It might be easy to brush off thick and yellow-ish nails, but these symptoms could be signs of a condition that’s common but often overlooked: onychomycosis . The fungal infection causes thick, yellow nails. The nails can also appear to lift from the nail bed. Onychomycosis can occur in any of your nails, but toenail infections are the most commonly affected.
Despite how common the condition is, only 20% of patients get prescribed treatment, according to a recent study. laser diod 980
In the study, the researchers looked at data from the 2007–2016 National Ambulatory Medical Care Survey. They found that 71.6% of the 337 million provider visits by patients with onychomycosis were to see general practitioners, 25.8% were to see dermatologists, and 2.58% were to see pediatricians.
The data showed that most provider visits did not lead to treatment. Dermatologists were less likely to prescribe medication to treat nail fungus than general practitioners. No prescription medications for nail fungus were prescribed in 82% of the dermatology visits and 78.9% of general practitioner visits.
If the condition is so common, why don’t more people get treatment? Here’s what you should know about having onychomycosis and what you can do to get rid of the fungal infection.
One reason why onychomycosis is undertreated is because of education gaps and misperceptions of the effect the infection can have on a person’s quality of life, said Gabrielle M. Peck, first author of the study. In an online statement, Peck explained that a lack of awareness among healthcare providers and the general public can lead to delayed diagnosis and treatment for the nail condition.
Another possible reason for undertreatment is that onychomycosis is not a diagnosis your provider can make just by looking at your nails, according to Shari Lipner, MD, PhD, an associate professor of clinical dermatology and director of the nail division at Weill Cornell Medicine.
“A sample must be taken from your nails to confirm that it is indeed fungus,” said Lipner. Therefore, onychomycosis can be mistaken for other conditions if samples aren’t collected.
And a third reason: “Treatment is expensive and time-consuming,” Nelya Lobkova, DPM, a board-certified podiatrist and founder of Step Up Footcare, told Verywell. “Some options, such as laser therapy, are not covered by health insurance at all.”
Lobkova said that effective topical medications, such as Jublia (efinaconazole), are expensive and not covered by insurance. The lack of affordable and convenient treatments can contribute to the undertreatment of onychomycosis.
Onychomycosis is not a condition that goes away on its own. Lobkova said if it’s left untreated, the infection can spread to every nail. Over time, the nails become thick, brittle, and ingrown, causing pain.
People with untreated onychomycosis may have trouble wearing shoes and walking. In some cases, untreated fungal infections of the nails can spread to the skin, or secondary bacterial infections can develop. If these infections get bad enough, they can even lead to amputations, according to Lipner.
Anyone can get nail fungus, but some people are more likely to get it than others.
“People of any age can have onychomycosis, but it is more common in older people and relatively uncommon in children,” said Lipner. “People that are immunosuppressed, or have diabetes, or a history of athlete’s foot, are more likely to have onychomycosis.”
You should also keep in mind that you can spread toenail fungus to others or get it from someone else in your household—especially if you share things like nail clippers or shoes.
Currently, there are two common treatment options for onychomycosis: oral therapy and topical treatments.
The most commonly used oral drugs for onychomycosis treatment are griseofulvin , terbinafine , itraconazole , and ketoconazole . The downside is that these treatments can take weeks to work and have side effects like headaches, diarrhea, and rashes. These medications are usually taken daily for eight weeks for fingernail fungus and 12 weeks for toenail fungus.
Though oral medications have been used for years, some may be better for certain fungal infections than others. For example, some studies suggest that terbinafine is often recommended as a first-line treatment because it tends to be effective and has fewer side effects than other drugs.
Creams and other topicals are often recommended for fungal infections, but they may not work as well as oral treatments for nail fungus. The reason? Nails are just too hard for topicals to seep into and deliver medication.
One option is medicated nail lacquers, such as ciclopirox. These products have been approved to treat finger and toenail fungal infections, including onychomycosis. The lacquers form a hard and clear film on the nails that contains an antifungal agent and is resistant to washing, making them an effective and safe treatment choice.
It’s less common, but sometimes laser treatments or other physical treatments can be used along with topicals to help the medication get inside the nailbed.
Onychomycosis can come back after treatment, especially if you have an underlying health condition that makes you more likely to get nail fungus. If you get fungal nail infections repeatedly, despite treatment, your provider might choose to remove the nail to try to prevent the infection from coming back.
While nail fungus infections won’t clear up without medical treatment, there are some things you can try at home to ease the symptoms. To start, maintaining good nail hygiene is essential for managing and preventing fungus.
In between and after nail fungus treatments, you may want to try a natural toenail fungus remedy like tea tree oil.
“It may be helpful to add five to six drops of tea tree oil to soak the fingernails or toenails in order to prevent the spreading [of] the fungal infection to other nails,” Lobkova said. “Tea tree oil is naturally antiseptic, antiviral, and antifungal, preventing infection and keeping the nails healthy.”
When the weather turns cold, you probably want to keep your feet cozy in socks and warm footwear most of the time. However, the moist, dark, and enclosed environment is just right for toenail fungus to thrive. Lobkova recommends keeping your toenails open to the air and in a drier environment as much as possible.
“The nails on our fingers and toes could demonstrate a pattern that is a sign of nail disease such as onychomycosis,” Lobkova said. “It is advised to consult with a nail specialist, such as a podiatrist or dermatologist, to assess for patterns in the nail structure in order to properly diagnose and treat the root cause of the damaged nail.”
If your fingernails or toenails look yellow, thick, or lifted, experts recommend seeing a healthcare provider to find out if you could have a fungal infection called onychomycosis. While it’s very common, it’s also treatable.
Centers for Disease Control and Prevention. Fungal nail infections.
Peck GM, Fleischer AB Jr, Lipner SR. Onychomycosis treatment prescribed at only twenty percent of visits: a cross-sectional analysis of the National Ambulatory Medical Care Survey 2007 to 2016. J Drugs Dermatol. 2023;22(10):1040-1045. doi:10.36849/JDD.6770
Jazdarehee A, Malekafzali L, Lee J, Lewis R, Mukovozov I. Transmission of onychomycosis and dermatophytosis between household members: a scoping review. J Fungi (Basel). 2022;8(1):60. doi:10.3390/jof8010060
Kreijkamp-Kaspers S, Hawke K, Guo L, et al. Oral antifungal medication for toenail onychomycosis. Cochrane Database Syst Rev. 2017;7(7):CD010031. doi:10.1002/14651858.CD010031.pub2
NIHR Evidence. Terbinafine is probably first choice oral drug for fungal toenail infection.
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By Kayla Hui, MPH Hui is a health writer with a master's degree in public health. In 2020, she won a Pulitzer Center Fellowship to report on the mental health of Chinese immigrant truck drivers.
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