Treat stubborn nail fungus
Dr. Anja Loose-Roland
Updated on 02. November 2023
A nail fungus not only looks unsightly, but can also cause pain if not treated. The fungal infection can affect the nails on the fingers as well as on the feet. The disease, called onychomycosis in Latin, occurs frequently and about one in five adults worldwide is affected.
Nail fungus Brief overview:
- Causes: Warm and moist nails meet the pathogen
- Symptoms: Dull, milky coloured nails
- Prevention: Changes in lifestyle habits
- Treatment: Antimycotics
Symptoms of nail fungus
Finger and toenails are made of horn, which contains a high proportion of keratin. This horny layer normally forms a good protection against the penetration of pathogens such as fungi or bacteria. If the horny layer is damaged or less stable, germs and fungi can penetrate.
How can I recognise a nail fungus?
From the front edge of the affected nail, discolouration spreads over the entire area. As a result, nail fungus shows itself in the following symptoms:
- dull, milky coloured nails in the initial stage
- Brittle nails and splitting off of individual nail layers
- Light stripes or spots
- Yellowish to brown discolouration or spots
- Thicker nail plate
- Inflammation of the nail bed
- reddening of the surrounding skin
It is of great advantage to diagnose nail fungus already in the early stages, when the nails lose their shine and become cloudy. At this point, a quickly initiated therapy can significantly shorten the duration of treatment.
Is nail fungus dangerous?
Onychomycosis is not a life-threatening disease, but it can cause unpleasant consequences. If the nail fungus is not treated in time, it can spread to other nails. In the final stage, the fungus has eaten away the nail and it dies. The pain spreads from the tips to the fingers and toes. Everyday movements such as grasping with the fingers or walking are accompanied by pain. In addition, nail fungus can cause further complications. On the one hand, the fungus can spread from the nail into the body. At the same time, small injuries of the skin often occur in the final stage of nail fungus. Through these, viruses and bacteria can enter the body and cause inflammation.
Can nail fungus also cause black discolouration?
Nail fungus can also make itself felt through black discolouration of the nails. If fungi penetrate the horny layer and leave small cavities, the nail turns black. Likewise, a special type of fungus, the darkly pigmented filamentous fungus Neoscytalidiumdimidiatum, can cause black discolouration of the nails. Colloquially, this is often referred to as black nail fungus. However, nail fungus with a black colour is no more dangerous than other types. Treatment is also the same as for white nail fungus.
Causes of nail fungus
Nail fungus is usually caused by filamentous fungi called dermatophytes. In rare cases, yeast and smear fungi can also cause the infection. Filamentous fungi love a warm, moist climate, such as exists on the surface of the skin. Keratin is an important basis of life for these fungi. Finger and toe nails, with their high keratin content, therefore offer ideal living conditions.
Where nail fungus comes from
We encounter fungi in many places in everyday life. Mostly, nail fungus is the result of an existing disease, such as an untreated infection with athlete's foot. But small wounds on the nails or skin can also be a good entry point for the fungus. Warmth and moisture are particularly conducive to fungal growth. That is why dermatophytes are usually transmitted in the following places:
- Swimming pools, saunas and spas
- Changing rooms, showers and barefoot sports mats in fitness studios
- Carpeting in hotel rooms
- In all places where shoes are rented, such as climbing gyms, ski rental shops, etc.
- Shoe shops
Risk groups for nail fungus
Not every small injury immediately leads to nail fungus. A weakened immune system or poor circulation are the most common risk factors for an increased risk of infection. This is why older people are more likely to contract the disease. People with the following pre-existing conditions should be particularly attentive:
- Weakened immune system
- Diabetes
- psoriasis
- Circulatory disorders
- Sweaty feet
Do nail fungi occur equally often on toes and fingers?
People do come into contact with foreign objects with their fingers more often. At the same time, the hands are drier and are washed more often. The toes, on the other hand, are often in shoes where there is a moist environment. That is why nail fungus occurs more often on the toe than on the finger.
Treat nail fungus
Nail fungus does not go away without treatment. The important thing with nail fungus is early detection, if possible in the early stages. The sooner the fungus is treated, the shorter the duration. In general, patients must be prepared for a lengthy treatment that also requires some discipline from the patient.
Which doctor for nail fungus?
The contact person for fungal infections of the nails is the family doctor. The faster you start treatment, the easier and faster the healing process will be. The dermatologist can also make a reliable diagnosis through microscopy and laboratory tests and rule out other causes for the symptoms.
What does a doctor do if nail fungus is suspected?
When treating nail fungus, it is important to know the causative fungus. This allows a targeted antifungal agent to be used. The dermatologist carefully removes a sample from the affected area of the nail with the medical burr. With the help of the microscope, he can clearly diagnose nail fungus. So that the type of fungus can be assigned, a fungal culture is prepared from the sample by the dermatologist in the laboratory. For this purpose, the nail sample is inoculated with a nutrient solution and the fungal growth is accelerated. Modern laboratories can already determine the type of fungus by means of genetic analysis (PCR test) and thus shorten the time until treatment.
What helps against nail fungus?
Treatment essentially depends on the stage of the disease. Antimycotics, which kill fungi, are used. In the initial stage of nail fungus, nail varnishes, tinctures or ointments with antimycotic agents are often sufficient. If the nail fungus is advanced, systemic antimycotics in the form of tablets must be used. The products for local therapy are mainly available in pharmacies.
How does a nail polish work against nail fungus?
You can treat nail fungus with a varnish from the pharmacy. These products contain bifonazole, clotrimazole, econazole, ketoconazole, miconazole and sertaconazole as active ingredients. These ingredients are antifungal agents that fight the fungus and its spores. The watery varnish is applied thinly and penetrates the nail. Before applying a nail varnish to nail plic, the affected nail should be filed down as far as possible. This makes it easier for the active substances to reach the fungi in the cavities. Dermatologists and medical chiropodists also offer filing.
Which tablets help against nail fungus?
In the case of nail mycosis, the tablets are divided into two different groups of active substances depending on the fungus causing the infection. Infections with filamentous mycoses, which make up the majority of infections, the active substance terbinafine is used. Itraconazole works very successfully against yeast and smear fungi. Antimycotics require a prescription and may only be taken after consultation with the doctor. Especially in patients with liver disease, the intake should be carefully weighed up. In the case of nail fungus during pregnancy and breastfeeding, the use of antimycotics should also be discussed with the dermatologist.
Which remedies can also help with nail fungus?
A good active ingredient for nail fungus is bifonazole. It is used in creams and ointments against fungi. Since this substance cannot penetrate as deeply into the nail, products with bifonazole should additionally contain urea in a higher dosage. New products contain terbinafine, which is originally used in tablets against mycoses. Creams containing 40% resin are often recommended as a preparation for many topical antifungal agents. These agents soften the nail and it can be gradually removed. This allows antifungal agents to work better.
How long does the treatment for nail fungus take?
The treatment of nail fungus is lengthy and requires patience. On the one hand, the nail with its keratin offers the best conditions for the growth of the fungi. Furthermore, it is difficult to kill the fungi and spores under the nail plate. Therefore, a local treatment of nail fungus with varnish, tincture or ointment can take up to 12 months. When taking tablets against nail fungus, the disease usually subsides within several weeks or months.
What home remedies help with nail fungus?
There are some home remedies that have antifungal properties and can successfully fight fungi. However, their effect is too superficial to fight the pathogens in the hard-to-reach areas of the horny plate. Therefore, home remedies can rather be used in a supportive way to prevent the fungi from spreading to other fingers or toes and to relieve pain. For fungal infections of the toes, foot baths are often recommended to soften the nails before grinding them down. These can be mixed with appropriate home remedies. Recommended home remedies for treating nail fungus are:
- Baking soda dries out moist areas and can reduce further spread. Soda can be sprinkled on the toes as a powder or paste.
- Tea tree oil has antifungal and disinfecting properties. Diluted with a neutral oil such as almond oil 1.1, it is applied with a cotton swab to unaffected nails as a preventive measure. Lavender oil and sage oil also have a similar effect.
- Essential oils such as tea tree or lavender oil as an additive to a foot bath care for and also prevent the preparation on other nails.
- Apple cider vinegar lowers the pH value and thus creates an unfavourable environment for fungi. In a foot or hand bath, it thus protects against transfer to other toes or fingers.
- Tannins from witch hazel, for example, have an astringent effect and thus close wounds. Germs can penetrate the skin less easily. Witch hazel\]\(/witch hazel/) should be used especially for cracked skin. Witch hazel can be added as an extract to a foot bath or used as a cream on toes or fingers.
What do I have to consider in everyday life with nail fungus?
A nail fungus can be transmitted quickly. On the one hand, transmission to other areas can occur in the patient himself. But other people, especially family members, could also become infected. Therefore, strict hygiene must be observed in the case of a fungal disease. The following points should be considered:
- The patient should use a separate towel for the affected area. This must be changed daily or if it is damp for a longer period of time.
- In the case of athlete's foot, cotton socks should be worn if possible and changed every day. Shoes should be treated with a suitable shoe disinfectant once a week.
- Equipment for manicure or pedicure should be disinfected after use. This also applies if they have been used for apparently unaffected areas.
- In the case of nail fungus on the toes, socks should be washed at a temperature of at least 60 °C, as should bed linen. It is best to use a heavy-duty detergent. If the laundry cannot be washed at high temperatures, use a hygiene rinser.
- Out of consideration for others, do not walk barefoot in the home, in the swimming pool and on similar occasions if you have athlete's foot or nail fungus.
- In case of nail fungus on the toes, only walk in the bathroom with socks and only take them off in bed. Alternatively, towels can be used as bath mats and changed regularly.
How long do I have to treat the nail fungus?
The nail fungus must be treated until the doctor cannot see any spores under the microscope. As long as these are present, the fungus can quickly spread again. Even if the long duration of treatment tries your patience, it is important to persevere.
Can I go to a chiropodist with nail fungus?
Instead of cosmetic foot care, it is worth going to a podiatrist. Medical foot care also includes the treatment of nail fungus. Your podiatrist professionally roughens the skin of the nail so that varnishes, tinctures and creams can penetrate well.
Is there an insider tip for nail fungus?
A fairly new treatment method for nail fungus is laser irradiation. The laser destroys the fungi and their spores through heat. Depending on the type of fungus and the degree of the disease, different procedures are chosen. Multiple treatments are often necessary. The cure rate is between 68 and 80 %. The disadvantage of this procedure is that health insurance companies do not cover the treatment costs.
Prevent nail fungus
With simple changes in lifestyle habits, the risk of nail fungus can be reduced.
- Bathing shoes should be worn in the swimming pool, sauna and in the shower and changing room of gyms.
- Thoroughly dry hands and feet after washing or showering. Do not forget the spaces between the feet and the area around the nails.
- Sweat-absorbing cotton socks should be worn to prevent sweaty feet.
- Shoes should be made of breathable leather. Allow shoes to air out well after wearing, preferably for 24 hours. Only wooden shoe trees should be used, as this material can absorb moisture.
- Regular medical foot care is advisable for high-risk patients with diabetes and circulatory disorders. Preventive measures against nail fungus are taken. The treatment is partly covered by health insurance.
- Hands and feet should be regularly cared for with a suitable cream. This makes dry and brittle skin more supple and less chapped.
What home remedies can be used to prevent nail fungus?
Depending on the cause of the nail fungus, several preventive measures can help.
- For athlete's foot: Athlete's foot should be treated as soon as possible. Lavender oil and tea tree oil are effective against fungi. Both essential oils can be mixed with a caring neutral oil such as almond or coconut oil in a 1:1 ratio. The mixture is then rubbed onto the affected areas with a cotton swab. A foot bath with lavender and tea tree oil also helps effectively against athlete's foot.
- For cracked skin and small wounds: Dry skin with fissures tends to crack. Tannins have an astringent and wound-healing effect. Important suppliers of the valuable healing substances are [witch hazel\]\(/witch hazel/) and black tea. Both home remedies can be used as foot baths to promote rapid healing. Witch hazel ointment is also very suitable for this purpose.
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