Toenail Fungus

What Is Toenail Fungus?

It is a fungal infection of the nail. Fungal infections in toenails can cause toenails to thicken and become white or yellow. Toenails or fingernails may be affected, but toenails are more common to be affected. About 50% of nail conditions are fungal nails. This means the other 50% of nail diseases are not fungus.

What Causes Toenail Fungus?

The most common cause of onychomycosis is dermatophytes. Toenail is a perfect place for fungus to grow due to dark, moist and warm areas since toenails are hidden in the socks and shoes most of the day causing the toenail to be dark, moist from sweat, and warm due to lack of air from outside. Also, lack of sunlight to toenails may be another factor that makes it easier for fungi to grow. There are many reasons that can cause fungal toenail including but not limited to cutting toenail too close, poor immune system, picking up fungus from certain activities (janitor, plumber, etc), sharing nail clipper with someone else who has fungal toenail, visiting a nail salon for pedicures (most nail salon does not have sterile, clean instruments), sweating feet during sports,  walking barefoot in damp public places such as swimming pools, gyms, and shower rooms, previous injury to toenail, poor circulation, history of diabetes and many more conditions. Additionally, the fungus is easily spread.  Individuals with fungus may have contracted it through shared bathroom space, public locker rooms, showers, and pools, shared clothing or shoes, even carpeting.

Other causes of toenails discoloration that can cause a condition called nail dystrophy such as repeated microtrauma to the nail (for example, the nail hitting the top of the shoe over many years), trauma to the nail, shoe pressure on the nail, poor circulation, and some disease conditions. (psoriatic arthritis, etc)

Struggling With Toenail Fungus? We Can Help!

How Do Doctors Diagnose Toenail Fungus?

Doctors usually diagnose toenail fungus based on the appearance, history and confirmed by laboratory testing. Notice that there are many conditions that can also cause thick and yellow toenails. To avoid misdiagnosis of toenail fungus as nail psoriasis, nail trauma, nail dystrophy, yellow nail syndrome (3 common symptoms: respiratory problem, yellow nail, and lymphedema), laboratory confirmation testing may be necessary.

woman checking her toenails

What Is The Treatment For Toenail Fungus?

Treatments may vary, depending on the nature and severity of the infection. A treatment plan is highly customized with a combination of various treatment options such as topical antifungal, oral antifungal medication, laser treatment, or surgical removal. For more information about our laser treatment, please visit our laser page about our amazing cutting edge powerful laser for fungus.

  • Topical treatment of nail fungus with prescription antifungal medication – There are three topical prescription medications on the market that are FDA approved for the treatment of onychomycosis: ciclopirox (Penlac), tavaborole (brand name Kerydin), and efinaconazole ( brand name Jublia). Topical treatments are safe but they are not very effective by themselves. According to the study, complete cure rates (mycological cure and normal toenail appearance) of ciclopirox 8% nail lacquer are significantly lower, ranging from 5.5 to 8.5 percent. Another study showed that the complete cure rate with efinaconazole (Jublia) treatment was 15.2 to 17.8%. Another study from July 2015 showed that topical treatment with tavaborole 5% for toenails showed a complete cure rate of 6.5 to 9.1%. The main reason why topical prescription medications have a lower cure rate is that they are not able to penetrate toenails deeper due to a lack of penetrating agents.
  • Topical treatment of nail fungus with advanced topical antifungal medication – There are certain topical compound antifungal medications that are more advanced than prescription antifungal medications as they contain certain ingredients to enhance penetration for more cure rate as high as 50%.
  • Oral treatment with Terbinafine (Lamisil) achieved a 38% clinical cure rate at 48 weeks according to a study
  • Combination of topical compound antifungal with advanced powerful laser – Laser treatment with topical advanced antifungal medication is used by many of our patients because it is safe, painless, and has no liver side effects. Please visit our laser page for more information and pricing if you need to decide if this is the treatment you want to try.
  • A very important part of treating toenail fungus is to kill any fungus living in your shoes. If you don’t kill the fungus that living in your shoes, the chance that your toenails will be infected again is high.

    Treatment Cure Rate Effectiveness Treatment length Options
    Prescription Topical Medication 5.5 % to 17.8% 9 to 12 months




    Topical compound medication 50% 9 to 12 months Formula 7
    Oral Medication 50 to 60% 3 to 4 months Lamisil
    Laser treatment 70% to 80% 3 months Click our laser
    Nail restoration

    No cure

    No permanent solution

    Every 3 months Keryflex