Rashes that spread · 24 weeks
Fungal Nail: Confirm, Treat, Stop Reinfection
Thick, yellow or crumbly nails are not always fungus. Confirm it first, follow the treatment trials show works, and stop it coming back. Choose the lacquer track only for mild infection at the tip of 1–2 nails.
- Length
- 24 weeks
- For
- Women, Men
- Evidence A
- Strong evidence: guidelines or reviews of trials
- What to expect
- Fingernails take about 6 months to grow out, toenails 12–18 months. The nail looks better only as clear nail grows; keep going after week 24 until it reaches the tip.
The goal: Clear new nail growing from the base. Tablets clear about half of toenail infections in trials (48% vs 6% with placebo); lacquers alone clear fewer and suit only mild, tip-only infection.
Oral terbinafine: Cochrane review, high-certainty evidence (Grade A). Nail lacquers: Cochrane, low–moderate certainty and modest benefit. Trials mostly in white populations; reinfection advice is consensus.
Start this program
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The plan
Weeks 1–2
Confirm
Test before treating; check the feet.
Treatment is long; confirming fungus avoids months of the wrong treatment.
Morning
Trim and file thickened nails
After a shower, trim straight across; gently file thick areas down. Your own clippers only; wash and dry them after use. Use a separate file for healthy nails.
Why: Reduces fungal load and pressure pain; shared tools spread infection.
Antifungal tablets — only if your doctor has prescribed themDoctor or pharmacist
Your doctor will choose the medicine (usually terbinafine), may check liver blood tests, and will advise how to take it. Take it as prescribed until your doctor tells you to stop; do not start tablets before the nail test confirms fungus. Report rash, yellow eyes or skin, dark urine, severe tiredness, or loss of taste. Tablets are generally avoided in pregnancy and breastfeeding — tell your doctor.
Why: Cochrane 2017 (high-certainty evidence): terbinafine tablets clear more toenail infections than placebo, and more than azole tablets, with similar side effects.
Evening
Dry feet, breathable shoes
Dry between the toes after washing (towel or a cool dryer). Cotton socks changed daily. Alternate shoes so each pair dries for 24 hours. Open sandals when you can.
Why: Fungus thrives in warm, damp shoes — a big factor in Nigerian heat.
Habits
Get it tested before buying treatmentDoctor or pharmacist
Ask a doctor or pharmacist to send nail clippings or scrapings for fungal microscopy and culture. Take photos of all affected nails.
Why: Psoriasis, injury and other conditions look identical; BAD advises confirming fungus before a long treatment course.
Treat the feet too
Itchy peeling or cracks between the toes (athlete's foot) need an antifungal foot cream from the pharmacy at the same time; follow the label.
Why: Untreated foot-skin infection reinfects the nail.
A dark nail is not "just fungus"
If any nail has a brown or black streak, or dark colour on the skin next to it, do not self-treat as fungus: show a doctor first.
Why: Some fungi stain nails, but melanoma under the nail must be ruled out, especially on brown and black skin.
Weeks 3–12
Treat (doctor-led tablets)
Tablets exactly as prescribed; trim, dry, protect.
Oral terbinafine is the most effective treatment in trials for toenail fungus.
Morning
Antifungal tablets — only if your doctor has prescribed themDoctor or pharmacist
Your doctor will choose the medicine (usually terbinafine), may check liver blood tests, and will advise how to take it. Take it as prescribed until your doctor tells you to stop; do not start tablets before the nail test confirms fungus. Report rash, yellow eyes or skin, dark urine, severe tiredness, or loss of taste. Tablets are generally avoided in pregnancy and breastfeeding — tell your doctor.
Why: Cochrane 2017 (high-certainty evidence): terbinafine tablets clear more toenail infections than placebo, and more than azole tablets, with similar side effects.
Evening
Dry feet, breathable shoes
Dry between the toes after washing (towel or a cool dryer). Cotton socks changed daily. Alternate shoes so each pair dries for 24 hours. Open sandals when you can.
Why: Fungus thrives in warm, damp shoes — a big factor in Nigerian heat.
Habits
Trim and file thickened nails
After a shower, trim straight across; gently file thick areas down. Your own clippers only; wash and dry them after use. Use a separate file for healthy nails.
Why: Reduces fungal load and pressure pain; shared tools spread infection.
Shared floors, salons and roadside pedicures
Slippers in shared showers and washrooms. Bring your own pedicure tools or confirm they are sterilised; avoid whirlpool foot spas while you have broken skin. No bleach, kerosene or herbal soaks.
Why: Reinfection and spread are common; harsh soaks burn skin without clearing fungus.
Treat the feet too
Itchy peeling or cracks between the toes (athlete's foot) need an antifungal foot cream from the pharmacy at the same time; follow the label.
Why: Untreated foot-skin infection reinfects the nail.
Weeks 13–24
Continue & prevent
Keep taking any prescribed tablets until your doctor says stop; let clear nail grow out; stop reinfection.
Stopping early and reinfection from feet and shoes are common causes of relapse.
Morning
Trim and file thickened nails
After a shower, trim straight across; gently file thick areas down. Your own clippers only; wash and dry them after use. Use a separate file for healthy nails.
Why: Reduces fungal load and pressure pain; shared tools spread infection.
Antifungal tablets — only if your doctor has prescribed themDoctor or pharmacist
Your doctor will choose the medicine (usually terbinafine), may check liver blood tests, and will advise how to take it. Take it as prescribed until your doctor tells you to stop; do not start tablets before the nail test confirms fungus. Report rash, yellow eyes or skin, dark urine, severe tiredness, or loss of taste. Tablets are generally avoided in pregnancy and breastfeeding — tell your doctor.
Why: Cochrane 2017 (high-certainty evidence): terbinafine tablets clear more toenail infections than placebo, and more than azole tablets, with similar side effects.
Evening
Dry feet, breathable shoes
Dry between the toes after washing (towel or a cool dryer). Cotton socks changed daily. Alternate shoes so each pair dries for 24 hours. Open sandals when you can.
Why: Fungus thrives in warm, damp shoes — a big factor in Nigerian heat.
Habits
Keep going until clear nail reaches the tip
Do not stop prevention habits when the base looks clear. Photograph nails monthly.
Why: The old damaged nail must grow out completely.
Prevent reinfection
Treat athlete's foot promptly; keep nails short; dry feet; an antifungal powder in shoes is a reasonable option.
Why: Recurrence is common after clearance.
Shared floors, salons and roadside pedicures
Slippers in shared showers and washrooms. Bring your own pedicure tools or confirm they are sterilised; avoid whirlpool foot spas while you have broken skin. No bleach, kerosene or herbal soaks.
Why: Reinfection and spread are common; harsh soaks burn skin without clearing fungus.
Milestones
Your weekly check-in
Ask yourself these once a week. If an answer worries you, stop and see a doctor or pharmacist.
Stop and see a doctor if
- Diabetes with a red, hot, swollen toe or broken skin: see a doctor urgently
- A dark streak or pigment on the skin around the nail: see a doctor within 2 weeks (melanoma must be ruled out)
- Pain, pus, or a lifted nail with green colour
- Rash, yellow eyes or skin, dark urine or severe tiredness on tablets: stop and see a doctor
- Pitting or oil-drop patches with skin psoriasis (not fungus; topical self-treatments have weak evidence — see a doctor)
In an emergency, call 112112999911911.
Sources
- Ameen et al. British Association of Dermatologists' guidelines for the management of onychomycosis 2014 (Br J Dermatol)
- Kreijkamp-Kaspers et al. Oral antifungal medication for toenail onychomycosis (Cochrane Review, 2017)
- Foley et al. Topical and device-based treatments for fungal infections of the toenails (Cochrane Review, 2020)
- de Vries et al. Interventions for nail psoriasis (Cochrane Review, 2013)
- DermNet: Fungal nail infections
- DermNet: Melanonychia
- AAD: Nail care secrets
Education, not diagnosis. This plan cannot examine you; pending physician review where marked.
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