Brief overview
- Treatment: Long-term and consistent treatment with antifungal agents (antimycotics) as nail varnish, cream or stick, possibly in tablet form; laser therapy
- Symptoms: Depending on the type of fungus, discoloration from the edge or from the nail root, complete discoloration or spots, thickening and dissolution of the nail structure or splintering of the upper layers; often pain, reddening of the nail fold, nail bed inflammation
- Causes and risk factors: Infection e.g. via shared towels, carpets, beds; damp environment in closed shoes (“sweaty feet”), use of communal showers, frequently damp/wet hands, metabolic and immune diseases (e.g. diabetes mellitus, HIV infection), circulatory disorders, vitamin and zinc deficiency
- Progression and prognosis: Good chance of recovery if long-term treatment is started early and carried out consistently
- Prevention: Breathable shoes and socks, change underwear frequently, keep feet dry
What is nail fungus?
In a nail fungus infection (onychomycosis), one or more nails are infected by a fungus that destroys the nails. This affects both fingernails and toenails – although the latter are much more common. One reason for this is that the feet are exposed to greater mechanical stress. As a result, tiny injuries are more likely to occur, which serve as entry points for fungi and other pathogens.
In the early stages of a nail fungus infection, the fungus often grows on the big toe. However, it may also infect other toes or spread over several nails. The same applies to the fingernails. In severe cases, all the nails of a foot or hand are affected by nail fungus.
How can nail fungus be treated?
If the nails are unsightly and crumbling, many sufferers ask themselves: What is the quickest way to treat nail fungus? The answer is no, because depending on how badly the fungus has spread, the treatment of nail fungus is usually lengthy.
Antifungal nail polish, cream and stick
A local nail fungus treatment with antifungal nail polish, cream or stick can be carried out by any patient at home. This self-treatment may be sufficient in mild cases, for example if:
- Only one nail is affected
- A maximum of half of the nail surface is affected
- The nail root (nail matrix) is not infected, i.e. the area in which the nail plate is formed
If you are unsure whether these points apply to you, ask a doctor or podiatrist for advice.
Nail fungus treatment with tablets
See a doctor if independent nail fungus treatment is not successful or if many nails or larger nail areas are affected. Local nail fungus therapy must then usually be supplemented by systemic therapy – i.e. by taking antifungal tablets. They contain active ingredients such as terbinafine, itraconazole and fluconazole, which have an antifungal effect.
Older patients, on the other hand, are preferably treated with terbinafine. The risk of interactions with other medications is much lower with this active ingredient than with itraconazole and fluconazole. This is particularly important for older people because they usually take several different medications such as antihypertensives.
The nails of children and infants are also occasionally infested with fungi. Where possible, doctors try to combat nail fungus with ointments and varnishes as well as hygiene measures, as systemic antimycotics are generally not approved for children. However, there are now studies that show that antifungal agents are also low-risk in children.
Nail fungus treatment by means of surgery
Nail fungus treatment with laser
Laser irradiation is a new treatment option for nail fungus. The advantage of laser therapy for nail mycosis is that it hardly causes any side effects if carried out correctly.
You can find out more about laser therapy for onychomycosis in the article Nail fungus laser.
Nail fungus: homeopathy & co.
Many sufferers want to treat onychomycosis with alternative methods. Some rely on essential oils or Schuessler salts. Others rely on homeopathy. However, nail fungus is rarely treated exclusively with alternative medicine. In fact, there is a risk that nail fungus will spread rapidly without adequate treatment. Instead, alternative healing methods can often be used alongside conventional medical treatment.
The concepts of homeopathy and Schuessler salts and their specific effectiveness are controversial in science and have not been clearly proven by studies.
Nail fungus: home remedies
“Better natural than chemical” is what many people think and prefer home remedies in the fight against nail fungus. For example, vinegar or acetic acid, lemon, marigold and aloe vera as well as tea tree oil are used. Such remedies are considered a gentle aid against fungal infections. They are mainly applied externally directly to the affected nail.
Home remedies have their limits. If the symptoms persist over a longer period of time, do not improve or even get worse, you should always consult a doctor.
You can read more about the use of home remedies for fungal infections of the nails in the article Nail fungus home remedies.
Be sure to stick to the treatment!
Nail fungus treatment is lengthy and requires a lot of patience and consistency from those affected. Even in mild cases, it can take weeks to months. In severe cases, nail fungus therapy can take up to a year or longer. The reason for this is that the affected nail area must first have completely grown out before the patient is considered cured.
Infected fingernails are usually treated more quickly than toenails.
How can you recognize nail fungus?
The symptoms of nail fungus vary in the different forms of onychomycosis, as described below. However, the following applies to all of them: if the infection is not treated or treated too late, there is a risk that the entire nail will eventually be infected and completely destroyed by the fungus (total dystrophic onychomycosis).
Distolateral subungual onychomycosis (DSO)
Initially, the nail plate looks dull and dull before it turns white-yellowish in color. Other symptoms such as pain are usually absent in this phase of nail fungus.
Due to excessive keratinization under the nail plate (subungual hyperkeratosis), the nail gradually thickens and begins to detach from the nail bed. In some patients, the thickened nail plate presses painfully on the sensitive nail bed underneath. In the case of nail fungus on the foot, this is particularly noticeable when wearing tight shoes and walking.
There is also a risk that, in addition to the nail fungus, bacteria can colonize the damaged tissue and cause nail bed inflammation (onychia). Pain is then also possible and the entire nail is very sensitive to pressure.
Proximal subungual onychomycosis (PSO)
This form of nail fungus is also usually caused by the filamentous fungus Trichophyton rubrum. It penetrates the nail wall, where the nail grows out, via the skin into the nail plate and the nail bed. The nail shows a whitish discoloration and clouding. This form of onychomycosis almost exclusively affects people with a weakened immune system.
White superficial onychomycosis (WSO)
This nail mycosis is also known as Leukonychia trichophytica. The trigger is usually the filamentous fungus Trichophyton interdigitale (T. mentagrophytes). It penetrates directly into the surface of the nail plate. As a result, white spots form in the nail.
Onychia et Paronychia candidosa (Candida paronychia)
Later, the nail plate discolors at the edges. Depending on an additional bacterial infection, the color varies from yellowish to brownish to greenish. Without treatment, the fungus spreads to the nail matrix and the nail bed.
Candida paronychia develops preferentially on the fingernails of people who often work with their hands in damp or wet environments.
Edonyx onychomycosis
How does nail fungus develop?
Nail fungus is usually caused by filamentous fungi (dermatophytes). Sometimes molds or yeasts are also responsible for the infection. The latter mainly affect the fingernails.
The fungi attack all keratinized areas of the body, i.e. skin, nails and hair. They feed on the main component keratin.
Is nail fungus contagious?
Nail fungus reaches the skin through fungal spores. Spores are microscopically small particles of fungi that survive for a very long time and serve to spread. The most common transmission route is from person to person.
Fungal spores are also transmitted to humans from contaminated objects such as towels, bath mats, carpets and beds.
Risk factors for nail fungus
The same applies if you do not clean and dry the spaces between your toes properly. This is particularly true for people who have a physical disability or a leg in plaster, for example. They are more likely to get athlete’s foot and nail fungus.
Experts also suspect that nail fungus on the feet often develops as a result of a foot fungus infection (tinea pedis). As a result, many people suffer from both infections at the same time.
Other risk factors that favor nail mycosis on the feet are
- Frequent contact with fungal nail pathogens, for example in swimming pools, communal showers or saunas
- Injuries to the nails
- Certain skin diseases such as psoriasis
- Weakened immune system, e.g. with some diseases (such as HIV) or when taking medication that suppresses the immune system (such as cortisone)
- Family predisposition
Diabetics are more susceptible to fungal infections due to the high levels of sugar in their blood – the sugar serves as food for the fungi.
People who often have damp or wet hands at work are particularly susceptible to nail fungus on their hands. This includes cleaners, for example.
Vitamin deficiency (vitamins A, B1, B2, K, folic acid) and zinc deficiency are also suspected to be general risk factors for nail fungus (and also skin fungus).
How is a nail fungus infection diagnosed?
The first point of contact for the diagnosis of nail fungus is the family doctor. Dermatologists (dermatologists) also treat nail fungus.
- How long have the nail changes (thickening, discoloration) been present?
- Do you have any known chronic illnesses (such as diabetes or psoriasis)?
- What do you do for a living?
- Does anyone in your family have or have had a fungal infection?
The interview is followed by a physical examination: the doctor examines the affected nails and surrounding tissue. Thickened, discolored nail plates are often a clear indication of nail fungus.
Other differential diagnoses are rare chronic nail changes that develop, for example, in circulatory disorders, thyroid diseases, iron, calcium or vitamin deficiencies.
Detection of nail fungus pathogens
A nail fungus test helps the doctor to clarify the nail changes: he disinfects the affected nail with alcohol and then scrapes off some of the nail plate. He stains the tiny nail shavings with a special dye and examines them under the microscope for fungal spores. If he finds any, this indicates a nail fungus.
If the nail fungus is very pronounced, the doctor will start antifungal therapy beforehand – with an active ingredient that is effective against a whole range of fungi (broad-spectrum antifungal).
In rare cases, other tests are carried out for nail fungus. For example, the nail tissue is then examined more closely (histologically) in the laboratory.
If you have already tried a local nail fungus treatment (e.g. with antifungal nail polish), stop this two to four weeks before your visit to the doctor. Otherwise there is a risk that the result of the fungal culture may be falsely negative due to any active ingredient residues on the nail.
How does a nail fungus infection progress?
In contrast, advanced nail mycosis often causes considerable pain, for example when wearing shoes, when walking and due to the ingrowth of deformed nails. The skin around the nail or the nail bed occasionally becomes inflamed. In addition, in some cases the nail fungus develops into foot or skin fungus, which spreads even further.
If the fingernails are affected by the fungal infection, there is a risk that the fingertip sensitivity changes to such an extent that fine motor skills are impaired.
Last but not least, nail fungus is an aesthetic problem that places a heavy psychological burden on many sufferers.
How can a fungal nail infection be prevented?
Correct footwear
Rarely wear closed shoes in which your feet sweat a lot. Instead, prefer shoes that allow air to circulate, such as sandals or lightweight low shoes. Do not wear wet or damp shoes.
Air out your shoes well after each wear. If you have sweated a lot, stuff your shoes with paper after wearing them and allow them to dry out completely.
Always wear shoes, for example slippers, in changing rooms, swimming pools, saunas and solariums. Barefoot, you can easily catch athlete’s foot or nail fungus in such public facilities.
Socks and stockings
Never share shoes and socks with other people to avoid the possible transmission of nail fungus in this way.
Proper foot care
After washing and bathing, dry your feet well before putting on socks and shoes. Pay particular attention to the spaces between your toes when drying!
Regular and thorough foot care is especially important for people who are particularly susceptible to nail fungus. This includes, for example, diabetics and people with immune deficiencies as well as athletes and senior citizens. It often makes sense to visit a podiatrist regularly.
Change your clothes and wash them properly
Wash these and shower mats at a minimum of 60 degrees Celsius. Use heavy-duty detergent or special detergents that kill fungal spores. These are available in pharmacies and drugstores.
For nail fungus patients: Prevent the spread
People with nail fungus are advised not to walk barefoot either outside or indoors so as not to spread the robust fungal spores around and possibly infect other people.
Wear socks when sleeping. This prevents the fungal spores from spreading in bed and possibly reaching other parts of the body or your partner and causing a new infection there.
