Fungal infections of the nail, also known as onychomycosis, affect about 12 percent of Americans, according to the American Academy of Dermatology. A fungal infection of the toenail often begins as a white or yellow spot under the nail, then progresses to causing nail discoloration, brittleness, thickening, loosening and crumbling, according to MayoClinic.com. This sometimes painful problem is difficult to cure, and fungal nail infections frequently recur after treatment.
Oral Drugs
The most effective treatment for nail fungus are the systemic medications itraconazole, terbinafine and fluconazole, according to the American Academy of Dermatology. But according to MedlinePlus, they only work for about half of patients. These drugs are most appropriate for those at risk of more serious complications from a fungal nail infection, such as people with diabetes or a history of cellulitis. But they are also prescribed for those whose infections have become painful or just ugly. Patients take the medication for up to 12 weeks while a new nail that is free of infection grows in. Side effects include skin rashes and liver damage.
Topical Treatments
There are numerous over-the-counter treatments for nail fungus, but they don't work very well, according to MayoClinic.com. However, there is a prescription option called ciclopirox that a patient paints onto the nail and surrounding skin once a day. It's most appropriate for mild infections, and can take a year to clear up the nail. Ciclopirox can cause side effects, including irritation, itching, blistering, pain, discoloration and ingrown nails.
Some doctors may suggest using an over-the-counter preparation that contains urea, usually in combination with another topical antifungal drug or oral medication, to speed up healing.
Surgery
For severe infections that are causing a lot of pain, a doctor may recommend surgery, according to MayoClinic.com, where the nail is completely removed to eliminate the infection. Sometimes ciclopirox is then used to treat the nail bed to heal any lingering infection. A new, infection-free nail grows back slowly--it can take a year for the nail to finish growing back.
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