Nail Fungus

What it is:

Nail fungus (onychomycosis) is an infection of the toenail or fingernail plate and underlying nail bed. It is contagious, meaning you picked it up from someone else or somewhere else. Like most athletes foot infections, it is fungal, but is more resistant to treatment. A simple course of two to four weeks of a topical antifungal solution or cream can clear up a tinea based skin infection, but will not work on an established case of onychomycosis. Quite often, patients notice that their nail fungus infection was preceded by chronic problems with athletes foot. Since many cases of nail fungus cause thickening, especially towards the end of the nail, a reservoir of the fungus is contained and may be released to cause an athlete’s foot infection, and vice versa.

How to treat it:

Cases of onychomycosis can be categorized as mild, moderate or severe. The diagnosis can be made by a simple culture of the nail plate. This should be considered because not all cases of thickened nails are caused by fungal infection. Be sure your provider takes a careful medical history and physical exam prior to any treatment. The milder cases can be treated initially with debridement of the thickened or discolored nail, and a daily topical antifungal preparation. In any of the cases, laser treatments can safely be added to this protocol, and in the more resistant cases can be repeated several times if needed. Oral antifungal medications such as terbinafine and itraconazole can be used in the more difficult cases, and complete removal of the nail plate may also be performed. Since a new nail plate can take six to nine months or more to completely grow out or turn over, it takes a while before the patient notices significant change if the condition is improving. Basic hygiene consisting of daily sock and shoe changes, antifungal sprays and ultraviolet treatments to shoegear should also be practiced.


In my offce, I have a new laser that is FDA approved to treat onychomycosis. It works by heating up the nail plate and underlying nail bed. While there might be some discomfort associated with the application of this heat, it is temporary and very safe. Laser treatment can be effective in even the more difficult cases, and can be used by itself or as an adjunct treatment.