How to treat fungal toenail

Fungal toenails

It is the time of the year that people actively start coming in to have fungal toenails treated with summer around the corner. It is concerning how often people are presenting with this problem. I have been working for over 14 years and i don’t remember fungal toenails being such an issue 10 years ago. Could it be due to the rise of pedicure salons popping up everywhere and being used so frequently ? Maybe.

First line treatment

People with fungal toenails are often bombarded with many pharmaceutical treatment options and it can be very confusing as to what will work best. Ranging from $5 to $100, it can be an expensive exercise if you do not pick the right one. Topical products from the pharmacy (lacquer, cream or solution) can be effective. But it is not uncommon for people to be spending alot of money and time treating a nail which they suspect is fungal but infact it is not. It can be nail trauma from footwear, nail psoriasis or simply thick nails. It is vital to speak to a podiatrist before you begin any treatment so you can confirm it is fungal.

Moreso, not all fungal infections are the same. It can be under the nail (subungual), through the nail (nail plate) or on the surface of the nail (superficial). Depending on the level of infection, will determine which type of treatment is most suitable.

Infections can be  dermatophytes (most common),  candida or non-dermatophyte infections. A pharmacist or an individual will find it very hard to figure this out. It is important to know as different treatments have different strengths on certain types of infection.

If topical pharmaceutical treatment is pursued, it is vital that a podiatrist cleans and files back the the nail in order to increase the absorption rate of the topical products helping to improve the outcome.

Second line of treatment

Laser treatment has been a growing choice over past five years due to its convenient method. It delivers heat to the nail killing the fungus. You generally require 2-3 treatments about a month apart. Although it is more costly than topical treatments, we have found it is becoming the more popular choice due to people failing to diligently apply a topical treatment on a regualr basis for an extended period.  Laser treatment has about a 70-80% success rate. We carefully select our candidates for it, as not all people are suitable for it, and in some cases if the nail is too far progressed, we can guage if laser is not likely to work. It is important that you only see a podiatrist for this treatment, as correct medical advise and podiatry treatment is in adjunct to laser.

Third Line of treatment

If the above fails, then you could consider oral medication. Oral medications are usually taken for a period of 3months and have approximately atleast 80% success rate. I prefer to reserve this option as last resort because the medications is strong on the liver. Your doctor would be the prescriber of this treatment and they would assess if your medically suitable for the treatment.

The take home message is that fungal toenails are not as simple as the commercials display them. It is important you see a podiatrist for a professional and experienced opinion before you begin treatment. Avoiding unnecessary costs and time.


Dr Vanessa Hadchiti