Auteur: Podiatre Montreal
There is a lot of misinformation about how to best treat fungal nails and it can be frustrating trying to find the best treatment. On this page and on our Fungal Nail Laser Treatment page, we have gathered all the information you will need to make an educated and informed decision about the best treatment for nail fungal infections and other conditions that cause unsightly nails. The information is based on recent scientific studies and our own experience in treating thickened nails or nail fungus infections on a daily basis.
Nail fungus: prevention, symptoms and diagnosis
Although many people think that all thickened nails are caused by a fungus (a fungus of the nails), there are many causes that can cause such thickening. Before we can properly treat your thickened or discolored nails, we first need an accurate diagnosis. Although most people think thickened nails are caused by a fungal infection, trauma to the nail causing a condition called “nail dystrophy” is actually the most common cause of this disorder. Do not get treatment for your nails until the underlying cause of your condition is determined. To have your nails examined and discuss the best treatment plan for your nail problem, contact us today to book an appointment at our podiatry clinic in Montreal.
What are the causes of unsightly thickening of toenails?
There are two main causes of nail thickening. The first is nail fungus and the second is a condition called nail dystrophy. Nail dystrophy is a thickening of the nail caused by repeated microtrauma to the nail, for example a nail that hits the top of a shoe repeatedly for many years. The most common causes of thickened, yellowed and unsightly nails include :
- Nail fungus
- Trauma to the nail
- Tough shoes that exert pressure on the nail
- Poor circulation
- Certain pathological conditions (such as psoriatic arthritis, a disease that can cause nail changes)
Evaluation and diagnosis of fungal nail infections
We will first examine your feet and nails and take note of the circumstances that caused your fungus. This can help determine if you have a fungal infection or nail dystrophy. After completing your file and examination (to determine the cause of the changes in your nails), we may require a laboratory test. This involves taking a small sample of the nail and having it examined under a microscope in the laboratory.
This test is done using P.A.S. (Periodic Acid-Shiff) staining, a technique that turns fungus red if it occurs. This will also allow us to accurately identify the type of fungal infection present so that we can offer you the most effective treatment. This is often the only way to determine the difference between fungus and dystrophy as these two conditions tend to be similar.
This is a critical step as we see many patients who have spent hundreds of dollars on laser treatment for fungal nail infections or who have taken oral antifungal medications and then found that there was no fungal infection on the nails and therefore no reason to use these types of treatments. Sometimes a visual examination of the nail can properly diagnose the nail condition, but this is not always the case.
During your first visit to us, we will provide you with an action plan to treat your dystrophy or fungal nail condition. We may be able to provide you with recommendations at your first visit, but we often have to wait for laboratory tests before offering a final diagnosis. Therefore, we cannot guarantee that a specific treatment will be performed at your first visit.
We treat fungal infections and nail thickening in several ways at our Montreal clinic. The best type of treatment depends on several factors, including the underlying cause of the nail condition, the health of the Patient and the Patient’s preferences (once we have given all available treatment options).
Treatment options at our clinic include laser treatment of nail fungus, topical treatments and oral medications. However, no treatment for fungus will work if the cause of your thickening is nail dystrophy, since nail fungus treatments have been shown to be ineffective against dystrophy. We can help you choose the best treatment for your particular condition.
Laser treatment is used by many of our patients because it is a certain treatment option, painless and without potential liver side effects. The disadvantage of laser is that it is more expensive than oral medications and, while laser is very effective, there are fewer studies on it than oral medications. We will make sure you are well informed before deciding if this is the right treatment for you.
There are three commercially available topical drugs approved by the U.S. Food and Drug Administration for the treatment of fungal infections: ciclopirox (brand name Penlac), tavaborole (brand name Kerydin) and efinaconazole (brand name Jublia). Although topical treatments are safe and relatively inexpensive, they are not very effective on their own. Indeed, when used without additional treatment, the best topical medications only work 8-25% of the time. However, we use these medications to help prevent the recurrence of nail fungus after laser treatment or the use of oral medications. Our preferred topical medication contains 8% ciclopirox and should be used daily for 12 months after laser treatment or oral medication and then once or twice a week to prevent recurrence.
The advantage of ciclopirox is that it is one of the most effective topical medications. It is inexpensive and can be obtained with a prescription allowing for the possibility of reimbursement if necessary.
The disadvantage is that it cannot be applied easily, it must be removed weekly and you cannot use nail polish or other nail products during your treatment period.
Instructions for the use of ciclopirox
- Apply like nail polish over the entire nail, including under the nail.
- Apply daily and remove the build-up using isopropyl alcohol or nail polish remover once a week.
- Trim the tip of the nail and remove all debris and then apply a new coat.
What Studies Have Shown About Topical Medications
Here is a list of the three most effective topical medications and information about their effectiveness and cost.
- Ciclopirox: Less than 12% of patients were able to achieve complete or nearly complete disappearance of the mycosis.
Cost: $5.25 per ml
- Efinaconazole: Less than 26% of patients were able to achieve complete or near-complete clearance of fungal infections.
Cost: $117 per ml.
- Tavaborole: Less than 17.9% of patients were able to achieve complete or nearly complete disappearance of the fungus.
Cost: not yet available.
In summary, the best topical medications are effective 10-25% of the time. The newer drugs work a little better than ciclopirox, but they cost much more.
There are some types of medicated nail polish that contain antifungal ingredients, but these are only complementary treatments. We recommend a nail polish containing both tea tree oil and garlic extract, both of which have antifungal properties. This is not an alternative to ciclopirox, but it is probably better than other treatments for nail fungus.
Oral medications for the treatment of fungal nail infections
Oral medications are well studied and have a slightly higher success rate than topical treatment, but have potential side effects. It has been shown in the laboratory that terbenafine, a drug taken orally, can remove fungal infections from the nail 70% of the time. 59% of patients experienced partial improvement, as no signs of fungal infections were found in the laboratory and new growth of unaffected nails larger than five millimetres was observed. In addition, 38% of the patients experienced complete improvement because no visual signs of fungus were found in the laboratory.
Self-treatment plan for nail fungus
There is no perfect treatment for nail fungus. Currently, the best treatments are laser therapy and oral medication. If you want to try self-treatment, we have published below a 7-step treatment plan to kill or minimize your fungus in order to beautify your nails and prevent recurrence of the fungus.
Use an antifungal cream that kills fungus and promotes healthy nail growth. Preferably choose a cream containing grape seed extract, nature’s most powerful antioxidant because this ingredient softens the nails and increases permeability. Use this cream daily for six months and apply it every morning. An antifungal cream can help, but it is important to understand that there are no antifungal medications (prescription or over-the-counter) that effectively remove fungal infections from the nail.
These medications work about 10% of the time. They can, however, help prevent the spread of the fungal infection.
Use an antifungal gel to clean dark or yellowed nails with keratin debris under the nail. With regular use, the gel breaks down and removes this yellow or dark buildup and gives the nails a lighter, more attractive appearance. Use this product daily for six months and apply every night.
You can make your nails thinner and more attractive by first cutting the nail and then using a rotary burr to refine them. Steps 3 to 5 are the most effective ways to sharpen nails. To refine nails effectively, first soak your feet for 5 minutes.
Use a sturdy toe nail clipper to cut the thick nail. These are the same types of nail clippers we use in our clinic and they are much more effective and easier to use than those that would be available in a pharmacy.
Use a rotating tool to sharpen the nail. For perfectly refined nails, sand the nails almost every week (this kind of tool is also recommended to reduce calluses).
For women, an antifungal varnish can help prevent new infections. Choose a product with a superior blend of organic antifungal essential oils that promote nail health. Avoid polishes containing formaldehyde (a carcinogenic chemical), dibutyl phthalate (a potentially dangerous plasticizing agent) or toluene (a chemical that can cause nervous system disorders as well as liver and kidney damage).
An essential part of treating nail fungus is to kill any fungus that resides in your shoes. If you do not kill the fungus that grows in your shoes, it is likely that your nails will be re-infected. See our 6-step plan below to avoid re-infection.
If you don’t see improvement after 6 months, we suggest you make an appointment and come see us in our podiatric clinic.
Plan to prevent fungal reinfection of the nails
Even if laser treatment or oral medications have been effective, you must be very vigilant to prevent fungal infections from returning. If your nails have already been affected by fungus, this is a sign that you are likely to get this type of infection again. Here is our complete 6-step plan to prevent another fungal infection:
Do not wear the same shoes two days in a row. Let your shoes dry for one day. A hot and humid environment favours the development of fungus.
Use a shoe disinfectant that kills bacteria inside your shoes with ultraviolet light (UV-C). In a single 45-minute treatment, you can kill up to 99.9% of the microorganisms in your shoes, including odour-causing bacteria and fungi, nail fungus, and athlete’s foot.
Put antifungal powder in your shoes once or twice a week.
For women who love nail polish, we recommend a nail polish with antifungal properties containing tea tree oil and garlic extract.
We offer prescriptions for a medication called ciclopirox that must be applied daily. You can also try an antifungal cream, but this treatment is not as effective as the prescription drug.
Wear breathable socks that wick away moisture. We recommend socks with silver fiber. In addition to wicking away moisture, socks with silver fiber help kill fungi.
Make an appointment to consult our nail fungus experts located in Montreal. We will examine and diagnose the nail problem and discuss treatment options with you so that you can make an informed decision. This will allow you to get rid of your fungal infection and restore the health of your nails.2021