Nail Fungus in Lagos?
Oral Antifungals Treat It: Topical Creams Don't.

Nail Fungus (Onychomycosis): Why Most Lagos Treatments Fail

Onychomycosis is a fungal infection of the nail plate and nail bed, caused most commonly by dermatophytes (Trichophyton rubrum), with Candida species in some cases. It causes the nail to become yellow, brown, or white; thickened, brittle, and crumbling; and sometimes separating from the nail bed (onycholysis).

Why topical creams don't work

Topical antifungal creams and paints (clotrimazole, miconazole, ciclopirox) cannot penetrate the nail plate adequately to reach the nail bed where the fungus lives. They suppress surface growth but don't eradicate the infection. The only treatment that reliably cures nail fungus is an oral antifungal that reaches the nail via the bloodstream.

Oral terbinafine: the correct treatment

Terbinafine 250mg once daily for 6 weeks (fingernails) or 12 weeks (toenails) is the most effective oral antifungal for dermatophyte nail infection, cure rates of 70–80%. It concentrates in the nail keratin and continues to act for months after completing the course. Liver function tests are checked before starting in patients with liver risk factors.

When nail fungus is severe

Involvement of all toenails, immunocompromised patients, or Candida species (more common in fingernails) may require itraconazole pulse therapy or longer terbinafine courses. Dermatology referral is arranged where needed.

Prevention

Treat athlete's foot simultaneously (the same fungus infects both nails and skin). Dry feet thoroughly after bathing. Wear moisture-wicking socks. Avoid walking barefoot in communal areas. Clip nails short and straight across.