Treatment for a fungal nail infection includes using medicines, taking steps to prevent the infection from returning, and possibly removing the affected nail. Treatment is generally successful, but treatment does not work for 20% to 25% of people with the condition.
You may decide not to treat a fungal nail infection if your nail is discolored or damaged but not painful. Antifungal medicine does not guarantee a cure, and antifungal pills (oral medicine) can be expensive and have potentially dangerous side effects.
Without treatment, fungal nail infections tend to get worse, infecting more of the nail or surrounding skin. Early treatment may shorten treatment time and increase your chances of being cured.
If you have a fungal nail infection that causes quality-of-life problems, such as discomfort, pain, or embarrassment, you may decide to treat it.
Standard treatment for fungal nail infection includes one or a combination of the following:
Antifungal pills (oral medicine) offer the best chance of a cure. But they require close monitoring for dangerous side effects and are generally reserved for moderate-to-severe or difficult-to-treat fungal nail infections. Pills include terbinafine (Lamisil), itraconazole (Sporanox), and fluconazole (Diflucan).
Antifungal topical medicine (creams, lotions, gels, and lacquers) are applied to the infected nail and surrounding areas of the skin. They may be used for mild-to-moderate infections and to help prevent an infection from returning or to prevent athlete's foot from spreading to the nails. Topical medicines include terbinafine (Lamisil) and ciclopirox (Penlac). Topical medicines may not be as effective as oral medicines.
Removal of an infected nail is used for severe or recurring fungal nail infections. In nonsurgical nail removal, a urea ointment is put on the nail, softening and dissolving it for easy removal. In surgical nail removal, the infected nail and tissue is fully removed (avulsion) or partially removed (debridement). A topical or oral antibiotic is necessary only when a bacterial infection has developed along with the fungal infection.
Recurring infections and prevention
Even after apparently successful treatment with antifungal pills, a fungal nail infection can return, either as a new infection or as regrowth of the original fungi. Severe toenail infections, particularly those involving a big toe, are difficult to treat and tend to recur. If you have a mild fungal infection or are concerned about the risks of oral antifungal medicine, consider using a topical treatment, such as Lamisil or Penlac.
Fungal nail infections can be treated successfully, but some types are more easily treated than others. One type, distal subungual onychomycosis, can be a lifelong infection and hard to treat. Another type, white superficial onychomycosis, can be easily treated.
Even after treatment, your nails may continue to look irregular in shape and appearance. It can take a year or longer before they return to normal.
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