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Your doctor will examine your nails. He or she may also take some nail clippings or scrape debris from under your nail and send the sample to a lab to identify the type of fungus causing the infection.
Other conditions, such as psoriasis, can mimic a fungal infection of the nail. Microorganisms such as yeast and bacteria also can infect nails. Knowing the cause of your infection helps determine the best course of treatment.
Fungal nail infections can be difficult to treat. Talk with your doctor if self-care strategies and over-the-counter (nonprescription) products haven’t helped. Treatment depends on the severity of your condition and the type of fungus causing it. It can take months to see results. And even if your nail condition improves, repeat infections are common.
Your doctor may prescribe antifungal drugs that you take orally or apply to the nail. In some situations, it helps to combine oral and topical antifungal therapies.
- Oral antifungal drugs. These drugs are often the first choice because they clear the infection more quickly than do topical drugs. Options include terbinafine (Lamisil) and itraconazole (Sporanox). These drugs help a new nail grow free of infection, slowly replacing the infected part.You typically take this type of drug for six to 12 weeks. But you won’t see the end result of treatment until the nail grows back completely. It may take four months or longer to eliminate an infection. Treatment success rates with these drugs appear to be lower in adults over age 65.Oral antifungal drugs may cause side effects ranging from skin rash to liver damage. You may need occasional blood tests to check on how you’re doing with these types of drugs. Doctors may not recommend them for people with liver disease or congestive heart failure or those taking certain medications.
- Medicated nail polish. Your doctor may prescribe an antifungal nail polish called ciclopirox (Penlac). You paint it on your infected nails and surrounding skin once a day. After seven days, you wipe the piled-on layers clean with alcohol and begin fresh applications. You may need to use this type of nail polish daily for almost a year.
- Medicated nail cream. Your doctor may prescribe an antifungal cream, which you rub into your infected nails after soaking. These creams may work better if you first thin the nails. This helps the medication get through the hard nail surface to the underlying fungus.To thin nails, you apply a nonprescription lotion containing urea. Or your doctor may thin the surface of the nail (debride) with a file or other tool.
Your doctor might suggest temporary removal of the nail so that he or she can apply the antifungal drug directly to the infection under the nail.
Some fungal nail infections don’t respond to medicines. Your doctor might suggest permanent nail removal if the infection is severe or extremely painful.