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Treatment of Fungal nail infection

It is not always necessary to treat fungal nail infections, especially if the infection is mild or there are no symptoms. However, infections can worsen or spread to other nails, so it is worth removing them if possible, especially if they are unsightly or painful.

There are two main types of treatment; tablets and nail paints:

Antifungal tablets

There are three commonly used types of medicine:

  • Griseofulvin – the only treatment licensed for use on children, having the fewest side effects. It takes a long time to work and the cure rate is not as good as other medicines.
  • Terbinafine – has good results and works in a short period, but can cause skin and liver reactions, and is not licensed for children. 
  • Itraconazole – best results for candida albicans infections (a type of yeast infection).

You usually need to take tablets for 6-12 weeks, sometimes longer, but they will also cure other fungal infections that may be related, such as athlete’s foot.

Antifungal nail paint

Nail paint works best for infections that are at the tip of the nail and have not spread further. It should not be used to treat infections that are on the skin or are touching the skin. Treatment can be lengthy – up to 6 months – and the treatment has to be applied exactly as the instructions direct. The most common treatments are amorolfine nail lacquer, tioconazole nail solution, salicylic acid paint, and undecenoates paint. These treatments have antifungal and antiseptic properties. In order to help them to work properly, it may be necessary to file down any thickened nails.

It is possible to tell that treatment is working if you can see a new healthy nail growing out of the nail base. You need to let the old nail grow out, and trim it as the infected portion reaches the end. Eventually, the nail will appear normal again. The medication stays in the nail for up to 9 months after treatment has finished and continues to work on healing the nail.

While treating infected nails, keep your nails cut short, using a separate pair of scissors to prevent infecting the other nails. Try to avoid injuring your nails or exposing them to irritants by wearing protective gloves. If toenails are infected, make sure you wear properly fitted shoes and try to prevent feet getting hot and sweaty. Wearing clean cotton socks will protect the feet from fungi living in your shoes.

Cure rates for initial treatment of fungal nail infections are around 80%. If they fail, either an alternative drug can be tried, or the nail might be removed. Removal would be combined with further treatment following the some of the options above, during the period of regrowth. It takes about 12 months to fully re-grow a toenail.