Nail Fungus: Why Treatment Takes So Long and What Works

How do I know it is fungus and not something else?

The infection often starts with the tip of the nail turning white or yellow, then the nail thickens, crumbles and may lift from the skin underneath. Common signs include:

However, not every abnormal nail is fungal; psoriasis, repeated injury from tight shoes and some other conditions can look very similar. That is why a doctor usually takes a small nail sample to examine under a microscope or culture before prescribing a long course of treatment.

• Yellow, white or brown discolouration of the nail.
• A thickened nail that is hard to cut.
• Crumbling or splitting at the edges.
• The nail lifting from the skin with white debris underneath.
• Athlete's foot (fungus between the toes) at the same time.

Who is most at risk?

Fungi thrive in warm, damp places, so infection is more common in people whose feet stay in closed shoes for long hours or who sweat a lot, especially in summer heat. The risk rises with age, diabetes, poor circulation in the feet and weakened immunity, and with walking barefoot in shared damp areas such as gym changing rooms and swimming pool showers.

Not drying well between the toes after showering or ablution also leaves moisture that helps fungi grow, and untreated athlete's foot can spread to the nails.

What are the treatment options, and why does it take so long?

Your doctor chooses treatment based on how many nails are affected, how deep the infection is and your general health. With every option, results appear slowly: fingernails take about 6 months to grow out, and toenails about 12 to 18 months.

Even after a cure, the infection can return in some people, so prevention remains part of treatment.

• Topical treatment: an antifungal lacquer or solution applied daily for months, usually suitable for mild infection in one or two nails.
• Oral antifungal medicines: more effective for widespread or deep infection, such as terbinafine or itraconazole. They need a doctor's prescription, your doctor may request blood tests before or during treatment, and they interact with some other medicines.
• Trimming and thinning the affected nail in clinic to help topical treatment penetrate.
• Other options such as laser, for which the evidence is weaker than for medicines.

Why is self-treatment not recommended?

Many people try vinegar, oils or ordinary creams for months without benefit, which delays proper treatment and lets the infection spread to other nails. Taking antifungal tablets without a prescription can cause liver side effects or serious drug interactions.

People with diabetes in particular need a doctor's assessment, because a thick nail can cut the skin and open the way to infection. Oral medicines are not usually used during pregnancy or breastfeeding, and children need a plan set by their doctor.

How can I stop the fungus coming back?

Prevention is about keeping feet clean and dry and limiting exposure to shared damp areas.

• Dry well between your toes after showering and ablution.
• Wear cotton socks and change them daily, or more often if your feet sweat.
• Choose breathable shoes and alternate pairs so they dry fully.
• Wear your own sandals in gym showers and changing rooms.
• Do not share nail clippers or files, and cut nails straight across.
• Treat athlete's foot early, before it reaches the nails.