Fungal Nail Infection Treatment Online

Can an online doctor treat a fungal nail infection?

How an online consultation helps with a fungal nail infection

• The right diagnosis: Fungus, psoriasis, an old injury or something that needs checking: the doctor tells them apart.
• Treatment that fits: A nail paint for a mild infection, or tablets when more of the nail, or more nails, are affected.
• Tests arranged: A nail clipping test to confirm fungus, and liver blood tests when tablets are planned.
• Less chance of a repeat: Treating athlete’s foot at the same time, and footwear habits that keep it away.

What the doctor checks in an online consultation

The doctor asks about:

• The nail: which nails, how much of each nail is affected, and how long it has been changing.
• What it looks like: white or yellow, thick, crumbly, lifting off the nail bed, or a dark streak.
• Your feet: itchy, peeling skin between the toes, which is athlete’s foot.
• Injury and sport: stubbing, tight shoes, running, and gyms or pools.
• Your health: diabetes, poor circulation, a weakened immune system, psoriasis, and liver problems.
• Medicines: what you take, as some interact with antifungal tablets.

Before the call, take sharp photos of the nails in daylight, from above and from the side, and have your feet ready to show.

Fungal nail infection symptoms

Fungal nail infections usually affect the toenails, but they can affect fingernails too. The infection often starts at the edge of the nail and can spread to the whole nail:

• the nail turns white or yellow, and becomes discoloured
• it becomes thicker than usual
• it may become brittle and crumbly
• the whole nail can sometimes lift off, which can leave the skin around it swollen and painful

It often starts as a white or yellow-brown spot under the tip of the nail. As it spreads, the nail can become ragged or misshapen and may smell. In another form, flaky white patches appear on the surface of the nail. Green or black discolouration points to bacteria rather than fungus.

Fungal nail or something else?

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What causes a fungal nail infection?

Most fungal nail infections are caused by the same fungi that cause athlete’s foot, and the infection often spreads from the skin to the nail. You can get one if your feet are constantly warm and damp. You are more likely to get one if you:

• wear trainers for a long time and have hot, sweaty feet
• have athlete’s foot
• are older, or have diabetes or a weakened immune system
• have psoriasis, or have injured the nail
• walk barefoot in shared showers, gyms, pools and changing rooms
• have poor circulation in the legs, smoke, or are overweight

About 5.5% of people have a fungal nail infection, and it accounts for more than half of all nail problems. It is common over 65 and rare in children. Dermatophytes, the fungi of athlete’s foot, cause more than 75% of cases, moulds about 10%, and yeasts are uncommon.

How to treat a fungal nail infection

A pharmacist can suggest an antifungal nail paint, which you brush onto the affected nail:

1. Use it daily or weekly, depending on the type, as the leaflet says.
2. Keep going for 6 to 12 months; it can take several months before you see an improvement.
3. Keep the nail short, and file down thick parts gently if the leaflet advises.
4. Treat athlete’s foot on the skin at the same time.

Nail paints work best when only part of one or two nails is affected. See a doctor if the infection is severe and treatment has not worked, if it has spread to other nails, or if you have diabetes or a weakened immune system.

What kills nail fungus, and how do you know it is working?

Nothing kills nail fungus instantly. Treatment has to reach the fungus in and under the nail, and the damaged nail does not recover: it has to grow out. Antifungal tablets can clear the infection in 6 to 12 weeks, but a whole toenail takes 12 to 18 months to regrow, and a fingernail 6 months or more.

How to tell that nail fungus is dying

Look at the base of the nail. When treatment is working, the new nail growing from the cuticle is clear and normal in colour, and the line between healthy and affected nail moves towards the tip as the nail grows. The old, discoloured part does not turn clear: it grows out and is trimmed away. The infection is cured when healthy nail has grown back from the base.

Tea tree oil, menthol rubs and lasers

Tea tree oil and mentholated chest rubs have been tried in small studies with some possible benefit, but how well they work, and their side effects, are not known. Lasers are approved in the United States only to improve how a nail looks, not to treat the infection, and good trials are still needed. Over-the-counter terbinafine cream treats athlete’s foot on the skin, but not the nail.

Is it okay to leave nail fungus untreated?

For a mild infection that does not bother you, treatment is not always needed, because it is not serious. Left alone, it can spread to other nails and back to the skin as athlete’s foot, severe cases can be painful and damage the nail for good, and with diabetes or a weakened immune system it can lead to more serious infections.

Which fungal nail treatment might the doctor recommend?

Treatment depends on how much of the nail is affected, how many nails, and your health. This is the framework the doctors use, in line with NHS and dermatology guidance.

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Treatment options for a fungal nail infection

What you can do yourself

• Use an antifungal nail paint every day or week for the full course.
• Keep nails short, and feet clean and dry.
• Treat athlete’s foot early, and wear clean socks every day.

Prescription treatment

A prescription is never issued without a consultation. When the infection is extensive or nail paints have not worked, the doctor may prescribe antifungal tablets, such as terbinafine or itraconazole. A nail clipping is usually tested first to confirm the fungus, because other conditions look the same. Tablets are taken for up to 6 months, often 3 to 4 months for toenails, and less for fingernails, which clear more quickly. They work less well in people over 65. You may need blood tests to check that your liver is working properly, and the doctor checks your other medicines. For milder infections, nail lacquers contain amorolfine or ciclopirox, and a urea cream can soften a thick nail so that treatment reaches deeper. If the doctor prescribes, use the prescription at a pharmacy near you.

What does not help

Stopping treatment when the nail starts to look better lets the fungus come back. Treating the nail but not athlete’s foot on the skin, and sharing towels, nail clippers or shoes, spread the infection again. Nail varnish and artificial nails over an infected nail keep it warm and damp.

How long does fungal nail treatment take?

The infection is cured when healthy nail grows back from the base, which takes months, because nails grow slowly. Improvement can take several months to show. Toenails take longer than fingernails.

Even after successful treatment, about 20% to 25% of infections come back, sometimes a year or more after the nail has cleared. Poor circulation, older age, diabetes, a weakened immune system and stopping treatment early make this more likely. Treat a returning infection early, and if it keeps coming back, ask about using a nail treatment regularly to keep it away.

How to prevent a fungal nail infection

1. Treat athlete’s foot as soon as it appears.
2. Keep your nails short, and your feet clean and dry.
3. Wear clean socks every day, and avoid shoes that make your feet hot and sweaty.
4. Wear flip-flops in gym showers and around pools.
5. Do not share towels, nail clippers or other people’s shoes.
6. Trim nails straight across, and disinfect clippers after each use.
7. Wear well-fitting shoes without narrow toes, change socks during the day if your feet sweat, and replace old shoes.
8. Choose nail salons that sterilise their tools.

Special situations

Diabetes

Fungal nail infections are more common with diabetes, and foot problems can be more serious. See a doctor rather than relying on pharmacy treatment alone, and keep diabetes well controlled.

Pools, gyms and holidays

Walking barefoot in damp public places, such as pools, gyms, changing rooms and hotel showers, is a common way to pick up the fungus. Wear flip-flops, dry between your toes, and keep up a course of nail treatment while you travel.

Pregnancy and breastfeeding

Antifungal tablets are not usually used in pregnancy or breastfeeding, so treatment often waits or uses nail paints. Tell the doctor if you are pregnant or breastfeeding.

A dark streak under the nail

A brown or black line or patch under a nail is not typical of a fungal infection and needs an in-person check, as it can rarely be a melanoma.

Children

Mobi Doctor consultations are for adults aged 18 and over. A child who is unwell needs a paediatrician or a local doctor in person, and emergency signs in a child mean 112.

How Mobi Doctor works

1. Book a time that suits you: daily 7am–11pm CEST. You can see a doctor over video, usually within 15 minutes. No subscription, and the exact price is shown before you pay.
2. Speak to a licensed doctor about the nail: show it close up on camera in good light or share photos, and mention diabetes and the medicines you take.
3. Leave with a plan: what to do, what to use and for how long, and which signs mean you should be seen in person. If the doctor prescribes, use the prescription at a pharmacy near you.

Frequently asked questions about fungal nail infections

Related conditions

Athlete's Foot Paronychia Ingrown Toenail Foot Infection Psoriasis Jock Itch All skin conditions