Treating Nail Infections


Published: 19 July 2015

Fungal infections of the nails cause embarrassment and discomfort for millions of people worldwide. These infections are often very difficult to treat and full resolution may take more than a year.

Who Gets Fungal Infections of the Nails?

Anyone can contract a fungal infection of the nails. Although other types of infections can occur in the nails, fungal infections are generally the most common and are present among all age groups, but are particularly common among older adults. Dr. Allison Harvey states that in western countries, approximately ten percent of individuals contract a fungal nail infection prior to the age of sixty. By age seventy, the rate increases to one out of every two people.

Factors that promote the occurrence of fungal infections include working in warm damp environments, wearing closed shoes, using public pools and gyms, and having family members with nail infections. Men tend to have higher rates of infection than women do.

Illness and medical treatments also impact the rate of occurrence. Individuals who are diagnosed with psoriasis or psoriatic arthritis are more prone to fungal infections. People who suffer from skin diseases, including eczema and athlete’s foot, have an elevated risk. Conditions, such as diabetes and peripheral vascular disease, impair the body’s ability to fight infection. Individuals who have sustained injuries to their fingers or toes are more prone to developing fungal infections of the nails.

Medications that weaken the immune system, such as chemotherapy, make it easier for fungi to infect nails. Steroids, surgery, and radiation all lower resistance to disease and increase the risk of nail infections.

Signs of Fungal Infections of the Nails

Fungal infections tend to grow in warm, damp environments.

Fungal infections tend to grow in warm, damp environments.

The signs of a fungal infection of the nails vary, but can include:

  • nails that are thick, rough, or ridged
  • crumbling or flaking nails
  • discolouration—so that the nail appears yellow, white, brown, grey, or white
  • separation of the nail from the nail bed
  • a foul odor
  • inflammation, pain and itchiness of the surrounding tissue.

If the fungal infection remains untreated, it may spread to other nails, or a secondary bacterial infection may ensue and the nail may become permanently deformed or destroyed.

Treatment options for Fungal Infections of the Nails

While many treatment options are available for fungal infections of the nail, most have low success rates. The risks and benefits must be carefully weighed when deciding upon a treatment plan. The entire nail must grow out before treatment can be clearly identified as a success. Fingernails can take up to twelve months to grow out, while toenails may take as long as a year and a half.

Home and Over the Counter Remedies for Nail Infections

Patients may ask you about home remedies. Most of these are ineffective; some are merely cumbersome while others can cause damage to the nails and surrounding tissues. People sometimes use bleach, vinegar, mouthwash, or hydrogen peroxide to treat their infections. Healthcare professionals must be prepared to discourage the use of these treatments.

Undecylenic acid is a common ingredient in commercial over the counter remedies. It is an FDA approved anti-fungal ingredient in the USA. Tea tree essential oil has also been shown to destroy fungi, reduce inflammation, and ease pain and itchiness.

The major problems faced by users of topical remedies are inconsistent use, difficulty penetrating the nail to the tissue below, and recontamination.

Topical Prescription Medications Used to Treat Fungal Infections of the Nails

Topical prescription remedies are generally more effective for preventing reinfection of nails, rather than eliminating infection. While safer than oral medications, topical remedies may cause discomfort and inflammation of the tissues surrounding infected nails. The antifungal agents get directly to the tissues without the risk of systemic complications. However, these treatments can be very expensive and application may be difficult for some individuals.

Oral Agents to Relieve Fungal Infections

Oral agents may be convenient for some people, however, they have a comparatively low success rate when compared to other treatment options. Even when an infection is considered to be cured with an anti-fungal oral treatment, it recurs in twenty to fifty percent of people. Many of these agents also have the potential to cause severe side effects. They may cause damage to foetuses, deafness, and other serious conditions.

Nail Removal to treat Serious Fungal Infection of the Nails

Debridement of a partial or entire nail may be accomplished by chemical or surgical means. This is performed in conjunction with the use of topical and, sometimes, oral agents.

The Future of Treatments

Nail infection being treated | ImageLasers are currently being promoted as an effective, safe treatment for nail infections. Yet, most studies that have evaluated their effectiveness have been small in size. Researcher, Ivan Bristow, determined that lasers offer no substantial benefits over other therapies. He found that reinfection was still very common among recipients of laser therapy.

Effective treatment of this uncomfortable and embarrassing ailment relies on increased awareness and education being provided to patients so that fungal infections of the nails may be treated promptly. Further research is needed to develop safer, faster, economical, and more effective treatments for this common condition.
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  • Bristow, I. (2014, July). The effectiveness of lasers in the treatment of onychomycosis: a systematic review. Retrieved from Pub Med:
  • Del Rosso, J. Q. (2014, July). The Role of Topical Antifungal Therapy for Onychomycosis and the Emergence of Newer Agents. Retrieved from Pub med:
  • Harvey, A. (2015, March 15). Fungal Nails. Retrieved from medicine



Portrait of Andrea Salzman
Andrea Salzman

Andrea Salzman, MS, PT graduated from the University of Alabama at Birmingham with a Master’s degree in physical therapy in 1992. Over the last two decades, she has held numerous prominent leadership roles in the physical therapy field, with a heavy emphasis on academic writing and administrative functions. Between 1995 and 1998, Salzman served as the Editor-in-Chief of an American Physical Therapy Association (APTA) journal. In 2010, Salzman received one of the highest honors given to a physical therapist from the American Physical Therapy Association, the Judy Cirullo Leadership Award. Between 2012 and the present, Salzman has written 12 physical therapy courses for Care2Learn, Relias Learning and reviewed over 100 other course offerings. Currently, Salzman continues in her writing, leadership and administrative roles at Aquatic Therapy University and 10K Health. See Educator Profile

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