What is nail fungus?
Nail fungus (onychomycosis) is a fungal infection of one or more nails — usually toenails. It affects about 10% of US adults and rises with age. It's primarily cosmetic but can cause discomfort, secondary infections, or significant nail damage.
Treatment is long — nails grow slowly. Topical antifungals can work for mild cases; oral antifungals clear it more reliably but require lab monitoring.
Do I have nail fungus? Common signs
If most of these describe what you're experiencing, telehealth may be a good next step:
What causes it
Dermatophyte fungi (same as athlete's foot), occasionally yeast or molds. Risk factors: age, athlete's foot, diabetes, peripheral vascular disease, nail trauma, communal showers/pools, occlusive footwear.
Is it contagious?
Yes, but slowly. Direct contact with infected nails/skin or surfaces. Often spreads between own toes, between feet, or to family members.
Cheap topical fixes rarely work for thick fungal nails — by the time it's visible, you usually need oral treatment.
Can it be treated online?
Nail fungus is well-suited to telehealth — photos confirm the diagnosis in most cases. Oral terbinafine requires baseline LFTs (liver function tests), which we order with a lab order. Diabetics with foot involvement or severe cases benefit from in-person podiatry.
How nail fungus is treated
Oral terbinafine 250mg daily for 6 weeks (fingernails) or 12 weeks (toenails) is most effective — clears about 70% of cases. Requires baseline LFTs. Itraconazole is alternative. Topicals: efinaconazole (Jublia), tavaborole (Kerydin), ciclopirox — work for mild cases but clear rates are 30–55%. Laser treatments have modest evidence.
Self-care while you wait
- Keep nails trimmed and clean
- Dry feet thoroughly, especially between toes
- Wear breathable shoes; rotate them
- Cotton or moisture-wicking socks
- Antifungal powder in shoes
- Don't share nail clippers
- Don't walk barefoot in gym showers or pool decks
- Treat any concurrent athlete's foot
How long does it last?
Even with effective treatment, nails take 6–12 months to grow out clear. Recurrence is common (10–50%) — prevention matters.
Frequently asked questions
Do I really need oral medication?
For mild distal involvement, topicals can work. For thick nails or multiple nails, oral is much more effective.
Are the labs really necessary?
Yes for oral terbinafine — checks liver function baseline. Repeated periodically during treatment. Risk of liver issues is low but worth monitoring.
Will Vicks VapoRub work?
Small studies show some benefit. Not as effective as Rx but reasonable for mild cases or alongside treatment.
Why won't it clear?
Common reasons: stopped treatment too early, dense thick nail blocking penetration of topicals, untreated foot fungus reservoir, or non-dermatophyte (yeast/mold) infection needing different treatment.
Should I just remove the nail?
Permanent nail removal is reserved for severe, recalcitrant cases. Usually unnecessary if oral treatment works.
