Treatment Overview
For many people, a fungal nail infection (onychomycosis) is more than just a cosmetic nuisance; it is a persistent and often painful condition that can affect daily confidence. The thickening, discoloration, and crumbling of the nail can make wearing shoes uncomfortable and walking difficult. It is common to feel embarrassed by the appearance of the feet or hands, leading many to hide them. While fungal infections are notoriously stubborn, they are not permanent.
Treatment is essential not only to restore the appearance of the nail but to prevent the infection from spreading to other nails or the skin (athlete’s foot). In severe cases, particularly for individuals with diabetes or weakened immune systems, untreated fungal nails can lead to serious secondary bacterial infections. Because nails grow slowly and the fungus lives deep within the nail bed, treatment requires time and patience. The choice of medication depends heavily on the severity of the infection and the patient’s general health (American Academy of Dermatology, 2023).
Overview of treatment options for Fungal Nail Infection
The primary goal of treatment is to eradicate the fungus and allow a new, healthy nail to grow in its place. Because the nail acts as a hard protective shield, reaching the fungus underneath is challenging. Consequently, treatment approaches generally fall into two categories: topical treatments applied to the nail surface and systemic medications taken by mouth.
Clinical experience suggests that while topical treatments are safer, oral medications are significantly more effective for established or thick infections. Treatment is a long-term commitment; even after the fungus is killed, the damaged nail must grow out completely, which can take several months for fingernails and up to a year for toenails. In some cases, doctors may recommend removing the nail surgically or chemically to allow medications to work better, but pharmacologic therapy remains the standard approach.
Medications used for Fungal Nail Infection
Oral antifungal drugs are considered the first-line treatment for most moderate to severe infections. The most commonly prescribed medications in this class include terbinafine and itraconazole. These drugs travel through the bloodstream to reach the nail bed, attacking the infection from the inside out. Studies show that terbinafine typically offers the highest cure rates for toenail infections (Centers for Disease Control and Prevention, 2022).
For mild cases or for patients who cannot take oral medications due to liver issues or drug interactions, topical antifungals are used. These include medicated nail lacquers like ciclopirox or newer topical solutions such as efinaconazole and tavaborole. These are applied daily or weekly, similar to nail polish, and are designed to penetrate the hard nail plate.
Fluconazole is another oral option sometimes used, though it is often considered a second-line choice depending on the specific type of fungus (yeast vs. dermatophyte). Patients should expect gradual improvement; the clear nail will appear at the base (cuticle) and slowly move outward as it grows (Mayo Clinic, 2022).
How these medications work
Antifungal medications work by compromising the structural integrity of the fungus. Fungal cells are protected by a rigid cell membrane that relies on a substance called ergosterol to stay intact. Both oral and topical drugs interfere with the enzymes the fungus needs to produce ergosterol.
When this production is blocked, the fungal cell membrane becomes unstable and “leaky.” It can no longer regulate what enters or exits the cell, causing the fungus to die or stop reproducing. Oral medications accumulate in the nail bed and remain there for months even after the patient stops taking the pills, providing a sustained attack on the infection.
Side effects and safety considerations
Oral antifungals are potent drugs that require medical supervision due to risks like potential liver damage. Doctors often require liver function blood tests before and during treatment. Other common side effects include headache, taste changes, diarrhea, or rash.
Topical medications are generally safer but may cause localized redness, stinging, or ingrown nails. Patients must inform their doctor of all medications, as oral antifungals can have dangerous interactions with blood thinners and certain heart drugs. Seek immediate medical attention for signs of liver issues, such as jaundice, dark urine, or severe fatigue (MedlinePlus, 2021).
Since everyone’s experience with the condition and its treatments can vary, working closely with a qualified healthcare provider helps ensure safe and effective care.
References
- American Academy of Dermatology. https://www.aad.org
- Centers for Disease Control and Prevention. https://www.cdc.gov
- Mayo Clinic. https://www.mayoclinic.org
- MedlinePlus. https://medlineplus.gov
Medications for Fungal Nail Infection
These are drugs that have been approved by the US Food and Drug Administration (FDA), meaning they have been determined to be safe and effective for use in Fungal Nail Infection.