
In addition to podiatrists, dermatologists are also specially trained and experienced in diagnosing and treating nail fungus. Treatment usually involves an oral or topical anti-fungal medication.
Nail fungus, also known as onychomycosis, is a common yet persistent infection that can cause the nail to become discolored, thicken, or even crumble and fall off. Although it’s a relatively painless and harmless condition in its early stages, it can become more serious as it spreads.
Since it’s contagious, it’s always advisable to address the condition as soon as possible. Fortunately, a dermatologist can help — here’s how.
Understanding Nail Fungus and Its Causes
What Is Fungal Nail Infection?
A fungal nail infection happens when microscopic fungi infiltrate the nail bed or the surrounding skin.
Since fungi flourish in moist, warm environments, the delicate skin beneath the nail is particularly vulnerable. Especially if nails remain wet for long periods, such as when someone wears damp shoes, fungi may easily grow.
Fungi hotbeds also include environments like swimming pools, locker rooms, and public showers.
How Nail Fungus Develops in Toenails and Fingernails
Due to the environments where they flourish, fungal infections are more common in toenails than fingernails. Fungi typically enter through tiny cuts in the skin, cracks in the nail, or in the space between the nail and skin.
The condition can be contracted either through direct skin-to-skin contact with someone with an existing fungal infection or by contact with an item or surface the fungi recently touched, such as nail clippers, towels, or a locker room floor.
Risk Factors for Fungal Infections
Nail fungus is a common condition that anyone can contract. However, there are certain factors that make someone more likely to get it, including:
- Older individuals (as the risk of infection rises with increasing age).
- Those who live in hot, humid environments.
- Those with compromised immune systems (such as those with an existing infection or conditions like diabetes, psoriasis, or who are undergoing chemotherapy).
Signs You Might Have Nail Fungus
Symptoms of an Infected Nail
Signs of an infected nail may include:
- Discoloration (yellow, white, brown, etc.)
- Discoloration that spreads (e.g. from a small spot to covering more of the nail)
- Debris accumulation under the nail
- A nail that begins to separate from the nail bed
- Nail thickening, splitting, crumbling, or forming a white powder
When to Seek Professional Help
Though nail fungus is typically painless when it initially impacts the nail, it may become more uncomfortable as it grows. Without treatment, wearing shoes or walking may hurt, and the nails may eventually crumble or fall off. There’s also the risk that the infection spreads to others or to your other nails — including from your hands to feet or vice versa.
For that reason, prompt treatment is recommended. As the fungus grows, the condition becomes more challenging to treat.
Treatment Options for Nail Fungus
Prescription and Over-the-Counter Antifungal Creams
Although there are several over-the-counter antifungals available, evidence strongly suggests that they are less effective than prescription options. According to a 2024 study of seven topical prescription and non-prescription topicals, the most effective treatments for onychomycosis were the prescription treatments.
Scientists found that efinaconazole, followed by tavaborole and finally ciclopirox, inhibited the two main types of toenail fungus most drastically.
With that in mind, over-the-counter options available in the U.S. include:
- Tolnaftate (brand name: Tinactin).
- Miconazole (brand name: Monistat).
- Terbinafine topical (brand name: Lamisil AT)
As previously mentioned, a prescription topical treatment is most likely needed to help inhibit fungal growth and prevent its recurrence. These medications are Food and Drug Administration (FDA)-approved and include:
- Efinaconazole (brand name: Jublia)
- Tavaborole (brand name: Kerydin)
- Ciclopirox (generic)
Oral Antifungal Medications: Effectiveness and Side Effects
For moderate to severe nail onychomycosis (nail fungus) or resistance cases, a prescription oral medication may be needed. FDA-approved treatments include:
- Terbinafine oral (generic)
- Itraconazole (brand name: Sporanox)
When taken as directed, it typically takes 2-3 months to completely heal an infection. Although these medications clear more aggressive infections faster and more effectively, they also come with certain risks and side effects. Make sure to discuss these with your treating medical provider.
Keep in mind that in some cases, a combination approach may be necessary to fully remove the fungus. In the rare case of a very advanced infection or if treatments fail to work, the doctor may need to fully remove the nail (either chemically or surgically) to heal the condition.
Can a Dermatologist Help with Nail Fungus?
Role of Dermatologists in Diagnosing and Treating Nail Fungus
As skin specialists, dermatologists play an integral role in diagnosing and treating nail fungus. They can:
- Examine and test nail samples.
- Identify the specific type of fungus.
- Prescribe topical or oral medications.
When to Consider Seeing a Podiatrist Instead
As foot specialists, podiatrists are also trained in treating nail fungus. So especially if a patient has another co-existing issue with their feet such as calluses, ingrown toenails, or bunions, they may want to visit a podiatrist for a complete assessment.
Preventing Nail Fungus in the Future
Tips for Maintaining Healthy Nails
Keep your nails healthy and fungi-free by:
- Wearing footwear in public areas with moist floors.
- Keeping feet clean and dry.
- Changing your socks regularly.
- Wearing breathable shoes.
- Sanitizing your nail tools regularly
- Keeping your nails clean and manicure
- Pedicure salons- use only licensed facilities, clean operating standards, and properly sanitized tools
- Moisturizing dry skin
How to Protect the Nail Bed from Future Fungal Infections
As an extra precaution, you can also take measures like sprinkling anti-fungal powder in at-risk shoes or areas.
Checking your nails monthly for changes in color, texture and appearance can also help you catch and treat any new fungal infections before they worsen.
Remember that early warning signs of infection include faint nail color or texture changes, tenderness or swelling, or dry or irritated skin around the nail. If you notice any of these signs, consult a medical professional right away.
Looking for Expert Help: Work with a Piction Dermatologist
If you suspect you have a fungal infection, it is recommended that you seek treatment as soon as possible to avoid further growth.
Fortunately, a board-certified and trained dermatologist from Piction Health can help diagnose and treat your condition with high-quality photos.