Nail fungus is related to a fungal infection that causes changes to fingernail or toenail color, shape and texture. Some patients report a thicker, deformed or yellow nail. This type of infection most commonly affects toenails.

Also referred to as onychomycosis, nail fungus can develop as a result of an overgrowth of many types of fungus. It is commonly related to cases of uncontrolled diabetes (due to general changes to blood flow in the body) and to recurrent antibiotic use.

Treatment for nail fungus usually involves the use of oral or topical (nail polish-like) antifungals, like fluconazole or itraconazole. Some home remedies, like foot soaks and natural creams or lotions can be used to complement your medical treatment.

Common symptoms

The most common signs and symptoms of nail fungus include:

White or yellow nails
Thicker nails
Opaque, fragile or breaking nails
Nails that lift from the skin
Nail deformities
Changes to nail texture
Foul smell

If you notice these changes, you should consult a dermatologist to assess your nails and confirm a diagnosis.

To diagnose this condition, the dermatologist will usually collect a sample of the nail or scrape the underside of a nail to send to the lab. The lab will then identify the type of fungus present, which will help to guide treatment.

Main causes

Nail fungus is caused by different dermatophytes, such as Trichophyton rubrum, Trichophyton mentagrophytes and Epidermophyton floccosum, for example.

Furthermore, yeasts such as Candida spp. and saprophytic fungi, such as Fusarium, Aspergillus, Acremonium, Scytalidium and Scopulariopsis brevicaulis, can also cause nail fungus.

Who is most at risk for nail fungus?

The main factors that increase the risk of nail fungus are:

Uncontrolled diabetes
Weakened immune system, from conditions like an HIV infection or AIDS
Nail trauma from sports or tight shoes
Prolonged use of antibiotics
Poor blood circulation
Ringworm on the feet or tinea pedis
Older age
Frequent contact with soap and water

Furthermore, people who have a family history of nail fungus, are over 40 years old and/or do not have good hygiene habits, may also develop this type of infection more easily.

Types of nail fungus

The main types of nail fungus are:

1. Distal subungual onychomycosis (DSO)

DSO is the most common type of nail fungus. It mainly affects the toenails, although it can less frequently affect the fingernails.

This type of nail fungus is mainly caused by the fungus Trichophyton rubrum and is characterized by the yellowish-brown color underneath the nail. It is typically visualized on the side of the nail or at the tip, close to the where the nail is cut.

DSO can also cause nail detachment and increased thickness of the nail.

2. Proximal subungual onychomycosis (PSO)

PSO occurs close to the cuticle region, leaving the nail with a thinner appearance, a whitish-yellow color. It is more commonly seen on toenails and rarely affects fingernails.

This type of nail fungus is generally caused by the fungus Trichophyton rubrum, and is more common in people with a weakened immune system, from conditions like diabetes, HIV or AIDS, for example.

3. White superficial onychomycosis

White superficial onychomycosis affects the most superficial layer of the nail, leaving it thin with opaque white spots. It can affect the entire surface of the nail.

This type of mycosis is more common on toenails and in people with a weakened immune system. It is most often caused by the fungus Trichophyton interdigitale.

4. Yeast infection in the nail

A yeast infection is caused by the fungus Candida albicans and generally starts in the soft tissues around the nail and spreads to the nail.

This type most commonly affects the fingernails and leaves the nail with an irregular, rough appearance, with a whitish-yellow, green or black color. Tissue around the nail may also be reddened.

5. Endoniacal nail mycosis

Endoniacal nail mycosis, also called Endonyx, affects the nail plate. It leaves the nail yellowish-brown and thick, but does not cause detachment of the nail.

6. Total dystrophic onychomycosis

Total dystrophic onychomycosis is considered to be the final stage of other types of nail mycosis, as it causes complete destruction of the nail.

Treatment options

Treatment for nail fungus should be guided by a dermatologist, and usually involves the use of antifungal medications.

The main treatments that may be recommended by the doctor are:

1. Antifungal medications

The main antifungals that may be recommended by your doctor are:

Medicated nail polishes, such as amorolfine or ciclopirox olamine
Oral tablets, such as terbinafine or itraconazole.

In some cases, the doctor may prescribe a combination of medicated nail polish and antifungal tablets, which varies depending on the severity of the nail fungus.

2. Laser therapy

Another treatment option is the use of laser therapy, which is normally used in cases of chronic nail fungus that appears frequently.

This technique eliminates ringworm fungus through the infrared rays emitted by the laser and is therefore quite effective. However, it is a more expensive form of treatment.

How long does treatment take?

Treatment is usually prolonged, as nail fungus is completed eliminated only after the nail has fully grown out.

It can take around 6 months for nail fungus to clear in the fingernails, and 12 months for nail fungus to clear in the toenails.

Home remedies for nail fungus

Nail fungus can be treated by applying 2 to 3 drops of clove essential oil on affected nails at least twice a day, Clove essential oil contains antifungal and healing properties that can help to speed-up recovery.

Oregano essential oil and tea tree oil are also excellent home remedies for nail fungus, and can also be used.

Other measures to speed-up recovery

Other important consideration for treating nail fungus at home include:

Avoiding the use of tight shoes
Opting for cotton-based socks
Washing and drying the feet thoroughly, including between the toes
Using flip-flops around pools or in locker rooms
Using personal manicure and pedicure tools (and not sharing)

These measures can help to accelerate fungal infection recovery and prevent new infections. They can be used when undergoing medically prescribed treatment.