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Fungal and Thickened Nails

Fungal nails usually start as a small area of discoloration and spread slowly. Over time the nail becomes thick, yellow or brown, brittle at the edges, and may separate from the nail bed. It is rarely painful early on, which is why most people wait a long time before having it looked at.

Not everything that looks fungal is fungal. Thickened, discolored nails also result from repeated trauma, psoriasis, and other conditions that respond to entirely different treatment. Confirming the diagnosis before starting treatment matters, because the antifungal treatments are long courses and there is no reason to spend months on the wrong one.

Treatment options

Treatment depends on how many nails are involved, how much of each nail is affected, and your medical history. Options include topical antifungal medications, oral antifungal medication, and reduction of the thickened nail to relieve pressure and discomfort.

Oral medication is the most effective option for many people but is not appropriate for everyone, and it requires monitoring. Topical treatment is safer but works best on limited involvement and takes longer. We will go over which options make sense for you.

What to expect

Nails grow slowly. A toenail takes roughly nine to twelve months to grow out completely, so improvement is measured in months, not weeks, and the nail continues to look abnormal while the healthy portion grows in. Recurrence is common, and treating shoes and the skin of the foot alongside the nail reduces the chance of it coming back.

Thickened nails that are difficult to manage

Some thickened nails are not infected at all but have become too thick to cut safely at home, particularly with reduced hand strength or poor vision. Routine reduction of these nails is a common reason for regular visits.

If you are diabetic or have neuropathy or poor circulation, nail care done in the office is safer than doing it yourself.