Nail Fungus

My 3 year old son smashed his finger in the door at day care last November. Since then, his finger has swelled and oozed puss and blood several times. We have been to the doctor many times and have been through many rounds of antibiotics. We finally stamped out the infection but now there is fungus on the nail of the finger. We have been applying Nizoral until we are sick of it. This has been going on since May! When will the fungus go away? The doctor says fungus is very hard to kill. This has been very hard to maintain with a 3 year old boy who likes to get dirty. Is there any other solution for stamping out this fungus? We are at our wits end with this. Tired of bandages and ointment! What can we do?
Lesley Cooper – Little Rock, Arkansas

Nail Fungus

Dr. Greene’s Answer:

Dear Lesley, Last night I had bad dreams about fungal nails. Your story reminded me of the seemingly interminable battle I have had with them. Mine began when I was in college and rowed on the crew team. I had athlete’s foot that eventually spread into the toenails.

The nails of our fingers and toes are tremendously effective barriers. This barrier makes it quite difficult for a superficial infection to invade the nail. Once an infection has set up residence, the same barrier that was so effective in protecting us against infection now works against us, making it difficult to treat the infection.

Fungus rarely invades an intact nail. Usually, there is some kind of trauma such as that experienced by your son. Prolonged wetness can also allow the barrier to be breached. Sometimes a prolonged athlete’s foot condition can even breach an intact nail. Usually, it is some combination of these methods. Fungal infections can also be a problem for people wearing acrylic nails. This happens because the fungus becomes trapped next to the natural nail in a warm, dark, moist environment for a prolonged period of time. Long-term bandages over the nails can have the same effect.

Fungal nails usually begin with an opaque white or silvery area at the distal (outside) edge of a nail. The fungus gradually works its way inward. As the fungus grows, the nail thickens and can become quite painful.

My Own Story (I) – Frustration

When I first noticed that I had a fungal nail, I began treating myself with over-the-counter athlete’s foot medicines — one after another. It soon became evident that while they were effective in treating the athlete’s foot, they were of no value in helping the nail condition. I went to see a physician and eventually went through a large number of more potent anti-fungal creams, including Nizoral, which you’ve used so liberally. Sometimes this seemed to slow the progression of the fungal infection, but the onward march across the nail was relentless. I later learned that the treatment was a little more effective if I gently filed the outer surface of the nail, thus making the barrier less complete, and immediately applied the Nizoral. This was much more work, and resulted in a small improvement in efficacy. Later, I learned from a podiatrist that this could be enhanced further by using an electric tool, called a dremel drill, to gently buff the outermost layer off the nail before applying the Nizoral. I tried this, but was also disappointed with the results. I have, however, known people who have had success with this method.

In the beginning, I was told that two oral agents were available for treatment of fungal nails. One of them is called griseofulvin. It requires daily treatment — 6 months for fingernails and 12 to 18 months for toenails. Even prolonged therapy does not always lead to a cure. With griseofulvin, recurrences are quite frequent. I eventually tried this medication, but was not able to tolerate it due to nausea. I also tried the other oral medication that had been suggested, ketoconazole (Nizoral), the oral form of the same medicine you have been trying as a cream. Oral Nizoral is another long-term, daily treatment. This is more effective in treating fungal nails, but it can have even more side effects than griseofulvin. I needed to stop taking this medicine because of the effect on my liver. Both of these oral agents are available for children.

My Own Story (II) – If At First You Don’t Succeed…

After a long and painful struggle, I became frustrated with all of the  conventional medicine approaches and looked at alternative medicines. A promising solution was a natural remedy called Australian Tea Tree Oil. It is a naturally occurring anti-fungal compound that can penetrate the nails. Full of hope, I began gently filing my nails and applying the Australian Tea Tree Oil two times daily. I found this to be about as effective as the Nizoral cream. It did slow the progression of the fungal nail, but it did not reverse the condition.

I finally accepted the fact that the fungus would never go away.

My Own Story (III) – Success At Last!

A few years after that, a pharmacist friend suggested I try a newer oral medication called fluconazole (Diflucan). This is taken once a week until all the infected nail grows out. Fluconazole is far safer and more effective than any of the previous oral preparations. I took the oral Diflucan as suggested and was giddy to see the fungal nails heal almost effortlessly! As the nail grew out, it was replaced by a perfect-looking nail. Fluconazole was developed as a result of AIDS research and is now available in a pleasant-tasting liquid for children. It is also being marketed as a single-dose medication for yeast infections in women.

Current Treatment

Two newer, more effective oral medications have now become the standards. Itraconazole (Sporanox) and terbinafine (Lamisil) are both FDA approved for the treatment of nail fungus. The most frequent side effects include nausea, diarrhea, and rash. As with other medications used to treat nail fungus, liver enzyme abnormalities can occur and should be monitored. The medicines work even better if part of the fungus-filled nail is filed away.

Effective Prevention

I have since learned that, unfortunately, I am prone to fungal problems. If I fail to keep up a preventive regimen, and my feet get moist for a prolonged period, then the fungal infection starts up again (for which I use Sporanox). Because your son’s infection was precipitated by an abrupt injury, we don’t know how prone to fungal infections he is. I would still recommend — at least while he has this infection — keeping his fingers as dry as possible. When his fingers do become wet, they should be dried thoroughly, perhaps with a hair dryer.

I have found an effective preventive routine for my feet: shoes that breathe, cotton socks, athlete’s foot powder (any brand) in my shoes, Fungoid Tincture on the nails before bed, and Lamisil cream to the whole foot once a week. The latter two may be useful for your son’s hands.

You have had a long battle with an annoying problem. I wish you the best in days to come.

Dr. Alan Greene

Dr. Greene is the founder of (cited by the AMA as “the pioneer physician Web site”), a practicing pediatrician, father of four, & author of Raising Baby Green & Feeding Baby Green. He appears frequently in the media including such venues as the The New York Times, the TODAY Show, Good Morning America, & the Dr. Oz Show.

  1. Susan Leach

    I too have had nail fungus in the fingernails, after several courses of Lamisal nothing. After reading this story I asked my GP if I could try Diflucan, she told me that the only dose that she could prescribe was 1 tablet of 150mg with 2 repeats. She added anything more could only be given to AIDS Patients. Any way have got the script and hopefully will se some result, I have been depressed about it as a woman you like to have lovely nails, if it were my toenails at least they can be hidden.

    Dr. Greene how long did you take the Diflucan for?

  2. Alan

    I’m a late-30’s male who has had toenail fungus for about 10 years. Slowly over the years it spread from toenail to toenail until I hardly had any good toenails left. I was very embarrassed about it and never took my socks off in public. Even if I went to the beach or pool I would wear water shoes. If I started dating a girl I would make sure to always have at least mid-socks on at all times. During the years I tried tea tree oil, vicks and a bunch of other home remedies. Nothing worked. I did not want to take lamisil or any of the other meds that could potentially damage my liver. I was excited when Jublia came out but after doing some research it seemed like it wasn’t too successful a treatment. So in mid-March of this year I went to my dermatologist for my yearly appointment. I tried keeping my socks on but she asked that I take them off so she could see if I had any moles or birthmarks in between the toes. I warned her that I had toenail fungus and, as expected, it didn’t bother her whatsoever. She asked if I was interested in treatment for it. I said, yes. She then recommended fluconazole as a one-pill-a-week treatment. She said “if” it worked it could take up to a year for a healthy nail to grow back. I told her that I wanted to speak to my PCP first before deciding to take it or not. I spoke to him and he cleared me to take it. So I started taking one pill a week (150mg) not thinking that it would work. To make a long story short, in mid-August I went to the beach and proudly did not have to wear my water shoes. In only 5 months the fluconazole has made an INCREDIBLE improvement. I still wouldn’t feel comfortable getting a pedicure because my nails aren’t fully clear but they are MUCH better. And that’s after only 5 months! I can only imagine what the next 5-7 months will bring for my toes. So I just wanted to share my story with everyone. Even though fluconazole seems to be working for me it may not work for you. Everyone’s body is completely different. Good luck to everyone!

    • Great story. Very encouraging. Thanks for sharing!

  3. Alison Kelemen

    I have nail fungus under two of my acrylic nails. After trying athletes foot creams and tea tree oil, I decided to switch to the oral fluconazole. I started the first day with 100 milligrams in the morning and 100 milligrams at night. Each consecutive day I have been taking only 100 milligrams every morning for the past 5 days. I will stay on it for 2 weeks, hoping to see some improvement and a shrinking of white area under the nail. If I don’t see any progress, I will probably continue for another 2 weeks of daily dosing.

    I don’t understand why this article recommends only one tablet per week. I don’t see how that can be effective. I have not consumed any alcohol during the treatment period, as I know this could be dangerous to the liver.

  4. Shannon Glineck

    I was wondering what strength fluconazole did you take every week to cure your toenail fungus?


    • Emuaid

      This method should only be used after the nail has been cut short and the nail plate has been filed. This will allow the bleach to easily go under the nail plate and penetrate the nail bed for the best results.

      • Carl

        Use a Dremel Moto tool (described above) and the Dremel 9306 and 7144 bit. A cheapo swing arm magnifier as well as personal dexterity are highly suggested. Do not use any pressure (let the tool do the work). Ventilation (to prevent inhaling the dust) is nice.

        The 9306 takes it off fast with little bleeding while the 7144 is good for detail particularly the sides of the nail.

        WARNING several of the Dremel bits can cause severe cutting with attendant bleeding. So get carefully organized and use no pressure. I’m able to completely eliminate the nail, which looks like a toe with the nail magically missing.

        Best of luck put on your thinking cap while proceeding very slowly.


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