Nail Fungus (onychomycosis)
What is Nail Fungus?
Nail fungus is where fungus grows into the toenails, and occasionally, the fingernails. This fungus is everywhere in our environment. The nail(s) will get thick and yellow, often with chunks of dead skin under the nail, and sometimes the nail splits at the far end. It usually happens in people with athlete’s foot (damp, peeling skin between the toes, and dry skin on the bottom and sides of the feet) - learn more on my Athlete’s Foot page.
Why do I have nail fungus?
The same triggers for athlete’s foot can lead to nail fungus (using communal showers at pools or in dorms), or shoes that don’t “breathe” combined with high humidity or sweaty feet. It is more common in athletes (possibly from the nails repeatedly hitting the front of the shoes). It is also more common and more concerning in older adults, people with diabetes, or who are immunocompromised (they have a weak immune system).
How do I fix nail fungus?
When you have nail fungus, a few over-the-counter options are more likely to work than others, but none of the over-the-counter options work great, because the nails are so thick, and it is hard to get medicines into them.
Use vinegar soaks every day.
Vinegar soaks are very helpful for cleaning up superficial infections with fungus or bacteria and healing up any scratched, broken, or damaged skin. Safe for all ages. It also helps other treatments have a better chance of soaking into the nails.
Apply a thin layer of topical antifungal cream twice a day. Head-to-head studies don’t exist on the best antifungal creams, but antifungals ending in “-afine” appear to work better (and are pricier) than antifungals ending in “-azole.” I would try a cheaper “azole” first.
“-afine” antifungals (more expensive): butenafine or terbinafine.
“-azole” antifungals (less expensive): miconazole or clotrimazole.
Use 40% urea cream at bedtime if the vinegar soaks aren’t helping.
Urea is a mild acid that can help other treatments have a better chance of soaking into the nails. Before bed, put urea on the toes (and nails) that have nail fungus, then wear cotton socks to sleep.
NOTE: As an acid, urea can sting when the skin is broken.
If your feet sweat or it is humid where you live, use a foot powder with antifungal in it.
Foot powders help keep the skin dry. I like ones with an antifungal medication (brand name or generic) in them to help clear the skin quicker.
Many nursing home doctors swear by Vick’s Vaporub for nail fungus.
Put Vick’s Vaporub on the toes with nail fungus twice daily. I have had patients report success with this, so it seems to work for some.
Wear flip-flops as much as possible to keep the feet dry.
How do I keep nail fungus from coming back?
After you clear your nail fungus, several things can be done to prevent it from returning:
Clean your feet daily in the shower with mild soap and water.
Dry your feet very well after your shower, especially between the toes.
Apply a thin layer of antifungal cream to your feet and around the edges of your toenails after drying on the weekends.
Wear cotton socks when wearing shoes.
Change your shoes every day (don’t wear the same pair of shoes two days in a row).
Treat shoes with antifungal spray or powder once every other week.
Wear flip-flops in public locker rooms (at gyms) or at public pools.
Avoid pedicures.
What if my nail fungus isn’t getting better?
The steps above can help some people’s nail fungus. But nail fungus is usually hard to treat by putting medication directly on the nails (topically). It usually needs a 3- or 6-month course of oral antifungal medicine to really clear the nails of fungus. This is really important if you have diabetes or a weakened immune system because nail fungus is a common entry point for bacteria to get in and cause a skin infection called cellulitis. Look for a board-certified dermatologist in your area to examine your nails. If you are in or near Utah, see one of my excellent colleagues at the University of Utah or me virtually with Honeydew.
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