A discolored, thickened, brittle, or damaged toenail can be easy to overlook at first. But when these changes persist or spread, they may be signs of onychomycosis, the medical term for a fungal nail infection.
Toenail fungus can take time to clear because the infection affects the nail and the tissue beneath it, while healthy nail growth happens slowly. Over-the-counter products designed for fungal skin infections may not be appropriate for treating an infected nail, and cosmetic products cannot address the underlying infection.
The good news is that effective prescription treatments are available. Depending on the diagnosis, severity of the infection, medical history, and other factors, a licensed healthcare professional may recommend an oral antifungal, a prescription topical treatment, or a combination approach.
Today, telehealth platforms such as STRIDE™ can make the evaluation and treatment process more convenient by allowing eligible patients to complete an online medical intake, submit photos of the affected nails, have their information reviewed by a licensed clinician, and receive prescribed treatment through a pharmacy when appropriate.
What Is Onychomycosis?
Onychomycosis is a fungal infection that affects the fingernails or toenails. Dermatophytes are common causes, although other fungi and yeasts can also be involved.
Common signs of toenail fungus include:
Discoloration: The nail may become yellow, white, brown, or otherwise appear different from a healthy nail.
Thickening: The nail may become thicker and more difficult to trim.
Brittleness: Infected nails may become crumbly, rough, or prone to splitting.
Separation from the nail bed: The nail may begin to lift away from the skin underneath, a condition known as onycholysis.
Debris beneath the nail: Keratin and other debris can accumulate underneath the nail and contribute to thickening or discomfort.
Several other nail conditions can look similar to fungal infections, including nail psoriasis and injuries. For that reason, an appropriate clinical assessment is important before starting prescription treatment. In some cases, a healthcare professional may recommend additional testing to confirm the diagnosis.
Why Can Toenail Fungus Be Difficult to Treat?
Toenails are made primarily of keratin, which creates a physical barrier that some medications must penetrate to reach the affected area.
This is one reason that a cream intended to treat fungal infections of the skin is not necessarily an effective treatment for fungal nails. For example, the American Academy of Dermatology notes that nonprescription terbinafine cream can treat certain fungal skin infections but does not penetrate the nail sufficiently to treat nail fungus.
Prescription treatment for toenail fungus are formulated differently. Some topical medications are designed specifically to penetrate the nail, while oral antifungal medications reach the nail through the bloodstream.
Treatment selection depends on factors such as the extent of nail involvement, the suspected cause of the infection, other medical conditions, current medications, and patient preferences.
How Does Online Toenail Fungus Treatment Work?
Online care can provide a convenient way for eligible patients to have a suspected toenail fungal infection evaluated by a licensed healthcare professional.
Although the exact process varies by provider, a typical online evaluation may include the following steps.
1. Complete an Online Medical Intake
The process begins with a medical questionnaire. You may be asked about your nail symptoms, how long you have had them, previous treatments, medical conditions, allergies, and medications or supplements you currently take.
Providing complete and accurate information helps the clinician determine whether prescription treatment may be appropriate.
2. Submit Photos of the Affected Nails
Clear, well-lit photos can help a clinician evaluate changes in the nail’s color, thickness, texture, and surrounding skin.
Photos can support a clinical assessment, although not every nail condition can be diagnosed from an image alone. Some conditions can resemble fungal infections, so a clinician may determine that additional evaluation or testing is appropriate.
3. Receive a Clinical Review
A licensed healthcare professional reviews the information you provide and determines whether your symptoms are consistent with a fungal nail infection and whether online treatment is appropriate.
The clinician may consider the number of affected nails, the extent of nail involvement, your medical history, medications, allergies, and other factors that could affect treatment selection.
4. Receive a Prescription When Appropriate
If prescription treatment is appropriate, the clinician can prescribe an antifungal medication based on your individual circumstances.
The prescription is then fulfilled through a pharmacy according to the provider’s process.
5. Receive Treatment at Home
With STRIDE™, eligible patients can complete the evaluation process online and have prescribed treatment delivered through a pharmacy, without an in-person visit when clinically appropriate.
Prescription Treatment Options for Toenail Fungus
There is no single treatment that is right for everyone. Healthcare professionals generally consider the severity and location of the infection, medical history, potential drug interactions, and patient preferences when selecting treatment.
Oral Antifungal Treatment
Oral antifungal medications work systemically, allowing the medication to reach the infected nail through the bloodstream.
Terbinafine is a commonly used prescription oral antifungal for dermatophyte toenail infections. Traditional treatment for toenail onychomycosis has commonly involved daily terbinafine for approximately 12 weeks, although treatment protocols can vary.
Because oral antifungal medications can have contraindications, side effects, and potential drug interactions, they should be used under the direction of a qualified healthcare professional.
STRIDE™ offers clinician-directed oral treatment options, including terbinafine and fluconazole, with daily or pulse-dosing options depending on the treatment plan.
Prescription Topical Treatment
Topical prescription treatments are applied directly to the affected nail. They may be appropriate for patients with certain mild-to-moderate infections or for people who cannot or prefer not to take oral antifungal medication.
Common prescription topical options include:
Efinaconazole 10% (Jublia): A prescription topical solution approved for toenail fungal infections.
Tavaborole 5% (Kerydin): A prescription topical solution used to treat toenail onychomycosis.
Ciclopirox 8%: A prescription antifungal lacquer used for certain cases of nail fungus.
These treatments generally require consistent application over an extended period because the infected nail must gradually grow out as treatment addresses the infection.
Combination Treatment
For some patients, combining oral and topical therapy may provide an alternative treatment approach.
STRIDE DUO™ combines prescription oral antifungal treatment with STRIDE™ Clear Nail Renewal™, a prescription topical formulation. STRIDE describes the approach as treating the infection from both the top and bottom of the nail.
The STRIDE treatment plan is clinician-directed, and the appropriate medication and dosing schedule depend on the individual’s medical evaluation.
How to Get a Terbinafine Prescription Online
If a healthcare professional determines that oral terbinafine is appropriate for your toenail fungus, an online evaluation may make the process more convenient.
The process typically involves:
1. Start an Online Evaluation
Visit STRIDE™ and select the toenail fungus treatment pathway.
2. Provide Your Medical Information
Complete the medical intake with information about your symptoms, medical history, allergies, current medications, and previous treatments.
3. Upload Clear Nail Photos
Submit clear, well-lit photos of the affected toenails so the clinician can evaluate the visible changes.
4. Complete the Clinical Review
A licensed clinician reviews the information you provide and determines whether oral terbinafine or another treatment option is appropriate.
5. Receive Your Prescribed Treatment
If treatment is prescribed, the medication is fulfilled through a pharmacy and delivered according to the provider’s process. STRIDE currently offers oral-only, topical-only, and combination treatment options.
How Long Does Toenail Fungus Treatment Take?
One of the most important things to understand about toenail fungus treatment is that treating the infection and growing out of the damaged nail are two different processes.
Antifungal medication can begin addressing the infection before the nail looks completely normal. However, toenails grow slowly, so visible improvement may take several weeks or longer.
The American Academy of Dermatology notes that even after the infection has cleared, a toenail may take a year or longer to grow out completely.
STRIDE’s current patient information similarly explains that visible improvement may begin around 8–12 weeks, while more advanced infections can take approximately 9–12 months for full nail clearance.
What Are the First Signs of Improvement?
One of the first visible signs can be healthy-looking nail growth beginning near the cuticle.
As the healthy nail continues to grow, the damaged portion gradually moves toward the end of the nail and can eventually be trimmed away.
The pace of improvement varies from person to person, so completing the prescribed treatment and following the clinician’s instructions are important.
Daily Routines That Can Help Decrease Chances of Reinfection
The treatment for toenail fungus can include medication but good foot and nail care can also minimize exposure to fungi thus minimizing chances of reinfection.
Make Sure Your Feet are Always Clean and Dry
You should wash them regularly (make sure all the areas in-between the toes are clean and dry). Fungi thrive in moist environments.
Wear Socks and Shoes that are Suitable for the Conditions
Be sure to wear clean socks and choose the appropriate footwear in order to permit moisture evaporation. Change socks whenever they feel wet or sweaty.
Keep Nails Trimmed
Trim toenails regularly and avoid cutting them excessively short. Clean and disinfect nail clippers and other grooming tools after use, and do not share them with others.
Wear Flip-Flops in Common Shower Spaces
When taking a shower in a public space, you should wear either shower shoes or flip-flops. Besides, it is necessary to avoid being bare-footed in a place where fungi can cause diseases.
Keep Shoes Dry and Clean
You ought to let your shoes dry entirely between wears and to adhere to the hygiene recommendations that may be prescribed by your doctor.
Such practices can’t substitute for the medical treatment if one needs it, however, they may significantly improve the hygiene of one’s feet
If the toenail:
- Is discolored or thickened
- Is becoming more brittle or damaged
- Is pulling away from the nail bed
- Has debris under it
- Has changed in other nails
- Has not responded to self-care at home
If you’re thinking about taking an antifungal pill, it’s important to consult with your healthcare provider to review your medical history, medications, and other health matters.
If you suffer from diabetes, poor blood circulation, a compromised immune system, bad pain, swelling, or any signs of a bacterial infection, you should not treat yourself but seek professional medical attention.
Start Your Toenail Fungus Evaluation Online
Toenail fungus can be persistent, but effective prescription treatment options are available.
The right treatment depends on the individual. A licensed healthcare professional can assess your symptoms and medical history and determine whether oral medication, topical treatment, combination therapy, or another approach is appropriate.
With STRIDE™, eligible patients can complete an online evaluation, submit photos for clinical review, and receive prescription toenail fungus treatment through a pharmacy when appropriate. STRIDE currently offers oral-only, topical-only, and combination treatment options designed to provide clinician-guided care without requiring an in-person visit when clinically appropriate.
If you’re dealing with persistent toenail changes and suspect a fungal infection, an online clinical evaluation can be a convenient place to start
