Diagnosis, risk factors and treatment


Your physician will examine your nails and may send a small sample for testing. Share with your physician how long you have had this condition, what treatments you may have tried to so far and how it has affected your day-to-day life.

Several factors unique to modern life have resulted in an increased prevalence of nail fungus. Patients can come into contact with the infecting yeasts or molds in many ways:

• Going barefoot in public areas, such as swimming pools and gym locker rooms or showers
• Getting your nails done in a nail salon where proper hygienic practices are not observed.
• Wearing shoes that trap moisture and warmth, particularly fashionably tight, high-heeled shoes


Other risk factors for nail fungus infections include: previous nail injury or trauma, skin infections such as athlete's foot, psoriasis, family history, poor circulation and smoking. The number of affected patients is much higher in those over age 55 or those with certain medical conditions such as HIV/AIDs or diabetes.


Treatment options

Fungal infections can be difficult to cure, and treatment depends on the severity of the symptoms. A 'true" fungal infection can only be diagnosed by a physician by obtaining appropriate nail cultures. We recommend you see your doctor if you suspect you have nail fungus.


  • Over the counter treatments: It is unlikely that an over-the-counter remedy will properly treat nail fungus. More importantly, the use of such remedies may delay appropriate treatment. 
  • Prescription topical treatments: Patients with mild to moderate infections are ideally treated with topical therapy as oral medications have the potential for serious adverse effects such as liver damage, serious skin reactions as well as other minor adverse effects. Topical nail fungus treatment options include Penlac (ciclopirox) and new Jublia (efinaconazole), recently approved by Health Canada.
  • Prescription oral therapy is preferred for treating severe nail fungus infections, but they may not be suitable for some patients because of drug interactions (especially in the elderly) and other safety concerns (e.g. liver toxicity). Options are Lamisil (terbinafine) or Sporanox (itraconazole)
  • Nail removal: With or without other treatments, your physician may suggest having your nail removed. Chronic pain may require permanent removal of the nail.
  • Laser treatment: A fairly new treatment option is light therapy done at a medical clinic. They can be a fairly expensive treatment options. As well, studies are being done to confirm the exact effectiveness of this therapy. Speak with your doctor to discuss if this option is best for you.

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