Nail Fungus: How to Treat it Effectively

Toe nails

Fungi can also attack the nails – one speaks then of nail fungus or onychomycosis. More about symptoms, therapy, and prevention of nail fungus.

What is toenail fungus?

Nail fungus also called onychomycosis (from onycho = nail, mycosis = fungal disease) by physicians, is a fungal infection of the nails. In most cases, it is caused by filamentous fungi, so-called dermatophytes, less frequently by yeast or mold.

Nail fungal diseases must always be diagnosed by a doctor. In contrast to the treatment of athlete’s foot, nail fungus treatment is more complicated and protracted.

If the affected nail is not treated properly, there is a risk that the fungus will destroy it completely and also attack the adjacent nails. This not only looks unattractive but can cause considerable pain and lead to impaired walking.


An infection of the nail is usually caused by filamentous fungi, especially the species Trichophyton rubrum. More rarely, yeast or mold fungi are the cause. Filamentous fungi, called dermatophytes, find almost ideal living conditions on the body surface. Because they have it on keratin apart: The horn-substance in skin, hair, and nails.

In addition, moisture and heat favor an infection with filamentous fungi. Accordingly, they prefer toe gaps, groins, skin folds, and armpits. Nail fungus is very often the result of a mycosis pedis disease, which spreads to the nails. The entrance gate is usually the nail bed in the area of the free nail edge. Direct infection of the nails is also possible. The infection usually occurs in public baths, saunas, fitness studios or showers, and changing rooms of sports facilities, where many people walk barefoot. This is because the fungi are transmitted through contact with pathogens that are found in skin scales, for example, and can survive there for days and weeks.

Risk groups

With the years the danger for a fungal disease increases completely generally: With older humans, several factors of risk come together, which makes them more susceptible to infection. The blood circulation is usually worse because the vessels are “calcified” (arteriosclerosis). In many cases, the immune system is weakened because they suffer from numerous diseases and may have to take medication to suppress their immune system.

Diabetics are also particularly at risk because they too often have a combination of risk factors: A weakened immune system, circulatory disorders of the feet, and sensitivity disorders, which make them not well aware of injuries, for example, which can be an entry point for pathogens.

In general, also all, which suffer from blood circulation disturbances, have an increased risk of getting foot and nail fungus. The same applies to people who have to take medication that suppresses the immune system.

Athletes also belong to a group of people at risk. On the one hand, people who do a lot of sport come into contact with others – potential fungal carriers – more intensively: The climate in communal showers and changing rooms are conducive to fungal infections. On the other hand, wearing a sports shoe creates conditions that are conducive to fungal growth: Due to the increased sweat secretion during sports, fungi have an easier time on the softened skin. This also explains why fungal infections are more common among some occupational groups such as construction workers or miners.

Nail Fungus Symptoms

The fungal attack usually starts at the front edge of the nail. From here the fungi spread over the entire nail plate and change the structure of the nail material: the nail substance, the keratin, is slowly dissolved and air-filled cavities are formed. These become visible as white stripes or spots. The affected nail area thickens and discolors whitish to yellow-brown.

With dermatophytes, the changes usually begin at the free nail edge. If, on the other hand, yeast fungi are responsible for the infection, the discoloration is more likely to appear at the nail wall – where the nail grows out. As the infection progresses, the nails become rough and brittle to crumbly. The nail plate loosens and the nail even partially lifts off the nail bed. If the nail matrix is also affected, the newly formed nail is immediately infected with the fungus.

Typical symptoms of nail fungus infestation are:

  • Brittleness of the nails and splitting off of individual nail layers
  • White stripes or stains
  • Whitish to yellowish-brown discolorations
  • Thickening of the nail plate
  • Inflamed nail bed

Complications with nail mycosis

Nail fungal diseases are not life-threatening, but should not be taken lightly. On the one hand, they can be very painful and severely restrict the function of the affected foot or finger. They also represent a starting point from which the fungus can spread to other parts of the body.

On the other hand, fungal infections of the nail can also pave the way for other diseases. This is because the fungal traces lead to tiny injuries on the nail, which makes it easier for bacteria and viruses to penetrate.

Nail Fungus Diagnosis

The suspicion of nail fungus should always be supported by the detection of the fungus: The more precise the diagnosis, the better the fungus can be controlled. To identify the fungus, the doctor mills or cuts a small piece of the affected nail. The nail samples are then prepared with solutions. This allows the doctor to determine under the microscope whether fungal spores are present in the nail.

Once it has been conclusively clarified in this way that it is indeed a nail fungal infection, the doctor will then create a fungal culture with the nail shavings. For this purpose, the fine nail pieces are placed on a special culture medium and cultivated under conditions suitable for fungal growth. If appropriate fungal colonies have developed, the doctor can tell which type of fungus is involved and initiate a treatment adapted to it. Alternatively, molecular biological methods are available today with which the genetic material of the fungus can be quickly detected and thus identified.

Nail Fungus Therapy

There are certain remedies against fungal diseases, the so-called antimycotics. They contain active ingredients that specifically kill fungi or inhibit their growth.

As long as only the superficial nail layers and less than half of the nail are affected, the infection can still be treated externally with tinctures and nail polishes containing antimycotics. However, if the fungi have already penetrated deeper into the nail, the growing nail is also repeatedly infected. In this case, an internal treatment with tablets or capsules is necessary. The fungicidal agent then reaches the nails via the bloodstream and is deposited in the nail matrix.

The choice of suitable preparation is made by the physician on the basis of the results of the fungal culture. If the type of fungus is not exactly known, so-called broad-spectrum antimycotics can be selected, which are directed against many different types of fungi at the same time.

It takes time until the active substances have penetrated the nail layers and can kill the fungus. This is because there are air-filled cavities between the nail layers. Fungal spores can survive for many weeks, months, and even years. No medication can reach them – neither from the outside nor from the inside.

To break through these, there are ointments that are applied to the nail in addition to the external and internal therapy. They contain potassium iodate or urea in relatively high concentrations and are thus able to dissolve the upper layers of the nail. On the one hand, this allows the active ingredients to penetrate the underlying nail layers better and faster. On the other hand, a part of the air-filled cavities, in which the fungal spores are located, is exposed. So also these can be killed. An alternative to such ointments may be to have the affected nail layers removed by a doctor with a kind of small milling machine.

The anti-fungal agents must be used regularly and above all long enough – until the nails have grown back healthy. And that takes time. One must count on three months of therapy when taking tablets. With a fungal nail varnish, the therapy can take about six months. An accompanying athlete’s foot should always be treated as well.


The following tips can help to avoid a fungal infection of the nails:

  • Do not walk barefoot in public facilities (saunas, swimming pools, hotels…)
  • Wash towels, bath mats, socks, and bed linen at temperatures above 140┬░Fahrenheit degrees; or even better cook them
  • Wear well-fitting and comfortable shoes. Breathable material is just as important as the right fit – so that foot moisture is quickly dissipated again. Therefore wear shoes with a breathable upper material such as leather or modern microfibers.
  • Wear sneakers only for the time of the sport. If possible, choose different shoes every day so that the individual pairs can dry. Use socks made of natural materials and change them daily.
  • Take care of your nails regularly
  • Diabetes mellitus must be treated accordingly and good blood sugar levels must be maintained – this prevents complications!
  • Diabetics should pay special attention to their feet and check them regularly for changes.

You should pay attention to this if you are already infected:

  • If you are already infected, you should use your own towel for your feet and change it daily
  • Clean tools such as nail scissors or file and of course hands very carefully after each contact with the infected nail. Otherwise, there is a high risk of infection for other parts of the body
  • Washing the socks at least 140┬░ Fahrenheit can kill fungi. In addition, it can be useful for people with nail fungus to disinfect their socks and shoes during and after therapy to prevent a renewed infection. Talk to your doctor about this!
  • Out of consideration for others: Do not walk barefoot! Neither at home nor in public institutions!

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