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What it looks like
A fungal nail infection, which you may see referred to as onychomycosis, often starts at the free edge or side of the nail and gradually spreads towards the base. The nail thickens, becomes crumbly and lifts away from the nail bed, and the colour changes to yellow, white or brown. It is not often painful, though a thickened nail can become sore under a shoe.
It is more common than people think, and it is nothing to be embarrassed about. Factors such as warm, enclosed footwear, shared changing rooms, previous nail injuries and increasing age can all increase the risk.
Why we test before treating
Several other things look almost identical. Psoriasis affects nails. So does an old trauma, such as a nail that took a knock years ago and has grown thickened ever since. Both can be mistaken for fungus, and neither responds to antifungal treatment.
Where testing is appropriate, a clipping can be taken from the nail and sent to a laboratory. This process can take a couple of weeks and the results can help confirm whether a fungal infection is present and guide the most appropriate treatment. Confirming the diagnosis first can help avoid spending time and money on antifungal treatment unnecessarily.
What treatment involves
- Reducing and thinning the nail, which removes some of the affected nail and can help topical treatment reach the remaining nail more effectively.
- A topical antifungal applied at home, consistently, while the nail grows out.
- Reviews along the way to thin the nail again and check that healthy nail is coming through at the base.
- In some cases, a conversation with your GP about tablets, which work from the inside and suit more stubborn or widespread infections.
The reducing part matters more than people expect. A thick, infected nail can be difficult for topical treatments to penetrate, which may reduce the effectiveness of over-the-counter treatments when used without professional nail reduction.
The timeline, honestly
You are not waiting for the infected nail to get better. You are waiting for new, healthy nail to replace it. The first sign of progress may be a clearer area of new nail growth at the base. It can take around nine to twelve months for a toenail to be fully replaced.
Anything promising a clear nail in a fortnight is describing something else, because nail simply does not grow that fast.
The nail you are looking at today was made months ago. Judge treatment by what is growing in at the base, not by the end you can see.
What helps it along
- Treat the skin as well as the nail. Athlete's foot between the toes is often the reservoir the nail keeps being reinfected from.
- Rotate your shoes so each pair dries out fully, and change socks daily.
- Use your own nail clippers and file, and clean them after each use.
- Wear something on your feet in changing rooms and around pools.
- Keep applying the treatment even once it looks better. Stopping treatment too early can increase the likelihood of the infection returning.
If you have diabetes or reduced circulation, have a thickened or discoloured nail looked at rather than treated at home. Nail changes can occasionally point to something other than fungus, and pressure from a thickened nail is worth relieving properly.
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