What is the treatment for a fungal nail infection?
Not treating
This is an option if the infection is mild or causing no symptoms. For example, a single small toenail may be infected and remain painless and of little concern. Some people may prefer not to take treatment because:
- Treatment does not always cure the infection. Cure rates are about 60–80%.
- Treatment that clears the infection does not always restore the nail's appearance to normal.
- The antifungal drugs used for treatment need to be taken for several months, sometimes longer.
- Although rare, unpleasant side-effects sometimes occur with antifungal drugs.
The option to treat can be reviewed at a later date if the infection becomes worse or if you change your mind.
However, treatment is usually advised if:
- Symptoms are troublesome. For example, if walking is uncomfortable due to an affected nail.
- Abnormal-looking nails cause distress.
- You have diabetes, vascular disease, or a connective tissue disorder (because of a higher risk for secondary bacterial infections and cellulitis).
- The nail infection is thought to be the source of a fungal skin infection on your body.
- You are, or are likely to develop, severe problems with your immune system. For example, if you are to have certain types of cancer treatment.
Antifungal tablets will often clear a fungal nail infection. The medication will also clear any associated fungal skin infection, such as athlete's foot. Your doctor will usually recommend one of the following two drugs. The one chosen may depend on the type of fungus causing the infection. Both of these drugs cause side-effects in a small number of people, so read the packet that comes with the drug for a full list of cautions and possible side-effects.
- Terbinafine tablets. The usual adult dose is 250 mg once a day; for between 6 weeks and 3 months for fingernails, and for 3–6 months for toenails. Visible improvement can be expected after the end of two months of treatment for fingernails and three months of treatment for toenails.
- Itraconazole tablets. This is usually given as 'pulsed' treatment. That is, for an adult: 200 mg twice a day for one week, with subsequent courses repeated after a further 21 days. Fingernail infections require two pulsed courses and toenail infections require at least three pulsed courses.
Studies suggest that in about 5 in 10 cases the nail will look fully normal again after treatment. In about a further 2 in 10 cases the fungus will be cleared from the nail after treatment, but the nail does not look fully normal again. Fingernails tend to respond better to treatment than toenails. One reason for treatment to fail is because some people stop their medication too early.
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