Are your nails smooth and strong, devoid of any pits and discoloration? Or brittle, crumbly, and discolored? If you answered the latter, you may have a nail fungus, or onychomycosis.1 Roughly 10% of Americans suffer from chronic nail fungus, and while treatable, can cause serious issues for the elderly, those with diabetes, and who are immunocompromised.7
Here, Better Health will discuss the causes, symptoms and types of toe fungus. Since there is no one nail fungus treatment, we will look into the many toenail fungus medication options, as well as investigate natural remedies for toenail fungus.
Toenail Fungus Symptoms
One way to know if you suffer from toenail fungus is to recognise it visibly. So, what does toenail fungus look like? These are the most obvious signs to look for1, 5
- Patchy, powdery discoloration on top of toenail
- Discoloration from fungus under toenail
- Thick toenail (fungus can cause this, but thick toenails can also be fungus-prone)
- Roughening of the nail
- Irregular shape of nail
- Brittle nails
Other, less visible symptoms include1, 2
- Toenail discomfort
- Pain while walking
- Pain while wearing shoes
- Interference with daily activities like sitting and dressing
- Difficulty in cutting nails
Nail Fungus Types
Broadly speaking, nail fungus is caused by two distinct groups of pathogens. These are called Dermatopohytes and Nondermatophytes. Each pathogen causes a specific set of symptoms.
White Toenail fungus is most commonly caused by dermatophyte pathogens like Trichophyton rubrum and T. mentagrophytes.1 In fact, these account for about 80% of all toenail fungus incidents.1 Symptoms can include white, powdery discoloration on the top of the nail or white discoloration beneath the nail.1
This type of toenail fungus is more often seen in temperate climates and humid areas. The most common species of nondermatophyte organism to cause nail fungus is candida.1 Candida onychomycosis is also known as yellow toenail fungus, and can cause one’s nail plate to come apart from the nail bed.5
Black toenail fungus is a yeast like fungi that can enter one’s skin, hair or nail and grow slowly. It is a saprophyte species in the nondermatophyte category that causes infection more rarely than candida.3 These tend to cause superficial infections, or mild toenail fungus, and are less likely to induce visible symptoms like discoloration.3
What Causes Toenail Fungus?
How do you get toenail fungus? There are several ways to contract a nail fungus, and many have to do with water and dampness. The primary cause is keeping your nails in a consistently wet environment. Wearing the same closed toe, tight fitting shoes that allow the foot to get sweaty on a daily basis, keeping nails wet for long periods, or walking barefoot across wet surfaces like pool decks are all possible ways to contract a nail infection.
People who have a history of nail problems are most prone to getting nail infections.1 Those suffering from diabetes, immunodeficiency, peripheral vascular insufficiency, and children who have Down’s syndrome are highly susceptible to toenail fungus.1 It has also been noticed that the incidence of nail fungal infections increases with age.1,6
Is Toenail Fungus Contagious?
Many beauty salons hear customers ask, “Can I get a pedicure if I have toenail fungus?” While soaking and softening thick toenails can help to clip, file and debride the infected nails, there could be risk of passing the infection through use of the same tools and soaking vessels.
It is not yet clear whether toenail fungus is contagious, but it has been noted that nail fungus tends to turn up in more than one family member.1 This could be through transmission from one member to another, or just that family members share similar genes, environments and behaviours.1 As transmission method or rate is not fully known, it’s best to take precautions, such not sharing nail clippers or footwear with someone suffering from a nail infection.
Toenail Fungus Treatment
Toenail fungus can be embarrassing, so the first thought for many is how to get rid of toenail fungus fast. There are a number of options available, including topical toenail fungus treatment, oral medicines, and a variety of home remedies for toenail fungus.
Topical treatments are usually suggested for more superficial infections, such as superficial onychomycosis, as the fungus is concentrated on the top of the nail.1 Oral treatments are advised when the infection is harder to reach, like beneath the nail bed.1 Some people, however, prefer to opt for toenail fungus home remedies, since they are natural and relatively harmless, as compared to oral treatments which may cause liver toxicity and harmful drug reactions.7
Toenail Fungus Treatment: Over the Counter Medicine
The best over the counter toenail fungus medicine is Lamisil.1 Clinical trials suggest that Sporanox, a prescription antifungal agent, is slightly less effective than Lamisil for toenail fungus.1
Over the counter topical treatment brands include Penlac in the United States, as well as Loceryl and Trosyl outside of the US.1 Another topical treatment that is believed to be effective is econazole nitrate cream for toenail fungus. However, studies have not shown it to cure toenail fungus.13
Laser Toenail Fungus Removal
Given the potential toxicity of oral medication and the limited efficacy of topical treatments on toenail fungus, laser treatment is emerging as a popular, nontoxic alternative.7 It involves the use of an infrared pulsed laser beam to irradiate the fungal infection.7 Preliminary trials have shown promise with about an 80% efficacy rate.7
However, when considering laser treatment for toenail fungus, cost can be an impeding factor. As compared to other toenail fungus cures, this option is among the most expensive.
Toenail Fungus Vinegar Solution
In traditional Chinese medicine, it is believed that by soaking feet in vinegar, toenail fungus can be cured.8 The most well-known choice is white vinegar for toenail fungus, but more people are using apple cider vinegar for toenail fungus. The idea is that the acidity of these products can kill the fungus in one’s toenails.8 However, research is ongoing, and some warn that it could harm the epidermal layer of the feet.8
To use vinegar for toenail fungus, combine equal parts vinegar and warm water, and soak feet for about 30 minutes, twice a day. Anecdotal evidence suggests that results should start after about one to two weeks.
Vicks for Toenail Fungus
Another at-home treatment includes the use of mentholated ointments like Vicks. One pilot study using Vicks showed very promising results, with mycological and clinical cures seen after 48 weeks, and all participants expressing satisfaction with their nail appearance after treatment was complete.9
How to use Vicks Vapor Rub for toenail fungus? Simply apply the ointment on the affected nail consistently for several months.9
Coconut Oil for Toenail Fungus
Rather than as a toenail fungus cure, some suggest that with the regular application of coconut oil, toenail fungus can be avoided in the first place.10 Coconut has lauric acid, which may build up one’s resistance against such infections.10
Tea Tree Oil for Toenail Fungus
Research has shown that with the regular usage of tea tree oil, toenail fungus can be cured. Clinical trials have established a success rate of 80% among patients who applied a cream with tea tree oil on their affected nails for a duration of 16 weeks.11 Because of its anti fungal properties, tea tree is one of the most common essential oils for athlete’s foot.
Other Essential Oils for Toenail Fungus
Many essential oils have been found to have strong antibacterial, antiviral, and antifungal properties. When using essential oil for toenail fungus, spearmint essential oil and cypress essential oil in have been found to be more effective than even some antifungal drugs.12
Listerine Toenail Fungus Treatment
There is a popular belief that one can use Listerine for toenail fungus, but there is no scientific research behind this. Anecdotal evidence suggests it works due to ingredients like eucalyptol, which is made from eucalyptus essential oil and known to have antimicrobial properties.
Using Listerine for toenail fungus is similar to the vinegar treatment above. Simply soak the infected foot in a solution of 50% water and 50% Listerine for 20 – 30 minutes daily, until you notice symptoms of infection go away.
Final Thoughts: Best Toenail Fungus Treatment
Laser treatment is one of the most efficacious options to deal with toenail fungus. However, it is also among the most expensive. Over the counter drugs have a good success rate, but are known to cause side effects, especially when taken over a long period of time. The best at-home and most cost-efficient treatment for toenail fungus are essential oils because they have a solid base of scientific evidence.
Scientific Research Referenced in this Article
- Berker, D. (2009). Fungal Nail Disease. The New England Journal of Medicine. 360:2108-2116, May 14, 2009. http://www.nejm.org/doi/full/10.1056/NEJMcp0804878
- Schein, J.R., Gause, D., Stier, D.M., Lubeck, D.P., Bates, M.M. & Fisk, R. (1997). Onychomycosis. Baseline results of an observational study. Journal of the American Podiatric Medical Association, November 1997, Vol. 87, No. 11, pp. 512-519. https://doi.org/10.7547/87507315-87-11-512
- Saunte, D. M., Tarazooie, B., Arendrup, M. C. and de Hoog, G. S. (2012), Black yeast-like fungi in skin and nail: it probably matters. Mycoses, 55: 161–167. https://doi.org/10.1111/j.1439-0507.2011.02055.x
- Zaias, N. (1967). Superficial white onychomycosis. Sabouraudia: Journal of Medical and Veterinary Mycology 5 , Iss. 2, 1967. Pp 99-103. http://www.tandfonline.com/doi/abs/10.1080/00362176785190181
- Kaur, R., Kashyap, B. & Bhalla, P. (2007). Onychomycosis – epidemiology, diagnosis and management. Indian Journal of Medical Microbiology, volume 26, issue 2, pp 108-116. https://doi.org/10.4103/0255-0857.40522
- Garber, G. (2001) An Overview of Fungal Infections. Drugs volume 61 (Suppl 1). pp 1-12. https://doi.org/10.2165/00003495-200161001-00001
- Harris, D.M., McDowell, B.A. & Strisower, J. (2009). Laser treatment for toenail fungus. Proc of SPIE Vol 7161. – View Reference
- Cheung, Y.Y., Lee, S.H.C., Hui, M. & Luk, T.N.M. (2014). Effect of pH on fungal growth: problems with using vinegar (5% acetic acid) in treating superficial fungal infections. Hong Kong J. Dermatol. Venereol. 22, 57-64. http://medcomhk.com/hkdvb/pdf/2014v22n057-064.pdf
- Derby, R., Rohal, P., Jackson, C., Beutler, A. & Olsen, C. (2011). Novel Treatment of Onychomycosis using Over-the-Counter Mentholated Ointment: A Clinical Case Series. Journal of the American Board of Family Medicine, January-February 2011, vol 24, no 1, pp 69-74. https://doi.org/10.3122/jabfm.2011.01.100124
- Rethinam, P. (2005). Coconut revival- new possibilities for the ‘tree of life’. Proceedings of the International Coconut Forum, held in Cairns, Australia, 22–24 November 2005. ACIAR Proceedings No. 125. – View Reference
- Syed, T. A., Qureshi, Z. A., Ali, S. M., Ahmad, S. and Ahmad, S. A. (1999). Treatment of toenail onychomycosis with 2% butenafine and 5% Melaleuca alternifolia (tea tree) oil in cream. Tropical Medicine & International Health, 4: 284–287. https://doi.org/10.1046/j.1365-3156.1999.00396.x
- Pandey, K. P., Shahi, S. K., Singh, R., Dutta, S. and Dikshit, A. (2002), Antifungal efficacy of Taxodiumand Mentha oils against some human pathogenic fungi. Flavour Fragr. J., 17: 443–444. https://doi.org/10.1002/ffj.1125
- Crawford F, Hart R, Bell-Syer S, Torgerson D, Young P, Russell I. Topical treatments for fungal infections of the skin and nails of the foot. Cochrane Database of Systematic Reviews1999, Issue 3. Art. No.: CD001434. https://doi.org/10.1002/14651858.CD001434.