Medically reviewed by Dr. A.M. van Coevorden, dermatologist
Nail funguswhat actually works, and what does not
A thick, yellow or crumbling toenail can be nail fungus, also called onychomycosis. Only testing can tell for sure, because a discoloured nail has several possible causes. Once the diagnosis is certain, there is one treatment that works: antifungal tablets on prescription. Creams, nail paints and laser do not reach far enough through the nail.
- What actually works against nail fungus?
- What works fastest?
- Can you remove a fungal nail?
- What is nail fungus?
- How do you get nail fungus?
- What symptoms does nail fungus cause?
- Is nail fungus contagious?
- Is it really nail fungus?
- How is the diagnosis made?
- Treatment with tablets
- Does nail fungus ever go away?
- How can you prevent nail fungus?
- What does it cost at 247dermatologist?
- Frequently asked questions about nail fungus
What actually works against nail fungus?
The short answer: antifungal tablets or capsules on prescription. They reach the nail matrix, the place where the nail is made, and kill the fungus there. A clear nail then grows out.
What does not work, or barely works:
- Creams and nail paints from the chemist. They do not get far enough through the nail plate.
- Nail lacquer against fungal nails. The same problem.
- Laser treatment. It is not effective.
- Light therapy with a special lamp. There is no evidence that this cures nail fungus either.
- Home remedies such as apple cider vinegar, tea tree oil or oregano oil. There is no evidence for these.
This follows the line of the Dutch Society of Dermatology and Venereology.
What works fastest?
The course itself cannot be sped up. A toenail grows about one millimetre per month, so it takes six to nine months before the nail has grown out completely clear.
What you do control is when you start. Many people first try products from the shop for months. That time adds fully to the rest. Anyone who has it established straight away and starts the right treatment is finished months earlier.
That first step takes 12 to 48 hours with us.
Can you remove a fungal nail?
No, and it is not necessary. The fungus is not only in the visible part of the nail but also in the nail matrix: the area under the cuticle where the nail is formed. If you only remove the nail, a new affected nail will grow back.
Cutting or pulling the nail off yourself is not a good idea either. It damages the nail bed and creates small wounds, and those wounds increase the risk of erysipelas, especially with diabetes.
What you can do is make the nail thinner. A thick nail can be carefully filed down, and a pedicurist or podiatrist can trim or grind the nail. That makes walking more comfortable and the nail tidier, but it does not kill the fungus. The fungus only disappears with treatment, after which a clean nail grows out by itself.
What is nail fungus?
Fungi are micro-organisms found everywhere in our surroundings and invisible to the naked eye. They can infect the skin and also grow into the nail. The medical term is onychomycosis.
How do you get nail fungus?
Fungal spores are everywhere, for example in gyms, swimming pools and other public spaces. They spread easily and survive for a long time, even a wash at 40 degrees. Contact with fungi is therefore hard to avoid completely, and it is usually unclear where the infection was picked up.
The fungus gets in more easily when the skin's protective barrier temporarily works less well, for example after a long shower or with a small wound around the nail.
What symptoms does nail fungus cause?
The fungus changes the nail: it often becomes thicker, fragile and crumbly and takes on a yellowish or brownish colour. The nail grows more slowly and is harder to cut, and sometimes comes loose. The infection usually starts at the tip of the nail and slowly grows towards the nail fold; left untreated the whole nail can be affected. Nail fungus rarely affects the fingers; toenails are affected most often. Sometimes there is athlete's foot on the skin of the feet at the same time, with itch, flaking and sometimes redness.
Is nail fungus contagious?
Yes, although nail fungus is not dangerous. It is contagious. Household members can become infected, although this does not happen often. Some people are more susceptible than others, especially older people and people with diabetes, and people whose immune system is weakened by illness or medicines.
Is it really nail fungus?
From the outside that cannot be said with certainty. A thickened or discoloured nail can also come from pressure of footwear, from a bruise under the nail or from another nail condition. Antifungal tablets are then pointless, and those tablets are not without consequences: they do not combine with all medicines and are not suitable with certain liver problems.
That is why every treatment starts with establishing what it really is. The dermatologist assesses the nail and can have a scraping examined under the microscope or sent to the laboratory.
How is the diagnosis made?
An affected nail often looks clearly different, but the diagnosis cannot be made reliably from the outside, because a thickened yellow nail can have several causes. Additional tests are therefore done: the dermatologist can examine a scraping of the nail under the microscope or send it to the laboratory. How long the result takes varies by method.
Treatment with tablets
Nail fungus usually causes no physical symptoms and treatment is not always needed. It is important, though, that the skin around the nails and between the toes has no small wounds, because these increase the risk of erysipelas, especially in people with diabetes. Nail fungus is hard to treat. Local products such as cream or a brush-on lacquer do not penetrate the nail enough, and laser treatment is not effective. Antifungal tablets or capsules work best: they kill the fungus in the nail matrix, after which a fungus-free nail grows out. The course usually lasts two months for fingernails and three months for toenails; because the medicine is built into the nail, it keeps working for months afterwards. In the end it often takes six to nine months before the toenail is completely clear. Tell your doctor which other medicines you take, because these tablets do not combine with all medication, and they cannot always be given if there are liver problems.
How often does it work? In about six out of ten people the nail is free of fungus after the course. In the others the infection persists or returns. That is the highest chance of any available treatment, but it is not a guarantee. These are also strong medicines that can cause side effects, which is why a doctor first assesses whether they are suitable for you.
Does nail fungus ever go away?
Nail fungus can usually be treated well, but treatment takes a long time. After the course there is a risk that the infection returns; how great that risk is differs per person. To prevent reinfection through shoes or socks, it is wise to wash socks at 60 degrees and treat shoes with miconazole powder.
How can you prevent nail fungus?
Fungal spores are everywhere, so preventing it completely is not possible. You can reduce the risk by keeping the feet dry and drying them well after washing, including between the toes; wearing cotton socks and breathable footwear; putting on clean socks every day and washing them at at least 60 degrees; alternating shoes so they can dry; always wearing flip-flops in public spaces; trying on new shoes only with your own socks; washing the feet without soap and drying them well, including between the toes; and wearing airy shoes, such as sandals or leather shoes.
What does it cost at 247dermatologist?
A consultation costs € 39 and you have an answer within 48 hours. Faster is possible too: € 59 within 24 hours, or € 79 within 12 hours. You do not need a referral and there is no waiting list.
If treatment with tablets is indicated, the dermatologist writes the prescription. The € 39 consultation falls outside the Dutch basic insurance package and you pay for it yourself. The tablets are a prescription medicine; whether and how much your insurer reimburses depends on your policy and your deductible.
Many people end up paying twice. First for months of shop-bought products that do not penetrate the nail far enough, and then for the treatment that does work anyway. Having it assessed straight away saves that first stretch.
Frequently asked questions about nail fungus
How do you really get rid of nail fungus?
With antifungal tablets on prescription. They kill the fungus in the nail matrix, after which a clear nail grows out. Products you apply to the nail do not get there.
What works fastest against nail fungus?
The course itself takes the same time for everyone, because the nail has to grow out. Speed comes from starting earlier. Months of trying products from the shop yourself add fully to the treatment time.
What is the best remedy for nail fungus?
Antifungal tablets or capsules on prescription. They are not available over the counter, because a doctor first has to assess whether they are safe for you.
Does laser help against nail fungus?
No. Laser treatment is not effective against nail fungus.
Do nail lacquer or a nail paint from the chemist work?
Barely. Those products do not penetrate the nail enough.
Is nail fungus contagious?
Yes. Household members can become infected, although this is not common. Flip-flops in public spaces and clean socks reduce the risk.
How long does treatment take?
The tablet course lasts two to three months. After that it often takes six to nine months before a toenail has grown out completely clear of fungus.
Do I always have to treat nail fungus?
Not always. The nail usually causes no symptoms. Treatment matters most when there are wounds around the nail, especially with diabetes, because of the risk of erysipelas.
Can you also get fungal nails on your fingers?
You can, but it is rare. Toenails are affected far more often.
How do I prevent the nail fungus from coming back?
Wash socks at 60 degrees, treat shoes with miconazole powder, keep the feet dry and wear flip-flops in public spaces.
Can you cut or pull off a fungal nail?
Do not do that. You damage the nail bed and create wounds, and the fungus is also in the nail matrix, so a new affected nail grows back. Carefully filing the nail down, or having a pedicurist trim it, is fine, but it does not kill the fungus.
What do fungal nails say about your health?
Usually nothing in particular. They are more common in older people, in people with diabetes and in people whose immune system is weakened by illness or medication. If you have diabetes, have any wounds around the nail assessed, because of the risk of erysipelas.
What does it cost to get rid of a fungal nail?
A consultation with us costs € 39, and if treatment with tablets is appropriate you get the prescription with it. What often costs people more is the route before that: months of buying products that do not reach far enough into the nail, and then seeing a doctor anyway.
Do those pills always work?
Not always. In about six out of ten people the nail is free of fungus after the course. In the others the infection persists or returns. It remains the treatment with the highest chance.
Does light therapy or a special lamp help?
No. As with laser, there is no evidence that light therapy cures nail fungus.
Sources and more information
- Schimmelnagel, kalknagel, onychomycose (nvdv.nl)
- Ik heb schimmelnagels, wat kan helpen? (thuisarts.nl)