Nail fungus, known medically as onychomycosis, is a common infection affecting the nail plate and bed. Acrylic nails significantly raise the risk for this condition. Fungi thrive in warm, moist places, and when an acrylic nail lifts or is improperly applied, moisture and debris become trapped between the artificial and natural nail. This sealed, damp space creates the perfect breeding ground for dermatophytes, the fungi most often responsible for onychomycosis, allowing them to multiply and invade the nail structure. Treatment is necessary because, without intervention, the infection will persist, worsen, and potentially spread to other nails.
Recognizing a Nail Fungus Infection
Recognizing a fungal infection (onychomycosis) involves identifying specific visual changes in the nail. The nail plate often becomes noticeably thickened, brittle, and may begin to crumble at the edges. Discoloration is a common sign, typically appearing as white, yellow, or brown patches beneath the nail plate.
It is important to distinguish a fungal infection from the “greenies,” or Pseudomonas bacterial infection, which is also common with acrylics. Pseudomonas aeruginosa produces a distinct greenish-black pigment, which is a bacterial excretion, not a fungus. While both infections result from moisture trapped under a lifted nail, onychomycosis causes nail thickening and crumbling, while the bacterial infection is recognized by its vibrant green stain.
A professional diagnosis is highly recommended before starting any treatment plan. A healthcare provider can perform a simple test, such as a potassium hydroxide (KOH) preparation or culture, to confirm if fungi are present. Self-treating an incorrect diagnosis will likely lead to treatment failure and delay proper care.
Immediate Actions and At-Home Care
The first step upon suspecting a nail infection is the complete and gentle removal of the acrylic nail. Leaving the artificial nail in place seals in moisture and prevents topical treatments from reaching the infected area. Once the acrylic is removed, the natural nail should be kept short and filed down as much as possible to reduce the area where the fungus can hide.
Rigorous hygiene is necessary, involving washing the hands and nails thoroughly and drying them completely after every exposure to water. For mild cases, or as a supplement to professional care, some non-prescription topical methods can help manage symptoms. Soaking the affected nail in a solution of one part vinegar to two parts warm water may inhibit fungal growth, as the acid creates a less hospitable environment for the organisms.
Topical solutions like tea tree oil, which has antifungal properties, can be applied directly to the nail plate. Other over-the-counter antifungal creams containing ingredients like clotrimazole are available and can be applied after thinning the nail surface. However, these non-prescription treatments are not strong enough to cure established or deep fungal infections and are best used only for minor surface issues.
Professional and Prescription Treatment Options
For established onychomycosis, medical intervention is often necessary because the infection is embedded within the nail plate and nail bed. Prescription treatment options include topical and oral medications. Prescription topical treatments, such as medicated nail lacquers, are painted onto the nail surface daily.
These lacquers, which may contain antifungals like ciclopirox or efinaconazole, must be applied consistently for many months, often up to a year, to be effective. Topical solutions are a good option for mild to moderate infections limited to the nail surface, or for patients who cannot take oral medications. They work by slowly penetrating the nail plate to reach the infection underneath.
Oral antifungal medications are generally considered the most effective option for severe or persistent infections, especially those originating from chronic acrylic nail use. The preferred first-line treatment is often terbinafine, taken daily for an extended period, typically six weeks for fingernails. Other effective oral options include itraconazole and fluconazole, which may be prescribed in a pulse-dosing regimen.
These systemic medications work internally to stop fungal growth as the nail grows out, but they require occasional blood tests to monitor for potential side effects, such as liver toxicity. Because the nail grows slowly, the final result of treatment may not be visible until the entire infected portion has been replaced, which can take several months. For severely damaged nails, a healthcare provider may perform in-office debridement, which involves thinning or removing the infected nail material to help medication penetrate more effectively.
Preventing Recurrence
Preventing the return of onychomycosis requires a change in habits and attention to the application process if acrylics are resumed. Ensure any salon visited adheres to strict sanitation standards, including the proper sterilization of all tools between clients. Contaminated tools are a common vector for transferring fungi and bacteria.
The natural nail must be completely healthy and dry before any new acrylic application. Avoid applying artificial nails to nails that show any sign of damage, lifting, or existing infection, as this instantly traps any present organisms. Trauma to the nail, such as aggressive filing or drilling during preparation, weakens the nail and makes it more susceptible to invasion.
If the acrylic nail begins to lift, it should be repaired or removed immediately to prevent moisture from pooling in the gap. Allowing the natural nail periodic breaks from artificial enhancements also reduces the risk of creating a continuously damp, sealed environment. Maintaining dry hands and using an antifungal powder, especially for those prone to moisture, adds a layer of protection against recurrence.