Nail Fungus

Nail fungus is a very common ailment. Fungi prefer to live in dark, warm, moist environments. Under your toenail, inside your socks and shoes is a great home for fungus to thrive. There is a risk of fungus under your nails causing a skin fungal infection. Nail fungus can cause your nails to get thick, brittle and discolored. You may be tempted to simply paint your nails to cover up the discoloration. Nail polish decreases the permeability of your nail and can actually make you more prone to getting nail fungus. I recommend giving your nails a break for a few days between applying a new polish. Many people also notice a build up of tissue under the nail. A nail that has a damaged nail bed can mimic a fungal nail. For this reason I recommend testing a clipping of the nail for fungus prior to starting any treatment.


Nail fungus can be difficult to treat successfully. Therefore, a multi-therapy treatment protocol is recommended. The fungi can get into your shoes, socks, sandals and slippers, and if not treated in those locations, can cause a reinfection of your skin and nails. Treating nail fungus may or may not change the appearance of your nails. If you have damage to your nails from long term infection, systemic illness, medications, or an injury, there may be residual discoloration and deformity to your nails after the nail fungus has been treated. It is very difficult to get rid of every fungus spore and permanently cure nail fungus, so I recommend a long term maintenance plan to prevent the recurrence of symptoms. The goal of treatment is to improve the cosmetic appearance of your nails and prevent the spread of the fungus to other nails and your skin.


Once you have confirmed you have nail fungus, you have the option of treating it with medications that are applied directly to the nails, or with an oral medication. It is recommended to have blood work done prior to starting treatment with oral medications to decrease the risk of complications. The medications are generally regarded as safe and having a low risk of complications. Topical medications can be used on their own, or with an oral antifungal medication. Topical medications need to penetrate through the nails to get to the underlying nail bed where the nail fungus grows. I recommend routinely filing your nails to make them thinner while using a topical nail fungus treatment. Using urea on your nails has been shown to increase the permeability of the nails by up to 20 fold. The nails can also be removed before starting the medication. This allows you to put the medication directly onto the nail bed where the fungus is. There are many otc topical treatments for nail fungus. Some of them have a whitening agent in them so it looks like the nail fungus is gone before it has been completely treated. Once you stop using it, the discoloration will often return.


Any treatment chosen is going to take several months, up to a year, to treat the nail fungus. This is because it takes 9-12 months for a toenail to grow out completely. Once you have achieved an improvement in the appearance of your nails, you should start a long term maintenance routine to help prevent a recurrence of your symptoms. I recommend a maintenance routine of using a topical medication a few times per week. You should continue to clean your shoes routinely and avoid wearing wet shoes or socks. If you see a recurrence of your nail fungus, you should return to using the antifungal medication daily.

Dr Katie Evans Dr Katie Evans writes a monthly column in the Hometown Focus. The articles cover a variety of issues concerning the foot and ankle. If you have any recommendations for future articles, email them to

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