How should the nail be filed and prepared?

File the surface of the infected nail with a medium-grit file to remove the superficial hyperkeratotic layer—once a week before applying the antifungal nail lacquer. Trim the nail short and straight, without rounding the corners. Disinfect nail clippers and files with alcohol or hot water after each use; ideally, use single-use cardboard files. Very thickened nails: Soften them first with a 40% urea solution applied daily for 7 to 14 days.

What post-treatment nail reconstruction care is recommended?

Strengthening treatments containing keratin, biotin, and silica to reinforce brittle nails. Non-occlusive, protective treatment polishes that allow the nail to breathe. Nourishing oils containing jojoba oil or vitamin E on the cuticles. Oral zinc and biotin supplements to support nail health.

What steps should be taken to prevent recurrence?

Disinfect shoes daily (using antifungal powder or diluted tea tree oil spray). Alternate between two pairs of shoes, allowing each to dry for 24–48 hours. Wear cotton or moisture-wicking technical-fiber socks, and change them daily. Wear flip-flops in public showers, swimming pools, and gyms. Avoid sharing pedicure tools (files, nail clippers). Treat any early signs of a foot fungus immediately.

How long does treatment take?

extensive infections: oral antifungal medication by prescription.

When should you seek medical advice?

A consultation is recommended if: more than 50% of the nail surface is affected, multiple nails are affected, a properly administered topical treatment has failed after 4 to 6 months, the patient has diabetes or is immunocompromised, or there is diagnostic uncertainty due to psoriasis or nail trauma. A mycological specimen with direct examination and culture confirms the diagnosis, identifies the species, and guides treatment. Severely thickened or painful nails: management by a podiatrist.

Nail Fungus: Choosing an Antifungal Treatment

Q: What is onychomycosis?

Onychomycosis is a fungal infection of the nail, most commonly affecting the toenails (90% of cases), caused primarily by dermatophytes (especially Trichophyton rubrum), and sometimes by yeasts (Candida) or molds. Clinically, the nail thickens, turns a yellowish-brown color, becomes misshapen, and crumbles. The condition progresses slowly, but so does treatment: a full toenail grows out in 9 to 12 months, which is the time required to see results.

Q: Which antifungal nail polishes should you choose?

Amorolfine 5% (Locéryl, Curanail): apply 1 to 2 times per week, after filing. Ciclopirox 8% (Mycoster, Onytec): apply daily; some formulations do not require filing. Tioconazole 28% film-forming solution: apply twice daily; broad-spectrum. 40% urea-based solutions: keratolytic to soften severely thickened areas before removal. Duration: 6 months for fingernails, 9 to 12 months for toenails.

Q: What is the treatment protocol for toenails?

Weekly filing with a single-use nail file, application of antifungal nail polish according to package instructions (Locéryl once a week after filing, Mycoster or Onytec once a day), thorough cleaning of shoes with antifungal spray, and careful drying between the toes. Supplement with topical skin treatment (imidazole or terbinafine) on the surrounding skin to prevent associated athlete’s foot. Monthly photographic follow-up is helpful.

What is onychomycosis?

Onychomycosis is a fungal infection of the nail, most commonly affecting the toenails (90% of cases), caused primarily by dermatophytes (especially Trichophyton rubrum), and sometimes by yeasts (Candida) or molds. Clinically, the nailthickens, takes on a yellow-brown color, becomes misshapen, and crumbles at its distal or lateral edges. The infection progresses slowly—over several months—but so does treatment: a full toenail grows out in 9 to 12 months, which is the time required to see results. Maintaining an intact skin barrier around the nail limits entry points.

Which antifungal nail polishes should you choose?

Over-the-counter antifungal nail polishes treat superficial or moderate infections:

Amorolfine 5% (Locéryl, Curanail): apply 1 to 2 times per week, after filing the nail;
Ciclopirox 8% (Mycoster, Onytec): apply daily; some formulations do not require filing;
Tioconazole 28% film-forming solution: apply twice daily; broad-spectrum;
40% urea-based solutions: keratolytic agents to soften severely thickened areas before removal.

Average treatment duration: 6 months for fingernails, 9 to 12 months for toenails.

What is the treatment protocol for toenails?

Toenails account for 80 to 90% of onychomycosis cases. The standard protocol combines weekly filing of the nail with a single-use nail file, application of antifungal nail polish according to the instructions (Locéryl once a week after filing, Mycoster or Onytec once a day), thorough cleaning of shoes with an antifungal spray, and careful drying between the toes. Supplement this with a topical skin treatment (imidazole or terbinafine cream) on the surrounding skin to prevent the often-associated athlete’s foot. Monthly photographic follow-up is useful for objectively monitoring healthy regrowth from the nail matrix. Damaged nails should also receive restorative care once the active antifungal phase is complete.

What post-treatment restorative care is recommended?

After the infection has been eradicated, support the regrowth of healthy nails:

Strengthening treatments containing keratin, biotin, and silica to reinforce brittle nails;
Non-occlusive,protective treatment polishes that allow the nail to breathe;
Nourishing oils containingjojoba oil or vitamin E for the cuticles;
Oral supplements containing zinc and biotin to support nail health.

What steps can be taken to prevent recurrence?

Recurrences are common if preventive measures aren’t taken. Disinfect shoes daily with antifungal powder or dilutedtea tree oil spray. Alternate between two pairs of shoes to allow them to dry for 24 to 48 hours. Opt for socks made of cotton or moisture-wicking technical fibers, and change them daily. Wear flip-flops in communal showers, swimming pools, gyms, and locker rooms. Avoid sharing pedicure tools (files, nail clippers). Treat any early signs of a foot fungus immediately, as this is the main entry point to the nail. Moisturize daily and use sun protection to preserve the integrity of the skin around the nails.