Nail Fungus

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There are many natural changes in finger and toe nails that occur with age. Fine ridges, for instance, may begin to develop from the cuticle to the nail tip. This and other changes are common, and are not a sign of poor health.

There are, however, nail conditions to watch out for, such as a small separation of the nail from the nail bed, a yellow or brown color, or a hardening, crumbling or thickening of the nail at the top edge. All of these conditions are symptoms of Onychomycosis, a common fungal infection.

Onychomycosis infects the nail bed under the surface of the nail. It can be caused by a variety of fungi. While unsightly, Onychomycosis is typically painless for several years after initial infection. However, if left untreated, the condition will worsen and can become so painful that simply wearing shoes or walking becomes unbearable.

Because fungi thrive in dark, moist areas-such as the inside of your shoes-Onychomycosis afflicts toenails more often than fingernails. Like mold or mildew, these parasitic organisms live on dead things—in this case, nail tissue. Once the fungus establishes itself on dead tissue, it excretes toxins into adjacent living tissue. As this tissue dies, it provides new ground for the fungus.

Once the fungus infects the nail, it digests the protective outer keratin layer. In response to this attack, the body produces excess keratin. This excess forces the nail to separate from the nail bed. The condition can spread to other toes and fingernails if untreated.

Fortunately, your dermatologist can prescribe both oral and topical treatments for Onychomycosis. If you're considering a nail fungal treatment, the following information will provide you with a good introduction to the options available. For more detailed information about how this procedure may help you, we recommend that you consult a dermatologist with experience in the treatment of nail fungus.

*The cost for nail fungus treatments vary depending on the method used.

Fungal nail infections tend to get worse without treatment, infecting more of the nail or surrounding skin. Early treatment may shorten treatment time and increase chances of being cured.

*Treatment is generally successful, but treatment does not work for 20% to 25% of people with the condition.









  1. What are some of the most common benefits of this treatment?
  2. How is this treatment performed?
  3. How are the treatments performed?
  4. How long do the treatments take?
  5. Where are the treatments performed?
  6. How much pain is there?
  7. What can I expect afterward?
  8. Ideal candidate:
  9. Other important information:
  10. Risks and limitations:

What are some of the most common benefits of nail fungus treatment?

Nail fungus can be unsightly and embarrassing. If left untreated, it can become quite painful and permanently disfigure the nail. Treatment kills the fungus and restores the nail to its normal strength and health.

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How is this treatment performed?

Before your treatment, your doctor will arrange for a consultation to talk about the changes you've noticed in your nails and the different options available for treatment. Your doctor will begin with a complete medical history and an examination of your nails. He/she will scrape the nail, or material from under the nail, and test it for the presence of fungi. This test is important because other diseases such as psoriasis or lichen planus can mimic Onychomycosis.

Take this opportunity to ask all the questions you have about the elimination of this fungus. Learning everything you can about your options is the key to making an informed decision about your treatment. See "Questions to Ask Your Doctor" below.

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How are the treatments performed?

The following medications are most commonly used to treat Onychomycosis:

  • Ciclopirox - a nail lacquer that is applied with a brush to the afflicted areas.
  • Fluconazole - a fungistatic, which means it stops fungi from multiplying but doesn't actually kill them. Available in pill form.
  • Griseofulvin - acts by forming deposits in keratin cells, preventing fungal infection of new cells. Most commonly taken in pill form. Eating a high fat meal helps your body absorb this medication.
  • Itraconazole - taken orally either in capsule or liquid form. Taking this medication with food helps maximize its absorption.
  • Terbinafine comes in both topical and oral preparations, but the oral treatments are considered more effective in curing nail fungus infection.

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How long do the treatments take?

Because nails grow slowly, treatment can take six months or longer. Most treatments kill the fungus and stop its growth. Once the fungus has stopped reproducing, the nail should grow out normally.

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Where are the treatments performed?

Your doctor will prescribe the medication likely to work best for you, and you will take it at home for the recommended length of time. You may be asked to make return visits for more tests, to make sure the treatment is working.

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How much pain is there?

There is no discomfort associated with nail fungus treatments, they simply involve taking a pill or brushing a solution on the nail. You'll only experience discomfort if you let nail fungi go untreated

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What can I expect afterward?

Treating nail fungi is a lengthy process, so you'll need to be patient and persistent in carrying out the treatment regimen. To reduce the risk of continued fungal infections, keep your nails short and your feet dry and clean, especially between your toes where fungi like athlete's foot most often strike. Don't walk barefoot around public pools, showers, or locker rooms. Change your socks often, especially if your feet perspire heavily, and wear sandals when possible. Consider using an over-the-counter anti-fungal powder or spray.

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Ideal candidate:

In general, the best candidates for nail fungus treatment are:

  • Individuals who are not pregnant or dependent upon oral contraceptives for preventing pregnancy (Griseofulvin users only).
  • Individuals who do not have lupus or porphyria (Griseofulvin users only).
  • Mature enough to fully understand the treatment process
  • Knowledgeable about the treatment
  • In good physical and psychological health
  • Realistic in their expectations

The above is only a partial list of the criteria that your doctor will consider in determining whether or not this treatment is appropriate for you. Be sure to ask your doctor if she/he considers you an ideal candidate for this treatment.

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Other important information:

Although millions of Americans of all ages have nail fungal infections, this condition most often afflicts those over forty years of age. People with diabetes are at a greater risk of contracting nail fungi, as are those with a history of foot fungus such as athlete's foot.

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Risks and limitations:

Significant problems with nail fungal treatments are infrequent, but potential complications with specific medications include:

  • Ciclopirox - may cause burning, itching, redness, swelling, or other signs of irritation.

  • Fluconazole - possible side effects include vomiting, diarrhea, abdominal pain, loss of appetite, dark yellow or brown urine, dizziness, skin rash, redness, blistering, peeling, or loosening of skin, including inside the mouth. On rare occasions, Fluconazole has caused liver damage.

  • Griseofulvin may interfere with oral contraceptives containing estrogen, resulting in unwanted pregnancies, and should not be taken during pregnancy. It may worsen lupus symptoms in patients suffering from lupus-like diseases and increase attacks of porphyria in patients with acute intermittent porphyria. It can increase the effects of alcohol including rapid heartbeat, increased sweating and redness of the face. Other possible side effects include sensitivity to sunlight, headache, dizziness, diarrhea, nausea, vomiting, stomach pain and unusual tiredness. Rarely, Griseofulvin can cause liver damage.

  • Itraconazole - may cause nausea, headaches, fatigue, abdominal cramps, rash and potassium loss.

  • Terbinafine - may cause nausea, fatigue, diarrhea, dyspepsia, abdominal pain, flatulence, rash, and taste disturbances, such as making foods taste salty. Changes in the ocular lenses and retina have been reported. On rare occasions, Terbinafine has caused liver damage.

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*The information on this web site is only intended as an introduction to this procedure. This information should not be used to determine whether you will have the procedure performed nor as a guarantee of the result. The best method of determining your options is to consult a qualified dermatologist who can answer specific questions related to your situation.

Sher RK, Baran R (2003). Onychomycosis in clinical practice: Factors contributing to recurrence. British Journal of Dermatology, 149(Suppl 65): S5-S9

Disclaimer: Costs source: According to the American Society f Plastic Surgery (ASAPS), nationally in 2009. Most surgeons offer convenient payments plans for this procedure. Cost does not include anesthesia, operating room facility, hospital stay, and other related expenses. Costs may also vary depending on location.

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