStock

15.Getty Images

16.iStock

Subscribe to MedicineNet's Newsletters

Get the latest health and medical information delivered direct to your inbox!

By clicking Submit, I agree to the MedicineNet's Terms & Conditions & Privacy Policy and understand that I may opt out of MedicineNet's subscriptions at any time.

VIEW PATIENT COMMENTS
  • Fungal Nails - Treatments

    What treatment did you use for your fungal nails?

    Post View 20 Comments
  • Fungal Nails - Signs and Symptoms

    What did your nails look like when you had a nail fungus? What were your signs and symptoms?

    Post View 2 Comments
  • Fungal Nails - Prevention

    If you've had a toenail fungus, how do you try to prevent it from recurring?

    Post View 2 Comments
  • Fungal Nails - Diagnosis

    Why did you go to a doctor for your nail fungus? How was the condition diagnosed?

    Post View 1 Comment

Health Solutions From Our Sponsors