Tinea and Fungal Nails
A common fungal infection of skin, scalp or nails: athlete’s foot, jock itch, ringworm. Creams clear most skin tinea. Nails are the slow, stubborn cousin.
The tinea ladder
Steps 1–2 sort most skin tinea. Scalp and nail infections usually need tablets, and it pays to test a nail before months of treatment.
- Step 1 · Self-careKeep it dry and stop the spreadDry between toes and skin folds, change socks and underwear daily, thongs in shared showers, don’t share towels.
- Works
- Helps creams work and stops it coming back; no trials on its own
- Cost
- Free
- How long
- Ongoing, especially after treatment ends
- Watch for
- Pets can spread ringworm: patches of missing fur mean a trip to the vet.
Fungus loves a warm, damp sock. Evict it.
- Step 2 · PharmacyAntifungal cream (terbinafine, clotrimazole, miconazole)For athlete’s foot, jock itch and ringworm on the body.
- Works
- Cut the chance of treatment failing by about two-thirds vs a dummy cream; terbinafine-type creams cure slightly more than the others
- Cost
- About $8–20 a tube
- How long
- Terbinafine: 1–2 weeks. Clotrimazole or miconazole: 2–4 weeks, and keep going after the skin looks normal.
- Watch for
- Stopping as soon as it looks better is the classic reason it comes back.
The rash leaves before the fungus does. Finish the course.
- Step 3 · PharmacyAntifungal nail lacquer or solutionPainted on, for mild nail infection near the tip.
- Works
- Modest: in trials, about 1 in 15 to 1 in 6 got a fully clear nail, vs up to 1 in 20 on a dummy treatment
- Cost
- About $30–60 a bottle
- How long
- 6–12 months, until a healthy nail grows out
- Watch for
- Best for only part of one or two nails. File and trim first.
Patience is the active ingredient.
- Step 4 · PrescriptionAntifungal tablets (terbinafine)For nail or scalp tinea, or widespread skin infection that creams haven’t fixed.
- Works
- Nails: about half cured after about a year, vs 6 in 100 on a dummy tablet; works better than the alternative tablets
- Cost
- Generic tablets usually cost under the $25 PBS co-payment
- How long
- Fingernails: about 6 weeks. Toenails: about 12 weeks. Nails take up to a year to look normal.
- Watch for
- Upset stomach, headache, rash, taste changes; rare liver problems, so your GP may check bloods. A nail test first is wise, as many thick nails aren’t fungal.
Toenails grow at glacier pace. The tablets finish long before the nail looks fixed.
- Step 5 · SpecialistDermatologist or podiatristFor unclear rashes, repeated nail treatment failure, or painful thick nails.
- Works
- No trials of referral itself; helps with diagnosis and nail care
- Cost
- Specialist fees vary; Medicare rebates with a GP referral. Podiatrist fees vary.
- How long
- As needed
- Watch for
- People with diabetes should have regular foot checks.
Sometimes the ‘fungus’ is psoriasis or an old injury. A second opinion earns its fee.
Save your money
Popular, heavily marketed or often asked about, but the evidence is weak or says no.
- Laser treatment for nailsIn trials, lasers cured no more nail infections than no treatment or sham. Expensive light, not a cure.
- Steroid cream on its ownSteroids calm the itch but don’t kill fungus and can let tinea spread. Use only with an antifungal if your GP suggests it.
- Home remedies (vinegar soaks, menthol rubs, tea tree oil)Small or poor-quality studies at best. Pharmacy antifungals are cheap and proven.
- Treating a thick nail without a testMany thick, discoloured nails are from injury or psoriasis. A clipping test before months of tablets avoids treating the wrong thing.
What you can do
- Dry carefully between your toes and in skin folds; dab, don’t rub.
- Rotate shoes so each pair dries out, and wear cotton or wool socks.
- Wash socks and towels hot, and don’t share towels, shoes or nail clippers.
- Treat athlete’s foot promptly so it doesn’t spread to the nails.
- Wash your hands after touching the rash, and after handling pets with bald patches.
See your GP if
- Creams haven’t worked after 2–4 weeks, or it keeps coming back
- It’s on the scalp (common in children) or in the nails
- You have diabetes or a weakened immune system
- It’s spread to several areas of the body
See a doctor the same day if your foot or leg becomes hot, red, swollen and painful, or you feel unwell or feverish: this can be a skin infection (cellulitis) getting in through cracked skin. Redness can be harder to see on brown or black skin. For a fast-spreading infection or feeling very unwell, call 000 (Australia) or your local emergency number. From a mobile, 112 works in most countries.
Common questions
What does tinea look like?
Itchy, peeling or cracked skin between the toes; a red or darker, scaly ring with a clearer centre on the body; an itchy, scaly rash in the groin; itchy patches with hair loss on the scalp; or thick, discoloured, crumbly nails.
How do you catch it?
From shared showers, changing rooms, towels and shoes, from other people, and sometimes from pets or soil. Sweaty feet and tight shoes raise the risk.
How is it diagnosed?
Usually by its look. If it’s unclear, or before tablets for nails, your GP may send skin scrapings or nail clippings to the lab. Results can take a few weeks.
Should my child stay home from school?
Not usually for body ringworm once treatment has started. Scalp ringworm needs a GP visit for tablets, and the family may need checking too.
Helpful resources
- Healthdirect: TineaTypes of tinea, treatment and prevention tips. Free nurse line 1800 022 222. Australia.
- NHS: Fungal nail infection treatmentWhat to expect from nail paints and tablets, and how long they take. UK.
Evidence and more information
- Healthdirect: Tinea
- NHS: Athlete’s foot
- NHS: Ringworm
- Cochrane: Topical treatments for fungal infections of the foot
- Cochrane (2017): Oral antifungals for toenail infection
- Cochrane (2020): Topical and device treatments for toenail infection
- Tools for Practice: Onychomycosis cure rates
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