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Fungal nail infection (onychomycosis)

Onychomycosis (tinea unguium) · Plíseň nehtů (onychomykóza)

What it is

Fungus growing in and under the nail — usually the big toenail — making it thick, yellow and crumbly; common with age, diabetes and athlete's foot.

Symptoms & signs

  • Thick, yellow or white nail
  • crumbly, lifting edge
  • debris under the nail
  • discomfort in shoes
  • athlete's foot alongside

🚩 Get help if…

  • see a doctor soon Red, hot, swollen toe or foot
  • see a doctor soon A dark streak under the nail, or a change of the nail fold
  • see a doctor soon Nail problem in a person with diabetes or poor circulation
  • see a doctor soon Pus or pain around the nail

Where it strikes

Medical treatment

  • Nail clippings for microscopy and culture
  • oral terbinafine for 3 months (toenails)
  • topical efinaconazole or amorolfine lacquer for mild cases
  • treat athlete's foot too

Natural & lifestyle

  • Keep feet dry, change socks
  • sandals in communal showers
  • disinfect shoes

Emerging & experimental

  • Laser and photodynamic therapy
  • newer topical azoles

Alternative, off-label & anecdotal

Approaches used outside the guidelines, with what their supporters report and what testing has found so far.

  • Tea tree oil (100%) — a small trial matched clotrimazole early / small studies
  • Mentholated rub (Vicks) — a small pilot study cleared some nails early / small studies
  • Vinegar and hydrogen-peroxide soaks — anecdotal anecdotal / traditional
  • Ozonised sunflower oil — small trials early / small studies

ICD codes