Nail Fungus (onychomycosis)
What is nail fungus?
Nail fungus happens when fungus grows into the toenails (and sometimes the fingernails). This fungus is everywhere in the environment. Infected nails become thick, yellow, and brittle, often with buildup of debris or dead skin under the nail. Sometimes the nail may split or crumble at the tip.
Nail fungus commonly develops in people who also have athlete’s foot (peeling skin between the toes, and dry or cracked skin on the bottoms or sides of the feet - see my Athlete’s Foot page).
Why do I have nail fungus?
The same factors that cause athlete’s foot can also lead to nail fungus. Common triggers include:
Walking barefoot in communal showers, pools, or locker rooms
Wearing tight, non-breathable shoes in hot or humid conditions
Sweaty feet that stay damp in socks or shoes
It’s more common in athletes (from nails repeatedly hitting the front of shoes) and in people who are older, have diabetes, or have weakened immune systems.
How do I fix nail fungus?
Over-the-counter treatments don’t work very well because nails are thick and hard for medicine to penetrate. Still, a few things may help:
Daily vinegar soaks – Mix 2 tbsp white vinegar into 2 cups warm water. Soak feet for 10–15 minutes to reduce fungus and help medicines soak in.
Antifungal creams – Apply a thin layer twice daily.
“-afine” options (more expensive, often more effective): butenafine, terbinafine
“-azole” options (cheaper): miconazole, clotrimazole
40% urea cream at bedtime – Softens nails and helps other treatments penetrate. Apply to affected nails before bed, then wear cotton socks. (May sting if skin is broken.)
Antifungal foot powders – Especially if your feet sweat or you live in a humid area. Powders keep skin dry and fight fungus.
Vicks VapoRub – Apply twice daily to affected nails. Some patients find this surprisingly helpful.
Wear flip-flops when possible – Keeps feet dry and less hospitable to fungus.
How do I keep nail fungus from coming back?
Once nail fungus clears, these steps can help prevent it from returning:
Wash feet daily with mild soap and water.
Dry feet thoroughly after bathing, especially between the toes.
Apply a thin layer of antifungal cream to feet and toenail edges once a week
Wear cotton socks with shoes.
Rotate shoes – don’t wear the same pair two days in a row.
Treat shoes with antifungal spray or powder every other week.
Wear flip-flops in public locker rooms, gyms, or pools.
What if my nail fungus isn’t getting better?
The steps above can help, but nail fungus is tough to treat with topical medicines alone. Most people need a 3–6 month course of oral antifungal medication to fully clear the nails of fungus.
This is especially important if you have diabetes or a weakened immune system, since nail fungus can be an entry point for bacteria and lead to cellulitis (a serious skin infection).
If pills are needed, see a board-certified dermatologist. If you are in or near Utah, see one of my excellent colleagues at the University of Utah or me virtually with Honeydew.
DISCLAIMER
The statements expressed and content of this website are not intended to be a substitute for professional medical advice. Readers should seek their own professional counsel for any medical condition or before starting or altering any treatment, exercise, or dietary plan. Please see our full disclaimer here.